6.1 C) Vii) Obstetrics And Gynaecology First Trimester Bleeding

Front 1

In regards to Molar pregnancy, which of the

following is incorrect ?
A. 80% of gestational trophoblastic disease is benign molar pregnancy.
B. It is often diagnosed by Ultrasound in patients with Symptomatic

vaginal bleeding and presumed first trimester pregnancy.
C. The bHcG is usually markedly elevated> 100,000 mU/mL
D. It requires no surgical intervention.

Back 1

D. Molar pregnancy usually requires Surgical

intervention.

Therefore requires Gynaecological referral.

Front 2

In regards to Ectopic pregnancy and

Ultrasound, which of the following is correct ?
A. The "Discriminatory Zone" is bHcG 1500-2000 IU / mL about 4 weeks post last LNMP with transvaginal Ultrasound.
B. The "Discriminatory Zone" is with bHcG of 6000 at about 5-6 weeks post LNMP and via Transabdominal Ultrasound.
C. BHcG levels in ectopic pregnancy are often above the Discriminatory Zone levels of 1500 IU/mL.
D. A suggested ectopic pregnancy is with a bHCG below the

Discriminatory Zone level and no IUP.

Back 2

B.

A = 1500-2000 IU/mL 5-6 weeks post LNMP
C = Often Below the Discriminatory Zone level of 1500 IU/mL
D = BHcG above the Discriminatory Zone level and no IUP.

Front 3

What is the Strongest risk factor for ectopic

pregnancy?

Back 3

Prior ectopic pregnancy.

Front 4

What is the most common risk factor for

ectopic pregnancy ?

Back 4

PID : Pelvic Inflammatory Disease is the most common risk factor for ectopic pregnancy.

Front 5

List the order of visualised Ultrasound

findings with pregnancy in the first trimester.

Back 5

1. Gestational Sac (GS)
2. Yolk Sac (YS)
3. Fetal Pole (FP)
4. Fetal HR (FHR)

Front 6

At what timing in the First Trimester do the

various Ultrasound findings occur for :

1. Gestational Sac
2. Yolk Sac
3. Fetal Pole
4. Fetal HR

Back 6

Gestational Sac : 5 weeks
Yolk Sac : 6 weeks
Fetal Pole : 7 weeks
Fetal HR : 8 weeks

Front 7

What 5 Ultrasound findings suggest ectopic pregnancy ?

Back 7

1. BHcG above Discriminatory Zone with no IUP
2. Fluid in the cul-de-sac with no IUP
3. Complex adnexal mass with no IUP.
4. Ectopic fetal Pole (FP)
5. Fetal HR outside uterus

Front 8

List the Risk Factors for Ectopic Pregnancy.

Back 8

1. Previous ectopic pregnancy
2. PID - tubal infection
3. Fallopian Tube Surgery ( tubal ligation)
4. IUD in situ
5. Fertility treatment
6. Diethylstilbestrol exposure
7. Endometriosis

Front 9

** (Check)
At what bHcG would there be a 90% chance of ectopic pregnancy, if the transvaginal ultrasound (TVUS) showed an empty uterus ?
A. 500
B. 1600
C. 1200
D. 2000

Back 9

C.

Front 10

At what bHcG can an intrauterine pregnancy be seen with an abdominal

ultrasound (TAUS) ?

A. 4000
B. 5000
C. 5500
D. 6000

Back 10

D.

Front 11

In regards to BHcG and Ultrasound in ectopic pregnancy (EP) , which of the following is

incorrect?
A. A viable intra-uterine gestation should be visible on TVUS when the BHcg is > 1500 U/mL
B. The presence of an adnexal mass and no visible intra-uterine

pregnancy has a Likelihood ratio (LR) of > 100 on TVUS for EP.
C. An empty uterus on TVUS and a BHcG > 500 U/mL is 90% predictive for ectopic pregnancy.
D. The findings on TAUS have a 1 week lag behind TVUS

Back 11

C. An empty uterus on transvaginal ultrasound AND BHcg > 700 U/mL is 90% predictive for

ectopic pregnancy.

Front 12

Which of the following is correct regarding

ectopic pregnancy ?

A. The incidence in the General population is 1/1000
B. The incidence of heterotopic pregnancy is 1/1000
C. It occurs in 1% of all pregnancies
D. 20% of ectopic pregnancies are ruptured at presentation .

Back 12

D.

A = General population incidence of ectopic pregnancy = 20/1000
B = 1 /4000
C = Ectopic pregnancy occurs in 2%

pregnancies

Front 13

Tintinalli

What are the percentage % of symptom

presentations in ectopic pregnancy for the

following ?

1. Amennorhoea (missed menses)

2. Vaginal bleeding

3. Abdominal pain

Back 13

Amenorrhoea

70% cases

15% cases report no missed menses

Vaginal bleeding

50-80%

Abdominal pain

90%

( most common symptom of ectopic

pregnancy)

Front 14

Tintinalli

List the Ultrasound findings that have a high Positive predictive value (PPV) for ectopic pregnancy.

Back 14

Empty Uterus +

1. Extrauterine gestational sac

2. Extrauterine Foetal pole (FP)

3. Extrauterine Foetal cardiac activity (FHR)

4. Free fluid (moderate/large ) 86%

( small amount free fluid = 52%)

5. Pelvic / adnexal mass 70%

* Echogenic mass + free fluid

= 97 - 100% risk EP. *

Front 15

Tintinalli

What is the definition for the "Discriminatory Zone" ?

Back 15

It is the level of BHcG ** at which findings of an Intrauterine Pregnancy (IUP) should be expected on ultrasound.

For transvaginal = 1500 IU/mL

For Transabdominal = 6000 IU/mL

Front 16

Tintinalli

In regards to the medical treatment with Methotrexate of ectopic pregnancy, which of the following is incorrect ?

A. Methotrexate inhibits cell division in rapidly growing tissues such as the trophoblast.

B. Treatment failure occurs in 15% when methotrexate used.

C. The most common side effect is abdominal pain.

D. Vaginal bleeding , abdominal pain or presyncope / syncope should

necessitate immediate evaluation for tubal rupture.

Back 16

B. Methotrexate has a Treatment failure of 36%

Front 17

Tintinalli

List 4 prognostic factors associated with a

high(er) failure rate with methotrexate in

ectopic pregnancy.

Back 17

1. High initial BHcG levels

2. Large tubal diameter

3. Severe abdominal pain

4. Foetal cardiac activity