Ectopic Pregnancy

Question 1

What percent of pregnancies do ectopic pregnancies account for?

Answer 1

2%

Question 2

In women presenting to the ER with bleeding or pain what percent will have an ectopic pregnancy?

Answer 2

18%

Question 3

What percent of ectopic pregnancies are in the fallopian tube?

Answer 3

97%

Question 4

What is the mortality rate associated with ectopic pregnacies?

Answer 4

3.8/10,000

Question 5

Infertility and the use of infertility treatments ____ your risk of ectopic pregnancy

Answer 5

increases

Question 6

T/F: DES exposure in utero increases your risk of ectopic pregnancy?

Answer 6

True

Question 7

At what level should bHCG increase in 48 hrs to suggest viable pregnancy?

Answer 7

increase by 53%

Question 8

If the initial HCG is < 1500 what is a normal percent rise in 48 hrs?

Answer 8

49%

Question 9

If the initial HCG is between 1500 - 3000 what is the normal percent rise in 48 hrs?

Answer 9

40%

Question 10

If the initial HCG is > 3000 what is the normal percent rise?

Answer 10

33%

Question 11

What is the first ultrasonographic finding of a viable IUP?

Answer 11

Double ring sign, decidual reaction

Question 12

What discriminatory zone for BHCG is is now used?

Answer 12

3500

Question 13

In early pregnancy the _____ produces progesterone

Answer 13

Corpus luteum

Question 14

If progesterone level is ____ that signifies normal IUP

Answer 14

> 20 ng/ml

Question 15

If progesterone level is _____ that suggests nonviable pregnancy

Answer 15

< 5 ng/dl

Question 16

If a pregnancy is non desired and technically a PUL, what is the next best step in management?

Answer 16

Dilation and curretage

Question 17

A BHCG decrease of ____ 24 hrs following D&C suggests removal of normal pregnancy

Answer 17

50%

Question 18

A BHCG decrease of < _____ 24 hrs following D&C indicates an ectopic pregnancy

Answer 18

15%

Question 19

What type of drug is methotrexate?

Answer 19

Folic acid antagonist

Question 20

What is the mechanism of methotrexate?

Answer 20

inactivates dihydrofolate reductase thereby decreasing available tetrahydrofolate, essential cofactor for DNA and RNA synthesis

Question 21

What labs should be checked prior to methotrexate administration?

Answer 21

Serum creatinine, LFTs, CBC, type and Screen

Question 22

What are absolute contraindications for methotrexate therapy?

Answer 22

Breastfeeding, Immunocompromised, liver disease, pulmonary disease ,peptic ulcer disease, renal dysfunction, blood dyscrasias

Question 23

What are relative contraindications for methotrexate therapy

Answer 23

MSD > 3.5 cm, HCG > 5000, presence of fetal heart beat, CRL > 5 cm

Question 24

What are the most common side effects of methotrexate

Answer 24

Nausea, vomiting, diarrhea

Question 25

True or false: When a patient takes methotrexate you should advise them to stop taking prenatal vitamins and folic acid supplements?

Answer 25

True

Question 26

What is the dose of methotrexate given in single dose regimen?

Answer 26

50 mg/m

Question 27

When should you recheck BHCG and at what percent should you see a decrease in HCG

Answer 27

Day 4 and Day 7, 15% decrease

Question 28

After you see a 15% decrease between day 4 and 7, how long should you follow BHCG?

Answer 28

Weekly until BHCG zero

Question 29

What is the regimen for fixed multidose Methotrexate protocol?

Answer 29

MTX 1 mg/kg on days 1,3,5,7 with folinic acid (Leucovorin) administration on days 2,4,6,8

Question 30

How do you measure HCG with the multidose methotrexate regimen?

Answer 30

Measure BHCG on the MTX treatment days (1,3,5,7) until you see a 15% decrease from previous day.

Question 31

When should you consider using the multidose methotrexate regimen?

Answer 31

More advanced pregnancies with higher HCG levels

Question 32

What is the regimen for 2 dose Methotrexate protocol?

Answer 32

MTX 50 mg/m on day 1 and day 4

Question 33

How do you measure HCG with 2 dose methotrexate protocol and how much should it decrease?

Answer 33

Measure BHCG on day 4 and day 7, 15%

Question 34

In the 2 dose methotrexate protocol, If the BHCG on day 4 and day 7 is < 15% following 2 doses of methotrexate, when should you give more MTX?

Answer 34

Day 7 and Day 11

Question 35

Following salpingostomy for surgical management of an ectopic pregnancy, what must be followed?

Answer 35

BHCG

Question 36

Pregnancy rates are higher after ______ than _______

Answer 36

Salpingostomy, Salpingectomy

Question 37

Ovarian pregnancy accounts for what percent of ectopic pregnancies?

Answer 37

< 3%

Question 38

What is the incidence of cornual pregnancy?

Answer 38

< 2%

Question 39

What is the standard treatment of cornual pregnancy?

Answer 39

Methotrexate

Question 40

How do you commonly treat a cervical ectopic pregnancy?

Answer 40

Methotrexate