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;
17 Cards in this Set
- Front
- Back
|
Reproduction System- Ectopic Pregnancy by Aliff
|
Reproduction System- Ectopic Pregnancy by Aliff
|
|
|
Define ectopic pregnancy
Differentiate early pregnancy bleeding from ectopic pregnancy Know available medical and surgical treatments and indications for treatment |
Define ectopic pregnancy
Differentiate early pregnancy bleeding from ectopic pregnancy Know available medical and surgical treatments and indications for treatment |
|
|
What is the definition of ectopic pregnancy? where is the most common?
|
*Pregnancy outside the uterine corpus
Incidence – 20 per 1000 90% increase since 1970 (parallel’s ^ STD) Death rate 3.4 per 10,000 *Tubal – ampulla most common 80% Other places: Cornual; Cervical; Abdominal at the cornual of the uterus is the most deadly. looks the most like a uterine pregnancy, but when it ruptures it has a lot of blood supply to put you in biig troubs. |
|
|
Risk Factors
|
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 inhospitable uterus. |
|
|
Normal progression...
where is fertilization normally? BHCG doubles how often? Normal level of progresterone? What age is there fetal cardiac activity? |
Fertilization occurs in fallopian tube
In utero and implanting by day 5 BHCG “doubles” every 2 days up to 10 weeks (or at least 60% increase) Progesterone > 20 in normal intrauterine pregnancy 5 weeks (or HCG 1500)– transvaginal ultrasound shows sac 6 weeks – yolk sac and or fetal pole 7 weeks – fetal cardiac activity |
|
|
Symptoms
|
Pain
Bleeding + pregnancy test Tubal rupture 6 – 8 weeks Cornual rupture 10 weeks Most do not present with pain and bleeding |
|
|
Findings with Ruptured Ectopic
|
Tender abdomen
Distended abdomen Rebound Guarding Tachycardia Unclotted blood in culdocentesis – possibly chorionic villi Low Hemoglobin |
|
|
Ultrasound Findings in Ruptured Ectopic; Ultrasound Findings in Unruptured Ectopic
|
Intrabdominal fluid
Empty uterus or pseudosac -- Depends on gestational age No pregnancy in uterus Until cardiac activity is seen in utero, presume ectopic |
|
|
Management of Ectopic
|
Methotrexate – folic acid inhibitor – interferes with DNA synthesis
Linear salpingostomy Salpingectomy Laparotomy Laparoscopy |
|
|
when do you use Methotrexate?
HCG has to be less than what? it's a folic acid inhibitor, messing up DNA synthesis. use this when you catch the ectopic early. this is not the standard of care anymore. |
Healthy, hemodynamically stable, reliable, compliant
Ultrasound shows no intrauterine pregnancy Dilation and curettage fail to show chorionic villi No evidence of rupture HCG < 10,000 No fetal cardiac activity Normal LFT’s, renal function tests, CBC Administer Rhogam if Rh negative MTX Follow Up: Day 1 – Baseline labs, HCG, and 50mg/m^2 MTX Day 4 – HCG Day 7 – HCG, CBC, renal panel, LFT’s Give dose 2 and repeat if a 15% drop has not occurred Follow weekly HCG levels until negative |
|
|
what is the standard of care now?
|
SalpingEctomy
Second ectopic same tube Childbearing completed Uncontrolled bleeding Severe tubal damage |
|
|
Hemodynamically unstable vs stable for surgery route.
|
Hemodynamically unstable – laparotomy
Stable – laparoscopy |
|
|
Salpingostomy
|
Linear incision of tube
Dissect pregnancy from tube 70% subsequent intrauterine pregnancy 84% subsequent tubal patency 12% subsequent ectopic 15% persistent trophoblastic disease Follow HCG to zero |
|
|
What's the risk of recurrence after 1 ectopic? 2 ectopic?
|
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.
|
First thing to do? US
if there is no fluid in the cul de sac or anything suspicious on US. but with progesterone greater than 22 she should be ok this time. |
|
|
Patient is a 25 yo prostitute with multiple elective abortions in the past. She has had a history of a “pelvic infection”. She had a light period 2 weeks ago and now complains of bleeding and pelvic pain after sex. Her urine pregnancy test is positive. Ultrasound does not show an intrauterine pregnancy but a sac in the left adnexa, with a moderate amount of free fluid in the cul de sac. P = 80, Hg = 9.8
|
do an US.
9.8Hb you're suspicious of an ectopic pregnancy put in a laproscope and look around. she has multiple risk factors. |
|
|
Patient is a 30 year old G3P2002 with a prior tubal ligation, reversed one year ago. She is 9 weeks by LMP with LLQ pain and spotting. She loses consciousness upon presentation, but on exam has a rigid, distended abdomen.
|
ectopic pregnancy.
|
