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OB-Gyn > Ectopic Pregnancy > Flashcards

Ectopic Pregnancy Flashcards

(46 cards)

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1
Q

Most common location of ectopic pregnancy

A

Fallopian tubes

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2
Q

Most common location of ectopic pregnancy in Fallopian tubes

A

Ampullary (81%)

Isthmus (12%)
Fimbriae (5%)
Cornual/Interstitial (2%)

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3
Q

Where in the fallopian tubes do tubal ruptures within few weeks usually occurs?

A

Isthmus

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4
Q

Risk Factors of Ectopic Pregnancy

A
  • Hx of Ectopic Pregnancy
  • Postsalpingectomy
  • Post-reversal of sterilization
  • Clomiphene
  • Copper IUD
  • Pelvic Organ Prolapse
  • Progesterone rel. IUD
  • Causes of peritubal adhesions (Infection, Smoking, AA/Endometriosis)
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5
Q

Classic Triad in Ectopic Pregnancy

A

Amenorrhea
Pain
Vaginal Bleeding or Spotting

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6
Q

Clinical Manifestations of Ectopic Pregnancy

A 
Amenorrhea
Pain
Vaginal Bleeding or Spotting
(+/-) Syncope/Vertigo
Diaphragmatic irritation
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7
Q

Symptoms of ruptured ectopic

A

Cervical Motion tenderness
Hypotension
Bradycardia
Bulging posterior fornix (Blood in cul de sac)

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8
Q

Laboratory Diagnosis of Ectopic Pregnancy

A

(+) Beta HCG at >1500 mIU/mL

(+) Serum Progesterone at 10-25 ng/mL

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9
Q

Sonographic Diagnosis of Ectopic Pregnancy

A

Transvaginal UTZ

Transabdominal UTZ

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10
Q

At what level does pregnancy test turns positive

A

10-20 mIU/L

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11
Q

Serum progesterone <5 ng/mL indicates

A

FDU/ectopic

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12
Q

Serum progesterone >25 ng/mL indicates

A

Excludes ectopic Pregnancy

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13
Q

What can you see on a TV-UTZ of an ectopic preganancy

A

Trilaminar pattern

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14
Q

When can you only use transabdominal UTZ on a uterine preganancy

A

28 days after timed ovulation (5-6 menstrual wks)

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15
Q

When can you detect the gestational sac in a TV-UTZ?

A

4.5-5 wks

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16
Q

When can you detect the yolk sac in a TV-UTZ?

A

5-6 wks

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17
Q

When can you detect the fetal pole with heartbeat in a TV-UTZ?

A

5.5-6 wks

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18
Q

What are the multimodality diagnosis?

A 
TV-UTZ
Serum B-Hcg
Serum progesterone
Uterine curettage
Laparoscopy/Laparotomy
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19
Q

How do you do culdocentesis to diagnose ectopic pregnancy?

Study These Flashcards
A

Aspirate on the posterior fornix. If it does not clot, it’s positive for ectopic pregnancy.

20
Q

Surgical Management for Ectopic Pregnancy and differentiate each

Study These Flashcards
A

Salpingostomy - Linear incision at the antimesenteric border; LEFT UNSUTURED to heal by secondary intervention
Salpingotomy - Same as above but SUTURED
Salpingectomy - tubal resection, cornual (1/3 of the interstitial portion)

21
Q

Contraindications for Methotrexate

Study These Flashcards
A 
Abdominal hemorrhage
Intrauterine Pregnancy
Breastfeeding
Immunodeficiency
Chronic Renal Disease
Chronic hepatic disease
Chronic Pulmonary Disease
Blood dyscrasia
Peptic Ulcer Disease
22
Q

What is the single best prognostic indicator of successful treatment using one dose of Methotrexate

Study These Flashcards
A

Initial Beta HCG

23
Q

Failure rate if Beta HCG is <1000 mIU/mL

24
Q

Failure rate if Beta HCG is <2000 mIU/mL

25
Failure rate if Beta HCG is <5000 mIU/mL
3.8%
26
Failure rate if Beta HCG is <10000 mIU/mL
14.3%
27
What should be monitored becuase its associated with an increased failure rate
Fetal cardiac activity
28
Size of ectopic pregnancy with a success rate of 93% with methotrexate
<3.5
29
Size of ectopic pregnancy with a success rate of 87-90% with methotrexate
>3.5
30
Regimens of Methotrexate
``` Single dose: 50mg/m2, IM Two doses: 50mg/m2, IM on day 1 and day 4 Multiple doses (7 days) - 10mg/m2, IM on odd days - Leucovorin 1mg/kg on days even days - Stop if B-HCG is >15% -Start surveillance q7 days ```
31
SE of methotrexate
``` Liver toxicity Stomatitis Gastroenteritis Myelosuppression Mild separation pain ```
32
Criteria for medical management
1. Stable patient 2. B-HCG <1500 3. <3.5cm 4. <6 wks 5. No FHR
33
Indications for an expectant management
- Tubal pregnancy - Low serum Beta-HCG - Diameter of ectopic mass is NOT >3.5 - No intraabdominal bleeding or rupture *These will lead to spontaneous resolution
34
Prognosis for ectopic pregnancies
It drops to 60% but if G1, 35% if G4 and above, 80%
35
S/sx + Lab of abdominal pregnancy
SSx: Pain, N/V, Bleeding, Decreased of absent fetal movement | Elevated maternal AFP
36
Risk factors of abdominal pregnancy
Follows early tubal rupture or abortion
37
Medications given before to ectopic pregnancy with PID
Px: Doxycycline 100mg BID for 4 days (for chlamydia), Ceftriaxone 250mg IM (for gonorrhea) Partner: Doxycycline 100mg BID for 7 days (for chlamydia), Ceftriaxone 250mg IM (for gonorrhea)
38
Updated medication for ectopic pregnancy with PID
Ertapenem 1g in 3.2mL 1% lidocaine IM OR Ertapenem 1g in 10mL sterile water, transfer to 50mL NSS x 30 mins, IV
39
When can you say its already a persistent ectopic pregnancy?
When there is an incomplete removal of the trophoblast
40
What are the risk factor of a persistent ectopic pregnancy?
Small pregnancy (<2cm) Early therapy (<42 menstrual days) Serum B-HCG > 3000 mIU/mL Implantation medial to slapingostomy site
41
What are the diagnostic exams of a persistent ectopic pregnancy?
B-HCG > 1000 mIU/mL on day 7 post sx B-HCG > 15% of original on day 7 post sx B-HCG > 15% of original on day 9 post sx Progesterone > 1.5 ng/mL on day 9 post sx
42
Highest risk factor in the development of ectopic pregnancy a. Previous abortus b. Previous tubal surgeries c. Pelvic inflammatory disease d. Use of artificial reproductive technology (ART)
B
43
23 y/o G2P1 (0010) came in due to 6 weeks missed menses with hypogastric pain (pain scale 9/10) associated with vaginal spotting. Patient has a history of incomplete abortion (which was completed via curettage). How do you initially approach this patient? a. Request for transvaginal ultrasound b. Request for serum BHCG c. Request for pregnancy test d. Perform internal examination
D
44
One hour after, patient developed hypotension (80/40), tachycardia (130 BPM), and decreased sensorium. What is your NEXT best step? * a. In cases of ruptured ectopic pregnancy, hypovolemia is expected so reassure the patient and wait for pending lab results b. Hydrate the patient using crystalloids and blood products c. Search for possible cause of hypovolemia via transvaginal ultrasound d. Immediately send the patient to OR for pelvic laparotomy
B
45
Upon opening up the abdomen, you visualized a ruptured ectopic pregnancy located in the ampulla measuring 6 x 5 x 4 cms. You also noted a hemoperitoneum which measures 1500cc. What is your NEXT step as the main surgeon? a. Perform salpingectomy b. Perform salpingostomy c. Replace the hemoperitoneum with blood products and crystalloid d. Search for possible source of bleeding and ligate the bleeders
A
46
What does it indicate if TV-UTZ shows a ring of fire pattern?
Tubal preganancy

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