Ectopic Flashcards Preview

Obstetrics and Gynaecology > Ectopic > Flashcards

Flashcards in Ectopic Deck (19):
1

Definition

Pregnancy outside the uterine cavity

2

Most common site

Fallopian tube-->ampulla

3

Most common cause of T1 pregnancy related death

Ectopic pregnancy

4

Biggest risk factor for ectopic

Previous ectopic

5

Risk factors

Previous ectopic
PID
STI's
Pelvic/abdominal surgery
IUD
Infertility treatment
Smoking

6

Epidemiology

2% pregnancies
More common in >35 yo

7

Symptoms

Abdominal pain
Amenorrhea
Vaginal bleeding

8

History

Abdominal pain, amenorrhea, vaginal bleeding
Risk factors
Evidence of rupture->shock, peritonitis
Shoulder tip pain, urge to deficate

9

Examination

General-->evidence of hemodynamic instability (rupture), hypotensive, orthostatic, tachyC, pallor
Pelvic examination->tender, mass, blood in vaginal vault
Cervical motion tenderness
Palpable adnexal mass
Rebound tenderness

10

Investigations

FBC
bHCG
TVUS/Pelvic U/S

11

When can a gestational sac be seen on TVUS (bHCG level)

serum hCG levels above 1500-2000 U/L (1500-2000 mU/mL) with a TVUS (higher levels for transabdominal ultrasound).

12

What to do if bHCG levels below which you can see a gestational sac

If the initial serum hCG levels are below these discriminatory levels, a repeat ultrasound in 1 week or serial serum hCG levels can be requested.

13

Medical management
Indications
Contraindications
Caution
Regimen
Followup

I: hemodynamically stable, unrupture, no signs of active bleeding, low HCG
CI: Geographic isolation, allergy, potential non-compliance
Caution: Baseline bHCG >5000, ectopic >3cm on TVS, presence of F. heart motion
R: Methotrexate
F/U: weekly bHCG until negative, , defer conception for 3-4 months

14

Surgical management
Indications
Method
F/U

I: Hemodynamically unstable, persistent excessive bleeding, other CI to medical
M: Laparoscopy GOLD
F/U: Weekly until bHCG -ve
Following salpingotomy, if bHCG fails to fall consider salpingectomy/medical management

15

Expectant management
Indications
Cautions
F/U

I: Hemodynamically stable
Low or falling bHCG, mass

16

US findings suggestive of ectopic

Absence of intrauterine gestational sac
Ectopic sac or cardiac activity
Complex adnexal mass
Fluid in culdesac

17

Mechanism of action of methotrexate

Inhibits conversion of folic acid to folinic acid
Cytotoxic, immunosuppression, anti-inflamatory

18

Side effects of methtrexate

NV, oral mucositis
Renal/hepatic toxicity
Rash, itch, urticaria

19

Counselling for use of methotrexate

Same day each week, followed by folic acid following day
Use the same medicine
Avoid conception until 3 months after cessation
Notify if signs of infection, breathing difficulty
Need to monitor blood counts, renal and liver function