8b Ectopic Pregnancy

Question 1

Define an ectopic Pregnancy

Answer 1

A pregnancy occurring outside of the uterus

Question 2

Ectopic Pregnancies usually occur where

Answer 2

Fallopian tube

But can also occur in the ovary , cervix and abdomen

Question 3

What percentage of ectopic pregnancies occur in the ampulla of the Fallopian tube

Answer 3

55%

Question 4

What percentage of ectopic pregnancies occur in the isthmus of the Fallopian tube

Answer 4

18%

Question 5

What percentage of ectopic pregnancies occur in the abdominal cavity

Answer 5

1%

Question 6

What percentage of ectopic pregnancies occur in the fimbria of the Fallopian tube

Answer 6

20%

Question 7

What percentage of ectopic pregnancies occur in the ovaries

Answer 7

2%

Question 8

What is the incidence of ectopic Pregnancies in the Caribbean

Answer 8

1 in 140

Question 9

What is the incidence of Ectopic pregnancy in the USA

Answer 9

1 in 100

Question 10

List four risk factors for Ectopic pregnancy

Answer 10

History of PID (Pelvic inflammatory disease)
Previous Tubal Surgery
Intrauterine Contraceptive device (IUCD)
Previous Ectopic Pregnancy

Question 11

List five symptoms of Ectopic pregnancy

Answer 11

Vaginal bleeding
Lower abdominal and pelvic pain
Shoulder pain
Palpitations
Syncope

Question 12

List five signs of Ectopic pregnancy

Answer 12

Tenderness of lower abdomen
Adnexal tenderness
Adnexal mass (20%)
Tachycardia and hypotension
Cullen’s sign (bluish discoloration around umbilicus)

Question 13

List three tests for Ectopic Pregnancy Diagnosis

Answer 13

Ultrasound Scan
Serial Quantitative beta hCG
Laparoscopy

Question 14

What is the criteria for Ectopic pregnancy- Expectant Management

Answer 14

Falling serum Beta hCG
Patient asymptomatic
No significant abdominal signs
Patient must be available for follow up

Question 15

What are the criteria for Ectopic pregnancy- medical management

Answer 15

Unruptured 
Diameter <3.5cm
No evidence of embryonic heartbeat 
Beta-hCG <10,000 mIU/ml
Reliable for follow up

Question 16

In the medical management of Ectopic pregnancy which drug is administered and how much

Answer 16

Methotrexate, 50mg/m

The drug stops cells from growing - the pregnancy is absorbed by the body by weeks 4-6

Question 17

In Medical Management of Ectopic Pregnancy

Quantitative beta HCG is measured on which days

Answer 17

Day 4 and 7

Question 18

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

Answer 18

Repeat dose of Methotrexate

Ps// Methotrexate works by blocking the enzyme in the body that maintain the pregnancy

Question 19

List the steps in Medical Management of Ectopic Pregnancy

Answer 19

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

Question 20

What are two types of surgical management for ectopic pregnancy

Answer 20

Conservative which is a salpingostomy

Radical which is a salpingectomy

Question 21

What is a conservative procedure for surgical management of an ectopic pregnancy

Answer 21

Salpingostomy

Question 22

What is the radical procedure for a surgical management of an ectopic pregnancy

Answer 22

Salpingectomy

Question 23

What is another name for Molar Pregnancy

Answer 23

Hydatidiform Mole

Question 24

What are the two classifications of Hydatidiform mole (molar Pregnancy)

Answer 24

Complete

Partial

Question 25

Describe the gross appearance of a Complete Hydatidiform Mole

Answer 25

Mass of grape- like vesicles varying in size from barely visible to a few cm in diameter

Question 26

Describe the histology of a Complete Hydatidiform Mole

Answer 26

Villous oedema Decreased vasculature Trophoblastic proliferation Absence of fetus amnion

Question 27

Describe the genetics of a Complete Hydatidiform Mole

Answer 27

Most are diploid and 46 XX | Chromosomes completely paternal in origin

Question 28

Describe the gross appearance of a partial Hydatidiform Mole

Answer 28

Hydatidiform changes are focal and less advanced | Fetal tissues may be seen

Question 29

Describe the histology of a Partial Hydatidiform Mole

Answer 29

Trophoblastic proliferation is focal rather than generalised

Question 30

Describe the genetics of a Partial Hydatidiform Mole

Answer 30

Karyotype typically triploid 69XXX, 69XXY, 69XYY One maternal but two paternal haploid compliments

Question 31

Molar pregnancies are associated with pregnancies at which age

Answer 31

Extremes of reproductive age

Question 32

List five clinical features of Molar Pregnancy

Answer 32

``` Vaginal bleeding Uterus large for dates No fetal heart tones Quantitative beta-hCG is elevated Bilateral the a lutein cysts on ovaries ```

Question 33

What are two tests done to diagnose Molar Pregnancy

Answer 33

Ultrasound scan | Quantitative beta hCG

Question 34

List five steps of management for Molar Pregnancy

Answer 34

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

Question 35

What is the prognosis of molar pregnancies with prompt diagnosis and prescription

Answer 35

Mortality rate almost 0

Question 36

20% of molar pregnancy is progressed to what type of tumor

Answer 36

Gestational trophoblastic tumor

Question 37

What is the rate of a molar Pregnancy in subsequent pregnancies

Answer 37

1-2%