Ectopic Pregnancy

Question 1

What is Ectopic pregnancy?

Answer 1

Implantation of fertilised ovum outside uterine cavity, most commonly in fallopian tube

Question 2

M/C site of Ectopic pregnancy

Answer 2

Ampullary part of fallopian tube

Question 3

Risk factors of Ectopic pregnancy

Answer 3

1. PID
2. Tubal surgery or sterilisation
3. ART
4. IUCD use (pregnancy despite IUCD)

Question 4

Maximum risk of Ectopic Pregnancy

Answer 4

1. Previous h/o tubal surgery
2. Previous h/o ectopic pregnancy

Question 5

Classic triad of Ectopic Pregnancy

Answer 5

1. Amenorrhea
2. Lower abdominal pain
3. Vaginal bleeding

Question 6

M/C risk factor of Ectopic pregnancy

Answer 6

PID/Salpingitis

Question 7

M/C nontubal site of Ectopic pregnancy

Answer 7

Ovary

Question 8

L/C site of Ectopic pregnancy

Answer 8

Cesarean scar/cervix

Question 9

What is Heterotopic pregnancy?

Answer 9

Twin pregnancy:
One is intrauterine
Other ectopic
Mx: Always surgical

Question 10

Symptoms to suspect ruptured ectopic

Answer 10

1. Orthostatic hypotension
2. Shoulder tip pain
3. Urge to defecate

Question 11

Signs of Ruptured ectopic

Answer 11

1. Shock (Inc in PR, dec in BP)
2. P/A: Abdominal distension, rebound tenderness
3. If localising signs: Hemoperitoneum
   >Guarding +
   >Rigidity +

Question 12

P/V findings in Ectopic pregnancy

Answer 12

1. Most imp: Adnexal mass
2. Cervical movement tenderness: D/t peritonitis (Cervical motion tenderness is also seen in PID)
3. Uterus is soft and enlarged but size is less than POG

Question 13

Management of Ruptured ectopic

Answer 13

Always surgical
Route of surgery:
1. If vitals stable: Laparoscopy
2. If unstable vitals: Laparotomy

Surgery of choice: U/L salpingectomy

Question 14

Surgeries never done in Ruptured ectopic

Answer 14

1. Saplingo-oophorectomy
2. Linear salpingostomy (Done for unruptured ectopic)

Question 15

Investigations done in Unruptured ectopic

Answer 15

1. TVS
2. Beta-HCG

Question 16

IOC in Ectopic

Answer 16

TVS

Question 17

Gold standard investigation in Ectopic

Answer 17

Laparoscopy

Question 18

Investigations never done in Ectopic pregnancy

Answer 18

1. Hysteroscopy
2. HSG
3. Colpotomy (Drainage of pelvic abscess)

Question 19

Confirmed sign of Ectopic pregnancy in TVS

Answer 19

G sac+Yolk sac+/-Cardiac activity seen in fallopian tube

Question 20

TVS findings suspicious of Ectopic

Answer 20

1. Adnexal mass (M/C finding on USG)
2. Bagel sign (Only G sac +)
3. Ring of fire appearance
4. Empty uterus

Question 21

What is Critical value of HCG?

Answer 21

Value of HCG above which in all intrauterine pregnancies, G sac is visible inside uterus

Question 22

Critical value of HCG in TVS

Answer 22

2000 IU

Question 23

Critical value of HCG in TAS

Answer 23

6500 IU

Question 24

Mx. If G sac+Yolk sac in fallopian tube

Answer 24

Medical management

Question 25

If signs suspicious of ectopic seen (>=1 sign +), next step

Answer 25

Beta-HCG checked

Question 26

Value above critical level

Answer 26

Yes: Confirms unruptured ectopic; Medical mx of ectopic No: Repeat HCG after 48 hours

Question 27

If HCG inc by >=66%, then it is

Answer 27

Viable intrauterine pregnancy

Question 28

If HCG inc by <33%, then it is

Answer 28

Ectopic pregnancy (Slow rise)

Question 29

If HCG decreases, then it is

Answer 29

Abortion

Question 30

Medical management of Unruptured ectopic

Answer 30

DOC: Methotrexate Frequency: Single dose therapy Dose: 1 mg/kg Route: IM

Question 31

Prerequisites for Methotrexate

Answer 31

1. Patient: vitally stable 2. Family: Not complete 3. Size of ectopic: <4 cm 4. Beta-HCG: <5000 IU All above absolute requirements 5. Cardiac activity: Preferrably absent (Relative requirement)

Question 32

When is beta HCG levels checked after administration of Methotrexate?

Answer 32

B/w D4 and D7

Question 33

If beta HCG levels dec by >=15% after giving Methotrexate, then

Answer 33

Successful medical mx.

Question 34

If beta HCG levels dec by <15% after giving Methotrexate, then

Answer 34

Repeat inj. MTX (Max 3 times)

Question 35

If beta HCG inc or repeat MTX does not work, then

Answer 35

Laparoscopic surgery: 1. Family complete: U/L salpingectomy (Size of ectopic: >=5 cm) 2. Family not complete: Linear salpingostomy