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46 Cards in this Set
- Front
- Back
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What is ectopic pregnancy?
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Implantation outside the uterine cavity
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What is the most common site of ectopic implantation? What %?
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In the fallopian tube - 95% are tubal ectopics
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Why has the incidence of ectopic pregnancy been increasing lately?
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Bc of an increasing prevalence of PID
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What is the frequency of ectopics in all IUPs?
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1 ectopic per 66 IUPs
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How has the rate of maternal mortality in ectopic pregnancies changed recently?
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It has decreased markedly
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Why has the mortality rate decreased though the ectopic rate has increased?
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Because of better detection and earlier intervention.
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Where in the fallopian tube do the vast majority of tubal ectopics implant?
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Ampulla
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What are the main adverse outcomes of ectopic pregnancy?
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-Hemorrhage
-Rupture -INFERTILITY |
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What is the PRIMARY risk factor for ectopic pregnancy?
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Past hx of Salpingitis/PID
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Why is a past hx of salpingitis a risk factor for ectopic pregnancy?
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Dmg/scarring of the tube inhibits passage of a conceptus to the endometrial cavity; it gets stuck.
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How much increased is the risk of ectopic in a woman with past hx of salpingitis?
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6X higher!
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What other pertinent history increases the risk of ectopic? By how much?
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Hx of a previous ectopic - 10x
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What is an inherent maternal risk factor for ectopic pregnancy?
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AGE 35-44 yo is 3X higher
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How is parity related to risk of ectopic pregnancy?
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Increasing multips are at higher risk of ectopic
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What 2 races have signif. higher rates of ectopic pregnancy?
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-Blacks
-Hispanics |
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What is ectopic pregnancy?
|
Implantation outside the uterine cavity
|
|
|
What is the most common site of ectopic implantation? What %?
|
In the fallopian tube - 95% are tubal ectopics
|
|
|
Why has the incidence of ectopic pregnancy been increasing lately?
|
Bc of an increasing prevalence of PID
|
|
|
What is the frequency of ectopics in all IUPs?
|
1 ectopic per 66 IUPs
|
|
|
How has the rate of maternal mortality in ectopic pregnancies changed recently?
|
It has decreased markedly
|
|
|
Why has the mortality rate decreased though the ectopic rate has increased?
|
Because of better detection and earlier intervention.
|
|
|
Where in the fallopian tube do the vast majority of tubal ectopics implant?
|
Ampulla
|
|
|
What are the main adverse outcomes of ectopic pregnancy?
|
-Hemorrhage
-Rupture -INFERTILITY |
|
|
What is the PRIMARY risk factor for ectopic pregnancy?
|
Past hx of Salpingitis/PID
|
|
|
Why is a past hx of salpingitis a risk factor for ectopic pregnancy?
|
Dmg/scarring of the tube inhibits passage of a conceptus to the endometrial cavity; it gets stuck.
|
|
|
How much increased is the risk of ectopic in a woman with past hx of salpingitis?
|
6X higher!
|
|
|
What other pertinent history increases the risk of ectopic? By how much?
|
Hx of a previous ectopic - 10x
|
|
|
What is an inherent maternal risk factor for ectopic pregnancy?
|
AGE 35-44 yo is 3X higher
|
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How is parity related to risk of ectopic pregnancy?
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Increasing multips are at higher risk of ectopic
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What 2 races have signif. higher rates of ectopic pregnancy?
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-Blacks
-Hispanics |
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What is the first step to do in the initial assessment of an otherwise hemodynamically stable patient w/ possible ectopic?
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A pregnancy test!
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Does a negative pregnancy test exclude the possibility of an ectopic?
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yes!
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What's more sensitive; urine or serum hCG? when would either become positive?
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Urine is less sensitive than serum. Urine pos at 14d, Serum pos at 5d.
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If the pregnancy test is positive, what are the next 2 things you need to decide?
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-Whether it's viable
-Where it's located |
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How do you determine if an early pregnancy is viable?
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Follow quantitative bhCG for 48hr intervals
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What would indicate nonviable pregnancy?
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Failure to increase at least by 66% in 48 hrs.
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When would a transvag ultrasound be able to visualize an IUP?
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When hCG is 1500 mIU/mL or higher
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When would a transabdominal ultrasound be able to visualize an IUP?
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When hCG is 5-6000 mIU/mL or higher
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What are serum progesterone levels >25 ng/mL indicative of?
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A normal, viable Intrauterine pregnancy - NOT ectopic, NOR nonviable.
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What is a Positive culdocentesis?
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Aspiration of NONclotting blood from the cul-de-sac showing hemoperitoneum where the clot has fibrinolysed.
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What is the significance of a positive culdocentesis?
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Signifies blood in the peritoneal cavity; need further eval to ID source.
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What is the most ACCURATE way to identify an ectopic?
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Direct visualization - laparoscopy or laparotomy
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What are 3 surgical methods of treatment for ectopic pregnancy?
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1. Salpingostomy
2. Partial resection 3. Salpingectomy |
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What sort of ectopics can be managed medically with MTX?
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-Smaller than 3.5 cm
-Unruptured -No heartbeat seen on US |
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What do you have to do for more conservatively managed cases of ectopic?
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Follow serial quantitative b-hCG levels to zero!
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What needs to be done if b-hCG levels don't go to zero?
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MTX or more surgery
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