Ectopic Pregnancy Flashcards
when do clinical symptoms of ectopic usually start
4-6 weeks after last normal mesntrual period
what are symptoms of pregnancy
breast tenderness
nausea
urinary frequency
risk factors for ectopic
history of STI/PID
hx IUD use
hx pelvic or abdominal surgery
endometriosis
smoking
infertility and use of clomiphene citrate or IVF
prior ectopic
what does the physical exam look like in women with small, unruptured ectopic pregnancies
often normal
what to look for on vitals in ectopic pregnancies
orthostatic changes
fever above 38
what to look for on abdo exam in ectopic pregnancies
abdo tenderness
may have rebound or other peritoneal signs
how does a ruptured ectopic present
acute abdomen
peritoneal signs
abdo distension
shock
investigations for ectopic pregnancies
CBC
blood type
type and screen
serial bhcg
U/S
how does bhcg norally change in pregnancy and how might in change in ectopic pregnancies
normally doubles every 2 days in early pregnancy
prolonged doubling time, plateau or decreasing levels before 8 weeks suggest non viable gestation
at what point is an U/S diagnostic for ectopic pregnancies
only if fetal cardiac activity detected
when should the intrauterine sac be visible on transvaginal U/S
serum b hcg above 1500
when should the intrauterine sac be visible on transabdominal U/S
serum b hcg above 6000
how do you manage an ectopic pregnancy
ABCs, monitors, IV fluids, blood products
rhogam if Rh-
medical vs surgical management
medical management of ectopic pregnancies
methotrexate 50mg/m2 in a single IM dose
what are the criteria for medical management of ectopic pregnancies
stable patient
less than 3.5 cm unruptured ectopic
no fetal cardiac activity
b hcg less than 5000
no hepatic/renal/hematologic disease
reliable patient who can follow up serial b hcg
