LMCC Study - OBGYN > Ectopic Pregnancy > Flashcards

Ectopic Pregnancy Flashcards

(21 cards)

Study These Flashcards
1
Q

What is an ectopic pregnancy?

A
  • Pregnancy that implants outside the uterine cavity

- Over 95% occur in fallopian tube

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2
Q

Describe the pathophysiology of an ectopic pregnancy?

What are the 3 outcomes of a tubal pregnancy

A
  • Implantation of trophoblast in tube
  • Erodes through mucosal layer of the tube and into vessels causing bleeding into endometrial cavity (causes spotting) & Peritoneum (hemoperitoneum)
  • Blood caught between serosal and mucosal layers of tube causing cervical motion tenderness
  • If bleeds enough, results in pressure necrosis of the tubal serosa and significant hemoperitoneum
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3
Q

What is the classic triad of ectopic pregnancy?

A

1) Missed menses
2) Vaginal bleeding (typically spotting)
3) Lower abdo pain

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4
Q

Previous ectopic pregnacy is one of the greatest risk factors for subsequent ectopic. What is the recurrence rate following an ectopic pregnacy?

A
  • 30%
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5
Q

Do IUD’s increase risk of ectopic pregnancy?

A
  • Overall no, due to decreased rate of pregnancy
  • However, up to 40% of pregnancy in patients with IUD in place are ectopic
  • Progestins slow tubal peristalsis meaning the oocyte is in the tube much longer and if becomes fertilized may progress too slowly and become stuck
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6
Q

How does assisted reproductive technology affect the rate of ectopic pregnancy?

A
  • Increases risk
  • High levels of progesterone used to hyperstimulate ovaries
  • Progesterone slows tubal motility increasing risk of ectopic
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7
Q

Which area of the fallopian tube do ectopic pregnancies occur in the most?

A
  • Ampulla (75-80%)
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8
Q

What is a heterotopic pregnancy?

A
  • When there are simultaneous implantation of pregnancies in both the endometrium and an extrauterine site
  • May occur in as many as 1 in 100 IVF pregnancies
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9
Q

What are the 3 outcomes of a tubal pregnancy

A

1) tubal rupture and hemorrhage
2) Resorption of pregnancy (due to interrupted blood supply)
3) Tubal abortion into peritoneal cavity (rarely results in abdominal pregnancy)

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10
Q

How would someone present with an acutely ruptured ectopic pregnacy?

A

Symptoms indicative of massive hemorrhage

  • Dizziness
  • loss of consciousness
  • Sudden onset severe pain
  • Shoulder pain may be present due to irritation of phrenic nerve in peritoneum

Physical:

  • Tachy
  • Diaphoresis
  • Hypotensive
  • Peritonitis
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11
Q

How would you manage an acutely ruptured ectopic?

A
  • Surgical emergency
  • Large bore IV’s and fluid resuscitation
  • Blood transfusion
  • Laparotomy typically
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12
Q

What is a probable ectopic pregnancy?

A
  • Postive pregnancy test, presenting with notable pelvic pain and spotting after other disease processes relating to early pregnancy are ruled out
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13
Q

What is the double ring sign? The ring of fire sign?

A

Double ring: Echogenic ring surrounding ectopic pregnancy

Ring of fire: Doppler flow showing ring of vascularity around ectopic

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14
Q

What is the expected doubling time of B hCG in a normal pregnancy?

A
  • 48 hours in the first few weeks of a pregnancy
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15
Q

At what hCG level should you be expected to see an IUP by transvaginal ultrasound?

A

1500 - 2000 IU

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16
Q

At what hCG level should you be expected to see an IUP by transabdominal ultrasound?

17
Q

What effect does having a salpingectomy have on a womans future fertility

Study These Flashcards
A
  • There does not seem to be any difference

- 10-20% increase risk of residual trophoblastic tissue is associated with saplinostomy (when entire tube isnt removed)

18
Q

What is the medical management of an ectopic pregnancy?

Study These Flashcards
A
  • Methotrexate
  • Patient returns on days 4 and 7 for repeat hCG levels
  • hCG levels must fall at least 15% between the return days (if not then repeat dose or surgery)
  • Following this followed every 7 days looking for 15% decrease per week
  • Follow down until hCG is undetectable
19
Q

What criteria must someone meet to be able to try medical management of ectopic?

Study These Flashcards
A
  • Stable
  • Ability to follow-up
  • Ectopic mass size under 3-4 cm
  • No cardiac motion seen
  • hCG levels less than or equal to 5000
  • Normal renal and hepatic function
20
Q

What additional treatment should you provide to all Rh-negative, unsensitized women with ectopic pregnancy?

21
Q

How long after an ectopic pregnancy should future pregnancy be avoided?

Study These Flashcards
A
  • 3 months
  • Allow for tubes to normalize and for methotrexate to clear system
  • Should use highly effective contraception during interm
LMCC Study - OBGYN
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