Ectopic Pregnancy Flashcards Preview

Gynaecology > Ectopic Pregnancy > Flashcards

Flashcards in Ectopic Pregnancy Deck (11):
1

Predisposing factors for ectopics (8)

damage to fallopian tubes

IUD/IUS

POP

maternal age>35

smoking

previous ectopic

endometriosis

IVF

2

Presentation of ectopic pregnancy and ruptured ectopics (7)

presents around 8wks w.:
-pain
-bleeding
-cervical excitation
-shoulder tip pain: peritoneal bleeding>diphragmatic irritation

rupture:
-sudden onset pain
-peritonism
-shock

3

Ix for ectopics (2)

B-hCG

USS:
-empty uterine sac
-fluid in pouch of douglas

4

detecting ectopic pregnancy <5wks gestation

<5wks, USS cannot detect foetus=> only B-hCG can be used to detect ectopic.

if B-hCG<1500, take another reading 48hrs later, if this doubles>normal pregnancy.

5

Mx of ectopic pregnancy (6)

NBM

IVI

anti-D if rh-ve

urgent laparotomy if ruptured

salpingectomy/salpingostomy

MTX

6

salpingostomy vs salpingectomy (4)

ostomy:
-higher chance of subsequent pregnancy and persistent trophoblast
-must have serial hCG until <20
-if part remains>MTX

ectomy:
-preferred option unless other tube is dysfunctional and fertility needs to be preserved.

7

indications for MTX Rx (5)

(50mg IM/intratubal)

no significant pain

unruptured

hCG<1500

no free fluid in pouch of douglas

<35mm ectopic

(will require regular f/u to check hCG<20. will rise till day 4 and fall by 7d)

(fertility rates similar to after surgery)

8

CI for MTX Rx (4)

>35mm

ruptured ectopic

foetal heart beat present

hCG>1500

9

complications of MTX Rx (4)

multiple ovarian cysts

life-threatening neutropenia

late pelvic collections of blood

pneumonitis

10

Expectant mx of ectopic pregnancy (4)

can be used for patients w.:
-no acute Sx
-no blood
-falling hCG w. initial levels<1000 (88% resolve spontaneously w. this level)
-<100ml fluid in pouch of douglas

11

Dx and Mx of persisent trophoblastic disease

hCG doesn't drop according to expected curve

Rx w. MTX IM

(occurs in 10% after laparoscopic salpingostomy, less likely in salpingectomy)