CRITOE gives us the order of ossification for the pediatric elbow – capitellum, radial head, internal epicondyle, trochlea, external epicondyle, and olecranon — typically occurring at year 1, 3, 5, 7, 9, and 11 – remember the order is the most important thing – all ossification centers should be accounted for. Make sure one is not missing – or where one has been “created” traumatically.
- Transvaginal ultrasound is the diagnostic tool of choice for tubal ectopic pregnancy.
- Tubal ectopic pregnancies should be positively identified, if possible, by visualising an adnexal mass that moves separate to the ovary.
- A serum beta-human chorionic gonadotrophin (β-hCG) level is useful for planning the management of an ultrasound visualised ectopic pregnancy.
- Expectant management is an option for clinically stable women with an ultrasound diagnosis of ectopic pregnancy and a decreasing β-hCG level initially less than 1500 iu/l.
- Systemic methotrexate may be offered to suitable women with a tubal ectopic pregnancy. It should never be given at the first visit, unless the diagnosis of ectopic pregnancy is absolutely clear and a viable intrauterine pregnancy has been excluded.
- Surgical methods of management are associated with a high failure rate and should be reserved for those women suffering life-threatening bleeding.
- Offer anti-D prophylaxis as per national protocol to all RhD-negative women who have surgical removal of an ectopic pregnancy, or where bleeding is repeated, heavy or associated with abdominal pain.