Abortion/Ectopic Pregnancy - Hill Flashcards
Where are most ectopic pregnancies located?
Ampulla of the fallopian tube
What is the most dangerous ectopic location?
Interstitial/Cornual
Which ectopic location bleeds the most?
cervical
What are risk factors for an ectopic pregnancy?
1) PID
2) hx of tubal surgery
3) prior ectopic
4) ART
5) smoking
6) hx of abdominal/pelvic surgery
What lab diagnosis is found in an ectopic pregnancy?
1) Normal serum hCG
2) progesterone (< 5) - not often used
At what hCG level should you be able to see an IUP (intra uterine pregnancy)?
1,500 - 2,000
What is seen on imaging in a normal IUP?
1) gestational sac (double echogenic rings)
2) yolk sac
3) fetal pole
4) cardiac activity (5.5-6 weeks hCG > 5,000)
What rules out an ectopic pregnancy?
identifiable IUP
Who is a candidate for medical treatment of an ectopic pregnancy?
1) hCG < 5,000
2) mass < 3.5 cm
3) no FHR
What are the absolute contraindications for medical treatment for an ectopic?
1) breastfeeding
2) immunodeficient
3) liver or renal dysfunction
4) blood dyscrasias
5) allergy to MTX
6) active pulmonary disease
7) PUD
What are the relative contraindications for medical treatment of an ectopic?
1) gestational sac > 3.5 cm
2) cardiac activity
What drug is used to medically treat an ectopic pregnancy and how does it work?
1) Methotrexate
a) folic acid antagonist - inhibits DNA syn,
irreversibly binds DHFR
b) renally cleared
What are the side effets of methotrexate?
N/V, stomatitis, diarrhea, gastritis
How is methotrexate administered to someone to treat an ectopic pregnancy?
1) IM injection on day 1
2) check hCG on day 4 and day 7
3) should see 15% decrease by day 7
- if not redose
4) weekly hCG check until < 15
What are the types of spontaneous abortions?
1) threatened
2) inevitable
3) incomplete
4) missed
5) septic
What is a threatened abortion?
1) closed os
2) vaginal spotting/bleeding
What is an inevitable abortion?
1) cervical dilation
2) gross ROM
3) bleeding
What is an incomplete abortion?
1) os open
2) POC not all expelled
What is a missed abortion?
1) demised fetus - no HB on US
2) POC retained
3) closed os
What is a septic abortion?
infection with fetal demise
What causes most spontaneous abortions?
chromosomal abnormalities
How do you manage an incomplete/inevitable or missed abortion?
1) surgical
2) medical
a) misoprostol
b) methergine
3) expectant
What is the most common medical treatment for a missed abortion?
1) Mifepristone + misoprostol
a) 95-99% success rate
b) vaginal administration
c) can be used up to 63 days GA
