ectopic pregnancy ppt

Question 1

About _____ in ______ pregnancies results in ectopic implantation.

Answer 1

1 in 150

Question 2

whats the leading cause of maternal death

Answer 2

ectopic pregnancy

Question 3

what is the death rate of ectopic pregnancy

Answer 3

1/1000

Question 4

If you have an ectopic are you likely to have another one

Answer 4

yes

1 out of 4 chance of reoccurence

Question 5

what are the most common locations of ectopic pregnancy

Answer 5

ampullary and isthmus makes up 95-97%

Question 6

does ectopic pregnancy produce HCG

Answer 6

yes but at a lower rate than IUP

Question 7

• surgical incision through naval

Answer 7

Laparoscopy

Question 8

• aspiration of non-clotting blood from the posterior cul-de-sac

Answer 8

Culdocentesis

Question 9

________- for microscopic evaluation of the endometrium

Answer 9

D&C

Question 10

Sonographic evaluation - Confirm IUP, screen for masses

Question 11

how often does Simultaneous occurrence of an intrauterine pregnancy and an extrauterine gestation occur

Answer 11

it is rare (1:30,000)

Question 12

two echogenic rings separated by a hypoechoic region

Answer 12

Double Decidual Sac -

Question 13

Inner ring of DDSS is called

Answer 13

chorionic villi

Question 14

outer ring of DDSS is called

Answer 14

Decidua vera

Question 15

Composed of a single echogenic ring surrounding intra-endometrial fluid

Answer 15

Pseudo Gestational Sac

Question 16

ddss vs pseudosac

Question 17

It protects the pregnancy from the maternal immune system.

Answer 17

decidual layer

Question 18

In cases of extrauterine gestation the decidua may create a mold of the interior of the uterus formed by exfoliated mucous membrane and blood. This is called a decidual cast.

Answer 18

Question 19

Positive Ectopic Findings

Answer 19

-Measurable levels of circulating hCG & no IUP demonstrated
-Demonstration of an adnexal mass or “ring”
-Fluid in the cul-de-sac
-Demonstration of a living adnexal embryo (100% specific)

Question 20

examples of ectopic pregnancy

Answer 20

Question 21

more ectopic examples

Answer 21

IUD In Uterus With Ruptured Ectopic and Blood

Question 22

what do you see

Answer 22

empty uterus (U)
with thickened endometrium (red arrow)
representing decidual reaction in a patient with adnexal mass.

Echogenic fluid (red arrowhead)
is seen in the cul-de-sac.

The combination of adnexal mass and echogenic cul-de-sac fluid makes this patient very high risk for ectopic pregnancy.

Question 23

Answer 23

A heterotopic pregnancy (an intrauterine pregnancy and left ectopic) at 7.2 weeks gestation.

Question 24

Color Doppler may demonstrate peritrophoblastic flow with a low resistance pattern on pulsed Doppler waveform

Color Doppler tends to show a focal area of arterial flow adjacent to the sac that is more intense than other color flashes in the uterus

Question 25

The patient must be reliable, compliant, and able to return for follow-up Contraindications: -gestation should not exceed 3.5 cm in its greatest dimension on ultrasound (US) measurement -No fetal cardiac activity present -The patient must be hemodynamically stable, with no signs or symptoms of active bleeding or hemoperitoneum

Answer 25

Methotrexate Therapy

Question 26

what size can the gestation not exceed with methotrexate therapy

Answer 26

3.5cm in its greatest dimension

Question 27

___________ is usually reserved for patients who are hemodynamically unstable or patients with cornual ectopic pregnancies.

Answer 27

Laparotomy

Question 28

_____________ may be performed in a patient who has complete childbearing, has a history of ectopic pregnancy in the same tube, or a patient with severely damaged tubes.

Answer 28

Salpingectomy

Question 29

patients are asymptomatic no evidence of rupture or hemodynamic instability must be objective evidence of resolution (i.e. declining bhCG levels). patient must be fully compliant and must be willing to accept the potential risks of tubal rupture

Answer 29

Expectant management

Question 30

Interstitial ectopic pregnancy (sometimes called ____________)

Answer 30

cornual

Question 31

Interstitial ectopic pregnancy occurs in the interstitial portion of the fallopian tube. It accounts for ____________ of all ectopics.

Answer 31

2% - 4%

Question 32

The diagnosis is suggested by visualization of an intrauterine gestational sac or decidual reaction located high in the fundus, that is not surrounded by more than 5mm of myometrium in all planes.

Answer 32

Interstitial ectopic pregnancy (sometimes called cornual)

Question 33

for a Interstitial ectopic pregnancy (sometimes called cornual) the myometrium should be how thick in all planes

Answer 33

more than 5mm

Question 34

An _______________________- is an echogenic line from the mass to the endometrial echo complex reportedly has high sensitivity (80%) and specificity (98%).

Answer 34

interstitial line sign

Question 35

Interstitial Line Sign

Answer 35

Question 36

what is this

Answer 36

cornual ectopic

Question 37

Management of interstitial ectopic includes methotrexate (either systemic or local), potassium chloride injection, conservative laparoscopic surgery, uterine artery embolization, cornuectomy or hysterectomy. The latter two are usually reserved for the emergency case or for failure of other methods.

Question 38

Empty uterus and any adnexal mass and/or blood with a qHCG at or above _______________is considered a need for surgery (Regional Rule for this area)

Answer 38

2000

Question 39

what is this

Answer 39

Ectopic in c-section scar