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15 Cards in this Set
- Front
- Back
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Where d omost ectopic pregnancies implant?
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Fallopian tubes
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What are the risk factors for ectopic pregnancy?
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Prior ectopic pregnancy
Hx of PID, tubal ligation, tubal reversal or other tubal sx, Mullerian anomalies, P4 IUD, Assisted reproduction, DES exposure, Cigs |
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Whats the normal progression of pregnancy?
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Fertilization in fallopian tubes --> in utero in-planting by day 5 --> BHCG doubles every 2 days up to 10 weeks --> P4 inc. by >20 --> 5 weeks = transvaginal US shows sac --> 6 weeks = yolk sac and fetal pole 7 weeks = fetal cardiac activity
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By what week do we see fetal cardiac activity?
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week 7
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Pt comes in with pain, bleeding, + preggo test, tubal rupture 6-8 weeks, cornual rupture 10 weeks. Dx?
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Tubal ectopic pregnancy
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What are the symptoms of a ruptured ectopic pregnancy
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tender abdomen, distended abdomen, rebound tenderness, guarding, tachy, unclotted blood in culdocentesis, low Hb
US = intrabdominal fluid, empty uterus or pseudosac |
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T/F: until cardiac activity is seen in utero, assume ectopic pregnancy
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TRUE
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How do we manage an ectopic pregnancy?
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Methotrexate
Linear Salpingostomy = hole in tube Salpingectomy = removal of tube Laparotomy = do if theres lots of blood loss Laparoscopy |
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What ectopic pts are the perfect candidates for methotraxate?
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They need to be RELIABLE, stable, healthy, compliant
US shows no intrauterine pregnancy D+C shows no chorionic villi No fetal cardiac activity Normal LFTs, renal function tests, CBC |
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Pt presents with signs + symtoms of ectopic pregnancy = Pt comes in with pain, bleeding, + preggo test, tubal rupture 6-8 weeks, cornual rupture 10 weeks. = it hasn't ruptured. What do you do after giving her Methotrexate?
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test for Rh status and give her Rhogam if Rh negative
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Whats our methotrexate follow up in the pt from previous question?
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Day 1 = baseline labs
Day 4 - HCG Day 7 = HCG, CBC, renal panel, LFTs Give dose 2 of methotrexate and repeat if a 15% drop in HCG has not occured Follow weekly HCG levels until negative |
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Whats the Sx route of Ectopic pregnancy management?
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Pt is hemodynamically unstable = bleeding a lot = Laparotomy
Pt is Stable = Laparoscopy |
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Salpingectomy (=take out whole tube) is used for ectopic pregnancy in what instances?
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second ectopic, same tube
Childbearing complete Uncontrolled bleeding Severe tube damage |
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Salpingostomy (=incision into tube, dissect pregnancy) has what outcomes?
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70% intrauterine pregnancy
84% subsequent tubal patency 12% subsequent ectopic pregnancy 15% persistent trophoblastic disease Follow HCG to Zero |
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PT has ectopic pregnancy. What can you tell her about her subsequent risk of another ectopic pregnancy?
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After 1 risk is 12%
10 fold inc. after 2 |
