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11 Cards in this Set
- Front
- Back
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Incidence of ectopic pregnancy in the U.S
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19.7 per 1000 pregnancies
(108,800 women) |
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Risk Factors
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Previous ectopic
Previous PID Previous IUD Previous infertility tx Previous tubal ligation Previous tubal surgery |
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Signs and symptoms of ectopic pregnancy
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Abdominal pain - 97-98%
Amenorrhea - 74% Irregular vaginal bleeding - 56% Palpable adnexal mass - 54% |
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sites for ectopic pregnancy
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Tubal > 90%
Abdominal (1.4%) Cervical (<1%) Ovarian (6%) |
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Diagnostic tools for Ectopics
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Quantitative HCG (level should double ~ every 2 days)
Progesterone level |
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Diagnostic tools
Ultrasound |
Abdominal approach
IUP visable with HCG >6500 Vaginal approach IUP visable with HCG >1200-1500 |
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Diagnostic tools
Culdocentesis |
Positive for non-clotting blood in 78-95% of ectopic pregnancies
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Diagnostic tools
Surgery |
Dilitation and curettage with frozen section, possible laparoscopy
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Treatment of Ectopic
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Laparoscopy
Laparotomy Methotrexate Instillation of hyperosmolar glucose |
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Candidates for methotrexate therapy
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Reliable patient
Asymptomatic HCG levels < 5000 Tubal diameter < 3cm No fetal cardiac activity on U/S Do not use alcohol until HCG is negative Do not have intercourse until HCG negative Do not use folic acid-containing vitamins Report severe or prolonged increase in vaginal bleeding and abdominal pain Be aware that approximately 4% of women experience tubal rupture after treatment |
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Correlates of repeat ectopic pregnancy
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Age <= 24 years at first ectopic pregnancy
History of repeat ectopic pregnancy Initiation of infertility work-up Conception with an intrauterine device at index pregnancy Pregnancy order (strongest correlate) |
