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Flashcards in Ectopic Pregnancies Deck (45)
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1
Q

What is the most common location of an ectopic pregnancy?

A

Tubal–ampullary part

2
Q

True or false: generally, ectopic pregnancies do not survive

A

True

3
Q

Which part of the tube do tubal pregnancies generally end up in?

A

Ampulla

4
Q

What is the prevalences of ectopic pregnancies?

A

2% of all pregnancies

5
Q

What are risk factors for the development of an ectopic pregnancy?

A
  • PID
  • IVF
  • Prior ectopic
  • Prior tubal surgery
6
Q

What is the most common cause of first trimester pregnancy related deaths

A

Ectopic pregnancies

7
Q

What percent of 1st semester bleeding is the result of ectopic pregnancies?

A

6-16%

8
Q

What type of bleeding is seen in tubal rupture 2/2 ectopic pregnancy?

A

Hemoperitoneum (no vaginal bleeding)

9
Q

Women of color have a (__)x higher risk of mortality from ectopic pregnancies.

A

5x

10
Q

Ectopic pregnancies have a (__)x greater risk of maternal death than abortion.

A

50x

11
Q

Ectopic pregnancies have a (__)x greater risk of maternal death than childbirth

A

10x

12
Q

What is the relationship between IUD use and the incidence of ectopic pregnancies?

A

Lower overall pregnancy rate, but if pregnant, then higher chance of ectopic

13
Q

True or false: smoking increases the risk for an ectopic pregnancy

A

True

14
Q

True or false: multiple sex partners increases the risk for ectopic pregnancies

A

True

15
Q

Why are prior PID, multiple sex partners, and prior tubal surgery all risk factors for the development of an ectopic pregnancy?

A

Prior uterine damage and scarring from trauma or infection

16
Q

What are the three common presentations of an ectopic pregnancy?

A
  • 1st trimester bleeding
  • Abdominal/pelvic pain
  • Asymptomatic
17
Q

How do you diagnose an ectopic pregnancy?

A
  • US see no live pregnancy

- hCG levels are high (1500-2000)

18
Q

When should an ectopic pregnancy be suspected?

A
  • 5-6 weeks from LMP

- 2 weeks after positive UPT

19
Q

What is the usual trend of beta-hCG throughout pregnancy?

A

Rapid rise in the first trimester, doubling about every 48 hours.

Plateau around 10 weeks, the slowly fall

20
Q

What, generally, occurs with hCG levels in an ectopic pregnancy?

A

Rise, but not as fast as normal pregnancy

21
Q

What level of progesterone levels are indicative of a normal and ectopic pregnancy?

A
  • Less than 5ng/ml = no normal pregnancies

- More than 25 ng/ml 97% of viable pregnancies

22
Q

At what level of hCG should you be able to detect a pregnancy with TVUS? Abdominal?

A

2500 with TVUS

6000 with abdominal US

23
Q

When can the gestational sac be seen with TVUS?

A

4.5 weeks

24
Q

When can the yolk sac be seen with TVUS?

A

5 weeks

25
Q

When can the embryo be seen with TVUS?

A

6 weeks

26
Q

When can fetal heart tones be seen with TVUS?

A

6 weeks

27
Q

When is hemolysis from Rh status a concern?

A

When mother is Rh - with an Rh + fetus

28
Q

What is the uterine cul-de-sec?

A

Space between the rectum and the uterus

29
Q

What happens to the ovary with ovulation?

A

May develop a luteal cyst that is visible on US

30
Q

What is the drug that can be used to abort a fetus in case of maternal distress? Is it useful for ruptured pregnancies?

A

Methotrexate

Useless for ruptured pregnancies

31
Q

Does the use of methotrexate preserve fertility?

A

Yes

32
Q

Is methotrexate safe for BF mothers?

A

No

33
Q

Can methotrexate be used in patients with immunodeficiencies?

A

No

34
Q

What are the GI diseases that contraindicates methotrexate use? (2)

A

PUDs

Chronic liver disease

35
Q

Can methotrexate be used in patients with acute pulmonary disorders?

A

No

36
Q

An unruptured mass of greater than (__)cm is a contraindication to methotrexate.

A

3.5 cm

37
Q

True or false: fetal cardiac activity is an aobsoulte contraindication to methotrexate use

A

False– relative. will not be as effective

38
Q

Quant hCG level greater than what amounts is a relative contraindication to methotrexate use?

A

6000-15000

39
Q

What is the dose used for methotrexate?

A

Single IM dose of 50 mg/m^2

40
Q

How do you follow methotrexate use?

A

Serial quant beta-hCG should decline by 15% by day 7. Repeat or move to surgery

41
Q

What are the side effects of Methotrexate use?

A

GI s/sx, including abdominal pain-thus should warn pt

42
Q

What happens to hCG levels with methotrexate use?

A

Rises initially, but should decline after 4 ish days

43
Q

What are the signs that methotrexate treatment is failing? (3)

A
  • Significantly worse abdominal pain
  • Hemodynamic instability
  • beta hCG not declining 15% by day 7
44
Q

What is a salpingotomy, and what are the risks benefits of it compared to a salpingectomy?

A

Making a hole in the fallopian tube to remove ectopic pregnancy.

increases the risk of a second ectopic

45
Q

What is the recurrence rate of ectopic pregnancies after salpingotomy/salpingectomy? What should be done to monitor these patients in future pregnancies?

A
  • 15-20%

- Monitor with early US and hCG levels