8b Ectopic Pregnancy Flashcards
Define an ectopic Pregnancy
A pregnancy occurring outside of the uterus
Ectopic Pregnancies usually occur where
Fallopian tube
But can also occur in the ovary , cervix and abdomen
What percentage of ectopic pregnancies occur in the ampulla of the Fallopian tube
55%
What percentage of ectopic pregnancies occur in the isthmus of the Fallopian tube
18%
What percentage of ectopic pregnancies occur in the abdominal cavity
1%
What percentage of ectopic pregnancies occur in the fimbria of the Fallopian tube
20%
What percentage of ectopic pregnancies occur in the ovaries
2%
What is the incidence of ectopic Pregnancies in the Caribbean
1 in 140
What is the incidence of Ectopic pregnancy in the USA
1 in 100
List four risk factors for Ectopic pregnancy
History of PID (Pelvic inflammatory disease)
Previous Tubal Surgery
Intrauterine Contraceptive device (IUCD)
Previous Ectopic Pregnancy
List five symptoms of Ectopic pregnancy
Vaginal bleeding Lower abdominal and pelvic pain Shoulder pain Palpitations Syncope
List five signs of Ectopic pregnancy
Tenderness of lower abdomen Adnexal tenderness Adnexal mass (20%) Tachycardia and hypotension Cullen’s sign (bluish discoloration around umbilicus)
List three tests for Ectopic Pregnancy Diagnosis
Ultrasound Scan
Serial Quantitative beta hCG
Laparoscopy
What is the criteria for Ectopic pregnancy- Expectant Management
Falling serum Beta hCG
Patient asymptomatic
No significant abdominal signs
Patient must be available for follow up
What are the criteria for Ectopic pregnancy- medical management
Unruptured Diameter <3.5cm No evidence of embryonic heartbeat Beta-hCG <10,000 mIU/ml Reliable for follow up
In the medical management of Ectopic pregnancy which drug is administered and how much
Methotrexate, 50mg/m
The drug stops cells from growing - the pregnancy is absorbed by the body by weeks 4-6
In Medical Management of Ectopic Pregnancy
Quantitative beta HCG is measured on which days
Day 4 and 7
In Medical Management of Ectopic Pregnancy, Quantitative beta-hCG is measured on day 4 and 7
If day 7 level is < 15% lower than day 4 what is done
Repeat dose of Methotrexate
Ps// Methotrexate works by blocking the enzyme in the body that maintain the pregnancy
List the steps in Medical Management of Ectopic Pregnancy
Methotrexate, single dose of 50 mg
Quantitative data – hCG measured on Day 4 and 7
If Day 7 level is less than 15% lower than Day 4 a repeat dose is given
There after weekly hCG levels are performed until the value is zero
What are two types of surgical management for ectopic pregnancy
Conservative which is a salpingostomy
Radical which is a salpingectomy
What is a conservative procedure for surgical management of an ectopic pregnancy
Salpingostomy
What is the radical procedure for a surgical management of an ectopic pregnancy
Salpingectomy
What is another name for Molar Pregnancy
Hydatidiform Mole
What are the two classifications of Hydatidiform mole (molar Pregnancy)
Complete
Partial
Describe the gross appearance of a Complete Hydatidiform Mole
Mass of grape- like vesicles varying in size from barely visible to a few cm in diameter
Describe the histology of a Complete Hydatidiform Mole
Villous oedema
Decreased vasculature
Trophoblastic proliferation
Absence of fetus amnion
Describe the genetics of a Complete Hydatidiform Mole
Most are diploid and 46 XX
Chromosomes completely paternal in origin
Describe the gross appearance of a partial Hydatidiform Mole
Hydatidiform changes are focal and less advanced
Fetal tissues may be seen
Describe the histology of a Partial Hydatidiform Mole
Trophoblastic proliferation is focal rather than generalised
Describe the genetics of a Partial Hydatidiform Mole
Karyotype typically triploid
69XXX, 69XXY, 69XYY
One maternal but two paternal haploid compliments
Molar pregnancies are associated with pregnancies at which age
Extremes of reproductive age
List five clinical features of Molar Pregnancy
Vaginal bleeding Uterus large for dates No fetal heart tones Quantitative beta-hCG is elevated Bilateral the a lutein cysts on ovaries
What are two tests done to diagnose Molar Pregnancy
Ultrasound scan
Quantitative beta hCG
List five steps of management for Molar Pregnancy
Evacuation of the uterus via suction curettage
Serial beta hCG for one year
Avoid pregnancy for one year
If beta hCG plateaus or rises this indicates recurrent disease with a malignant potential of 20%
Patients with recurrence are treated with chemotherapy and methotrexate
What is the prognosis of molar pregnancies with prompt diagnosis and prescription
Mortality rate almost 0
20% of molar pregnancy is progressed to what type of tumor
Gestational trophoblastic tumor
What is the rate of a molar Pregnancy in subsequent pregnancies
1-2%
