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Repro. Med 3 > Ectopic Pregnancy > Flashcards

Ectopic Pregnancy Flashcards

1
Q

A hx of ___ (condition) can increase risk of ectopic pregnancy

A

PID

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2
Q

Ectopic pregnancy affects ~___% of all pregnancies

A

~2%

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3
Q

What is the main cause of pregnancy loss?

A

Genetic abnormalities of the fetus

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4
Q

What 3 things that are causing the increase in incidence of ectopic pregnancy?

A
  1. More ART
  2. More pregnancies after tubal surgeries
  3. Increasing STD incidences
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5
Q

What is the most common area for an ectopic pregnancy to occur?

A

The fallopian tube is the site of >95% of ectopic pregnancies

  • Ampulla (64%)
  • Isthmus (25%)
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6
Q

What are RF for ectopic pregnancy? (x8)

**KNOW THIS!

A
  1. Congenital (long narrow tube)
  2. Hyperovulation (ART)
  3. Inflammatory (PID, salpingitis)
  4. Presence if IUD
  5. Functional (abnormal tubal movement, smoking)
  6. Endometriosis
  7. Traumatic (tubal surgeries)
  8. Hx of ectopic pregnancy

(“CHIP FETH”)

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7
Q

An ectopic pregnancy in the ____ may take longer to detect as the fetus can get larger before sx occur

A

interstitial portion

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8
Q

What are possible outcomes of ectopic pregnancies? (x4) Which one is life threatening? Most rare?

A

Self resolve (baby goes away)
Tubal extrusion
Rupture (LIFE THREATENING)
Secondary abdominal pregnancy (super rare)

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9
Q

What is the classic triad of ectopic pregnancy?

What % of people w/ ectopic pregnancy will present w/ this triad?

A 
Absence of regular menses
Lower abdominal/ pelvic pain (usually unilateral)
Vaginal bleeding (>75%)

50%

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10
Q

What causes the bleeding in the ectopic pregnancy?

A

Growth of endometrium from high E levels that out grows it’s blood supply and falls away regardless of progesterone levels

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11
Q

What is the #1 rule in women w/ abdominal pain and bleeding?

A

MUST r/o ectopic pregnancy

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12
Q

What would you find on an abdominal exam if an ectopic pregnancy is present?

A

Unilateral lower abdominal pain

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13
Q

What would you find on a vaginal exam if an ectopic pregnancy is present?

A

Cervical motion tenderness (unilateral)

Unilateral pelvic mass on palpation– (soft and tender)

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14
Q

T/F: You have to press really hard to be able to feel the ectopic pregnancy for dx

A

False: You do NOT want to press too hard bc you may rupture the ectopic pregnancy! Yikes!

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15
Q

Up to __% of pts give no hx of amenorrhea due to ____ bleeding that they mistake for a true menstrual period

A

25%

postconceptional

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16
Q

Is it possible for a pt to have no sx prior to ectopic rupture?

A

YES

17
Q

What is a Heterotopic pregnancy?

A

A pt will have a intrauterine and extrauterine pregnancy at the same time

18
Q

What B-hCG levels should be you be able to see something on vaginal US

A

1,000-2,0000 B-hCG

19
Q

What should the trend of B-hCG be if the pregnancy is normal?

A

Double in 48 hrs

20
Q

B-hCG of ____ is the discriminatory zone for visualizing a pregnancy by transvaginal ultrasound. Don’t see it= likely ectopic.

A

1,500

21
Q

What are S/S of ectopic rupture?

A

PAIN
Abd Guarding/Rigidity
Fainting
Hemodynamic shock

22
Q

What causes shoulder pain in a ruptured ectopic pregnancy?

A

Blood tracking up the paracopic gutter to the sub-diaphragmatic recess (referred pain)

23
Q

Ectopic pregnancy is more likely to rupture if it is ___ (size) by US or BhCG is____

A

> 4cm

> 5,000

24
Q

How can you tx an ectopic pregnancy surgically? (x2) Which is more common? Why would you utilize the less common option?

A

Laparoscopic (MOST COMMON)

Laprotomy (poor visualization or hemoperitoneum)

25
Q

What is the medical management for ectopic pregnancy? (medicine)

A

Methotrexate

***Repeat in 3 days is BhCG does not drop appropriately

26
Q

What are contraindications to using Methotrexate for an ectopic pregnancy?

A

Fetal cardiac activity present
Initial BhCG >5,000
Size <4.0 cm on U/S
Pt likely to be non-compliant

27
Q

What 3 things must you check to assess if a pt is a good candidate for Methotrexate?

A

Liver function
Kidney function
CBC
(don’t forget fetal size, cardiac, and BhCG lvl)

28
Q

Methotrexate is more likely to be successful with (high/low) levels of BhCG

A

Lower levels of BhCG ( best when <1,000)

**also better with small fetal size

29
Q

Rh sensitization of mother can happen if she is Rh (+/-) and carrying a Rh (+/-) infant

What should she be given to prevent sensitization?

A

Rh-
Rh+

RHOGAM

Repro. Med 3 (14 decks)

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