98 Ectopic Pregnancy and emergencies in the first 20 weeks

Question 1

Most common cause of abdominal ectopic pregnancy

Answer 1

most commonly derive from early rupture or abortion of a tubal pregnancy, with subsequent reimplantation in the peritoneal cavity.

Question 2

Problem with cesarean scar pregnancy

Answer 2

cause massive maternal hemorrhage.

Question 3

Significance of progresterone in ectopic pregnancy

Answer 3

with progresterone under 5ug/dL, there is almost 100% chance that it is pathologic

Question 4

What is the only thing that can confirm a pregnancy on ultrasound?

Answer 4

yolk sac

Question 5

Rate of heterotopic pregnancy

Answer 5

1/3000. Much higher now with IVF

Question 6

relationship of bladder to ectopic pregnancy ultrasounds

Answer 6

bladder should be full for transabdominal b/c it good acoustic window. Should be empty for transvaginal.

Question 7

WHen can we see gestational sac, yolk sac, and fetal pole?

Answer 7

4.5, 5.5 and 6 weeks. by transabdominal about 1 week later for each.

Question 8

Ultrasound finding most specific for ectopic

Answer 8

hepatorenal free fluid

Question 9

discriminatory zone for transvag and transabd. roughly

Answer 9

1500 and 6000

Question 10

When you should use multiple doses of methotrexate for ectopic?

Answer 10

fetal cardiac activity or BHCG >5000

Question 11

three most common side effects of methotrexate?

Answer 11

abd. pain, flatulence, and stomatitis

Question 12

preferred tx for ectopic?

Answer 12

methotrexate. it has shown similar success rates vs laparoscopic salpingectomy and salpingostomy without the side effects.

Question 13

problem with the known side effect of methotrexate?

Answer 13

abd. pain. is a problem b/c it is hard to distringuish between normal pain and a tubal rupture or another cause of abd. pain.

Question 14

Why should you not do many pelvic exams after methotrexate administration?

Answer 14

reduce risk of tubal rupture.

Question 15

most important d/c instructions for patients with ectopic and methotrexate administration?

Answer 15

Refrain from sex 14-21 days after treatment because of risk of rupture.

Question 16

Timeline and doses for rhogam administration

Answer 16

within 72 hours of fetal maternal mixing. if prior to 12 weeks, do 50mcg. if after, do 300 mcg.

Question 17

definition of spontaneous abortion

Answer 17

Loss of a fetus less than 20 weeks or less than 500 grams

Question 18

Home care for patients with threatened abortion?

Answer 18

No sex, or tampons. bed rest.

Question 19

Treatment for septic abortion?

Answer 19

ampicillin/sulbactam 3g IV, clindamycin 600mg with Gentamycin 1-2mg/kg

Question 20

Most common symptoms of gestational trophoblastic disease?

Answer 20

vaginal bleeding (75%) hyperemesis (25%)

Question 21

differnet between molar pregnancy and GTD?

Answer 21

molar pregnancy is in first trimester, GTD perists into second

Question 22

When pregnancy-induced hypertension is seen before 24 weeks of gestation, consider the possibility of

Answer 22

molar pregnancy

Question 23

tx for molar pregnancy/GTD?

Answer 23

suction curettage

Question 24

Worst comlications of GTD?

Answer 24

metastasis and trophoblastic embolization that can become an amniotic fluid embolus

Question 25

The presence of,in nausea and vomiting of pregnancy or hyperemesis gravidarum is highly unusual and should suggest another diagnosis

Answer 25

abdominal pain

Question 26

pros/cons of compazin/phenergan vs zofran?

Answer 26

Zofran is expensive and causes headaches. the other two are like the antispychotics and can cause dystonic reactions.