Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
36 Cards in this Set
- Front
- Back
|
Objectives
|
Define ectopic prego
diff early prego bleeding from ectopic prego medical and surgical treatments and indications for treatment |
|
|
What is the definition of an ectopic prego?
|
Pregnancy outside the uterine corpus
|
|
|
What does the increase in ectopic pregnancies parallel?
|
90% increase since 1970 (parallel’s ^ STD)
STDs |
|
|
Where do most ectopic pregnancies take place?
|
Tubal – ampulla most common 80%
|
|
|
What are some common risk factors for an ectopic pregnancy?
|
- Prior ectopic pregnancy*****
- History of PID - History of tubal ligation - History of tubal reversal or other prior tubal surgery - Mullerian anomalies - Progesterone containing IUD (Mirena)****** - Assisted reproduction - DES exposure - Cigarette smokers 2 fold increase******* |
|
|
Where does nl fertilization take place?
|
Fertilization occurs in fallopian tube
|
|
|
How long dose it take for implantation in utero for a NL pregnancy?
|
In utero and implanting by day 5
|
|
|
What is the Beta-hCG levels in a NL pregnancy?
|
BHCG “doubles” every 2 days up to 10 weeks (or at least 60% increase)
|
|
|
What is the Progesterone levels in a NORMAL (NL) pregnancy?
|
Progesterone > 20 in normal intrauterine pregnancy
|
|
|
What should you see in a nl pregnancy on US and beta-hCG levels at 5 weeks?
|
5 weeks
(HCG 1500) – transvaginal ultrasound shows sac |
|
|
What structures are present in a nl pregancy at week 6?
|
6 weeks – yolk sac and or fetal pole
|
|
|
What is present at week 7 in a nl pregnancy?
|
7 weeks – fetal cardiac activity
|
|
|
What are common symptoms of a ectopic pregnancy?
|
These are important!!!
Pain Bleeding + Pregnancy test Tubal Rupture 6-8 weeks Corneal rupture 10wks |
|
|
Do most ecoptic pregnancies present with pain and bleeding?
|
Most do not present with pain and bleeding
|
|
|
What are some findings you may see due to ectopic pregnancy?
|
- Tender abdomen
- Distended abdomen - Rebound - Guarding - Tachycardia - Unclotted blood in culdocentesis – possibly chorionic villi - Low Hemoglobin |
|
|
If you did an ultrasound (US) for a RUPTURED ectopic pregnancy what would you expect to find?
|
Intrabdominal fluid
& Empty uterus or pseudosac >2700 won't see an empty sac |
|
|
If you did an US for a UNRUPTURED ectopic pregnancy what would you expect to find?
|
Depends on gestational age
No pregnancy in uterus***** Until cardiac activity is seen in utero, presume ectopic Also expect ectopic if beta-hCG is not doubling |
|
|
What are ways to manage an ectopic pregnancy?
|
Methotrexate – folic acid inhibitor – interferes with DNA synthesis
Linear salpingostomy Salpingectomy Laparotomy Laparoscopy |
|
|
Not sure if these are going to be on exam but let's look at them
|
go
|
|
|
If you have:
Abnl rising HCG No gestational sac Villi present What is this? |
Incomplete abortion
|
|
|
If you have:
nl rising HCG Gestational sac present No yolk sac What is this? |
Nonviable pregnancy
|
|
|
If you have:
nl rising HCG Gestastional sac present Yolk sac present What is this? |
Nl pregnancy
|
|
|
If you have:
abnl rising HCG No gestational sac Villi are absent Large mass What is this? |
Ectopic pregnancy
Tx: Laparoscopy or Laparotomy |
|
|
If you have:
Alnl rising HCG No gestational sac Villi absent Mass of 4.0 cm or less What is this? |
ectopic pregancy
Tx: Methotrexate or medical |
|
|
When can you use Methotrexate?
|
Healthy, hemodynamically stable, reliable, compliant mother with ectopic pregancy
Ultrasound shows no intrauterine pregnancy Dilation and curettage fail to show chorionic villi No evidence of rupture No fetal cardiac activity |
|
|
What must the HCG levels be to use Methotrexate?
|
HCG < 10,000
|
|
|
What tests must the mother have done b4 we give her methotrexate?
|
Normal LFT’s, renal function tests, CBC
|
|
|
What if the mother is Rh negative what drug must you administer before you administer methotrexate for and ectopic pregnancy?
|
Rhogam
|
|
|
When administering Methotrexate (MTX) what do you do on day1?
|
Day 1 – Baseline labs, HCG, and 50mg/m^2 MTX
|
|
|
What do you monitor after MTX administration?
|
HCG
Follow weekly HCG levels until negative |
|
|
When would you give a second dose of MTX?
|
After 7 days if
Give dose 2 and repeat if a 15% drop has not occurred |
|
|
If a women has an ectopic pregnancy.....what Surgery would you do if she was hemodynamically
Stable vs Unstable |
Hemodynamically unstable – laparotomy
Stable – laparoscopy |
|
|
When would you have to do a Salpingectomy
|
This is where you actually REMOVE the fallopian tube
Second ectopic same tube Childbearing completed Uncontrolled bleeding Severe tubal damage |
|
|
When would you do a Salpingostomy?
|
Linear incision of tube
NOT REMOVEAL!!! Dissect pregnancy from tube 70% subsequent intrauterine pregnancy 84% subsequent tubal patency 12% subsequent ectopic 15% persistent trophoblastic disease Follow HCG to zero |
|
|
What is the risk of recurrence for an ectopic pregnancy?
|
After 1 ectopic 12% subsequently ectopic
10 fold increase after 2 |
|
|
Pt is a 24 year old G3P0010 with a prior ectopic pregnancy. She comes to you at 5 weeks pregnant by LMP with a positive home pregnancy test concerned about the potential for another ectopic. Her HCG is 1200, progesterone 22. She denies bleeding or pain.
|
Prior ectopic prego increases her risk of another one by 12%
HCG is 1200 @5wks - should be 1500@5 wks Progesterone should be >20, hers is 22 Have her come back....Chech her HCG in 2 days - should double to 2400....remember HCG doubles every 2 days up to 10 weeks |
