Chapter 11: Ectopic Pregnancy Flashcards
What Is an Ectopic Pregnancy?
the fertilized egg implants outside the uterine cavity
Where Can Implantation Occur in an Ectopic Pregnancy since it does not implant inside the uterine cavity?
- In the Fallopian tube (99%)
- on the Ovary
- on the Cervix
- on the outside of the Fallopian tube
- on the abdominal wall
- on the bowel
Patients who present with what symptoms should always be evaluated for an Ectopic Pregnancy?
- vaginal bleeding
- missed period
- abdominal tenderness
- pain
When does the Pain Increase during an Ectopic Pregnancy?
after rupture of the ectopic pregnancy
-woman may experience referred shoulder pain from diaphragmatic irritation caused by blood in the peritoneal cavity
Risk Factors That Place a Woman at Risk for Developing An Ectopic Pregnancy
Can include past and current medical and gynecological problems
- history of sexually transmitted infections or pelvic inflammatory disease
- prior ectopic pregnancy
- previous tubal, pelvic, or abdominal surgery
- endometriosis (painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus)
- current use of exogenous hormones (e.g. estrogen and progesterone)
- use of an intrauterine device
- In vitro fertilization or other method of assisted reproduction
- In utero diethylstilbestrol (DES) exposure with abnormalities of the reproductive organs
Heterotopic Pregnancy (HP)
existence of two (or more) simultaneous pregnancies with separate implantation sites, one of which is ectopic
To prevent major morbidity or death, when should ectopic pregnancy be diagnosed?
before the onset of hypotension, bleeding, pain, and overt rupture
What Alerts the Healthcare provider that there is a possible presence of an Ectopic Pregnancy?
- the patients history (e.g. unilateral, bilateral, or diffuse abdominal pain and missed period)
- physical exam (palpable mass present on bimanual examination)
What is associated with rupture?
active bleeding
Symptoms of an Ectopic Pregnancy
- hypotension
- tachycardia
- vertigo
- shoulder pain
What are the Diagnostic Laboratory Tests Done?
- beta-human chorionic gonadotropin (B-hCG) that is low for gestational age
- WBC count that can range from normal to 15000/mm3
Beta-human chorionic gonadotropin (B-hCG) diagnostic test
a B-hCG that is low for gestational age (because an ectopic pregnancy has a poorly implanted placenta)
-the level of B-hCG does not double every 48 hours as in normal implantation
What is hCG (human chorionic gonadotropin) hormone
the pregnancy hormone because it is made by cells formed in the placenta, which the placenta nourishes the egg after it has been fertilized and becomes attached to the uterine wall.
-showing hCG = pregnancy
Detecting hCG levels
can first be detected by a blood test about 11 days after conception and about 12-14 days after conception by a urine test
- The level will reach its peak in the first 8-11 weeks of pregnancy and then will decline and level off for the remainder of the pregnancy
- the level of beta (B) hCG will not double every 48 hours as it should because of the poorly implanted placenta
B-hCG and the Placenta
-the placenta makes the B-hCG hormone, so if not implanted correctly as in an ectopic pregnancy it will be low and not double every 48 hours as it should
What should be performed to confirm intrauterine or tubal pregnancy?
Transvaginal ultrasonography
What rules out the presence of an ectopic pregnancy?
ultrasonographic identification of intrauterine pregnancy
Salpingectomy
removal of the ruptured fallopian tube
Laparotomy
surgical procedure in which the abdomen is opened to visualize the abdominal organs
What Procedures have offered almost a 100% cure for an ectopic pregnancy?
- Salpingectomy
- Laparotomy
What Procedure is the treatment of choice if the goal is to prompt restoration of health through rapid recovery with preservation of fertility
Laparoscopy, Salpingostomy, and partial salpingectomy are replacing laparotomy as the treatment of choice
Laparoscopy
visualization of the reproductive organs using a laparoscope inserted into the pelvic cavity through a small incision in the abdomen
Salpingostomy
incision into the fallopian tube to remove the pregnancy
Laparotomy is only performed under what circumstances?
- laparoscopic approach is too difficult
- the surgeon is not trained in operative laparoscopy
- patient is hemodynamically unstable
Drug use in the Management of an Ectopic Pregnancy
Methotrexate (chemotherapeutic drug and folic acid inhibitor)
>stops cell production and destroys remaining trophoblastic tissue
>used in management of non-complicated, non-life threatening ectopic pregnancies
Methotrexate
chemotherapeutic drug and folic acid inhibitor
- stops cell production and destroys remaining trophoblastic tissue
- used in the management of non-complicated, non-life threatening ectopic pregnancies
What are the eligible factors to be able to use Methotrexate for management
-if the ectopic mass is unruptured and measures 1.6 in (4 cm) or less on ultrasound examination
Factors that make you not eligible for Methotrexate
- patients with larger ectopic masses (greater than 1.6 inches/ 4 cm)
- embryonic cardiac activity
- clinical evidence of acute intra-abdominal bleeding (acute tender abdomen, hypotension, or falling hematocrit)
Hematocrit
measure of how much of someone’s blood is made up of RBCs
