1.02 Complications of Early Pregnancy- Ectopic Pregnancy Flashcards
Most common location of ectopic pregnancy
Tubal
How is heterotrophic pregnancy handled?
The ectopically implanted conceptus will be treated while the intrauterine pregnancy will not be treated
At what age increases the risk for ectopic pregnancy?
35 years old
Classic triad of ectopic pregnancy
Delayed menstruation
Pain
Vaginal bleeding/spotting
What is culdocentesis for?
It checks abnormal fluid in the posterior fornix (cavity behind the uterus) > any bloody fluid that does not clot or old clots indicate ectopic pregnancy
However, it cannot detect unruptured ectopic pregnancy as it does not bleed
Inhomogenous mass with a classic ring of fire on ultrasound indicates what?
Increased vascularity -> ectopic pregnancy
T/F: In early pregnancy, bHcG levels increase in a curvilinear fashion until a platue at 1,000 mIU/mL is reached by 10weeks of gestation
Discriminatory threshold of b-hCG
T/F: Serial bhCG increases by 50% every 24 hrs
F
- it’s 100,000 mIU/mL
threshold- 3500 mIU/mL
F- every 48 hours
Progesterone value for nonliving/ectopic pregnancy:
For normal pregnancy:
Non-living/ectopic pregnancy: <5ng/mL
Normal: >25 ng/mL
What to do with hemodynamically unstable patient with positive pregnancy test + abdominal pain + vaginal bleeding
Culdocentesis > surgery if positive
What to do with hemodynamically stable patient with positive pregnancy test + abdominal pain + vaginal bleeding
TVS
If IUP > prenatal care
If abnormal (abortion) > treat
If nondiagnostic > measure bHCG
T/F: Single-dose methotrexate is the preferred option over multidose due to its less risk for adverse events
Single best prognostic factor for successful treatment of methotrexate:
T
b-HCG levels = must be declining upon measurement on days 1, 4, and 7 in single dose protocol; weekly surveillance afterwards
T/F: Methotrexate can be used for heterotrophic pregnancy
Methotrexate dosage for single dose
Methotrexate dosage for multidose
T
Single dose: 50 mg/m2 BSA on day 1
Multidose: 1mg/kg on days 1,3,5,7
0.1 mg/kg on days 2,4,6,8
Indications for additional doses for single and multidoses of methotrexate
Single dose: add dose if serum b-hCG did not decline by 15% from day 4 to day 7; or less than 15% decline during weekly surveillance
Multidose: add dose if serum bHCG declines less than 15%; repeat serum hCG in 48 hours and compare previous doses; max 4 doses
T/F: You can take methotrexate while breastfeeding
T/F: Methotrexate is contraindicated to ruptured ectopic pregnancy
F- absolute contraindications include breastfeeding
T
What are the relative contraindications for methotrexate use?
If there is embryonic cardiac activity on TVS
High intial bhCG concentration (5000-10000)
Ectopic pregnancy greater than 4mm size in TVS
Refusal to accept blood transfusion
This ectopic pregnancy is where the implant lies within the muscular uterine wall of a uterus within the proximal tube segment with a Mullerian Abnormality
What kind of resection is done?
Interstitial Pregnancy
Cornual resection
Criteria for interstitial pregnancy include >___ cm away from the most lateral edge of the uterine cavity and thin (<___mm) myometrial mantle surrounding the sac
> 1cm away
<5mm thin
The placenta, gestational sac, or both are embedded in the hysterectomy scar
Cesarean scar pregnancy
T/F: Methotrexate works on cesarean scar pregnancy
F- needs to be evacuated
What is the Rubins Criteria for Cervical pregnancy?
-The cervical glands must be opposite to the attachment of trophoblast/placenta
-The attachment of trophoblasts must be below the level of entrance of uterine vessels into the uterus or anterior peritoneal reflection
-Fetal elements must be absent form the corpus uteri
T/F: Methotrexate can be used for cervical pregnancy
Surgical Tx:
T
Hysteroscopy (camera-guided curettage)
Where is spiegelberg Criteria used?
What are the mentioned criteria?
For ovarian pregnancy
-Ipsilateral tube must be intact and distinct from the ovary
-There should be a gestational sac in the ovary
-The ectopic pregnancy is connected by the utero-ovarian ligament to the uterus
-Ovarian tissue can be identified histologicallly despite the placental tissue
Where is the Studdiford Criteria used?
What are its criteria?
for Abdominal Pregnancy
-The presence of normal bilateral tubes and ovaries with no evidence of recent or past pregnancy
- No evidence of uteroperitoneal fistula
-Presence of pregnancy related exclusively to the peritoneal surface, early enough to eliminate the secondary implantation after primary tubal nidation
