Chapter 19 Ectopic Pregnancy Flashcards

1
Q

Most common segment with ectopic pregnancy

A. ampulla

B. isthmic
C. fim­brial
D. interstitial

A
A. 
ampulla (70 percent) 

isthmic (12 percent)
fim­brial (1 1 percent)

interstitial tubal pregnancies (2 percent)
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2
Q

a condition in which epithelium-lined diverticula extend into a hypertrophied muscularis layer

A

Salp􏰀ingitis isthmica nodosa

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3
Q

Clinical manifestation of ectopic pregnancy

A
  • delayed menstrua­tion
  • pain (sharp, stabbing, or tearing )
  • vaginal bleeding or spotting
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4
Q

discriminatory threshold

A

1500-2000mIU/mL

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5
Q

B-HCG level for PT +

A

urine: 20 to 25 mIU/mL


serum: =5 mIU/mL

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6
Q

Serum progesterone excludes ectopic pregnancy

A

> 25 ng/mL

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7
Q

TV-UTZ Gestational Sac

A

4 1/2 and 5 weeks

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8
Q

TV-UTZ yolk sac

A

5 and 6 weeks

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9
Q

TV-UTZ Fetal pole with cardiac activity

A

5 1/2 to 6 weeks

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10
Q

adnexal finding of an ectopic

A

Ring of fire doppler

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11
Q

Pericolic gutter near liver

A

Morison pouch

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12
Q

Methorexate MOA

A

blocking the reduc­tion of dihydrofolate to tetrahydrofolate —> de novo purine and pyrimidine synthesis is halted, which leads to arrested DNA, RNA, and protein synthesis

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13
Q

Methotrexate side effects

A

bone marrow, gastrointesti­nal mucosa, and respiratory epithelium can also be harmed

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14
Q

Methotrexate single dose dosage

A

50mg/m2 BSA

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15
Q

Methotrexate multidose dosage

A

1mg/kg days 1,3,5,7

Leucovorin days 2,4,6,8

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16
Q

Methotrexate single dose serum B-HCG monitoring

A

Days 1,4,7

Once 15% decline achieved then weekly until undetectable

17
Q

Methotrexate multidose serum B-HCG monitoring

A

Days 1,3,5,7

Once 15% decline achieved then weekly until undetectable

18
Q

Single dose indication for additional dose

A

If serum B-HCG level does not decline by 15% from day 4 to day 7
Less than 15% decline during weekly surveillance

19
Q

Multiple dose indication for additional dose

A

If serum B-HCG declines <15% give additional dose then repeat serum BHCG in 48 hours and compare with previous value, maximum 4 doses

20
Q

Methotrexate surveillance

A

once 15% decline achieved then weekly serum B-HCG levels until detectable

21
Q

methotrexate contraindications

A
sensitivity to methotrexate
tubal rupture
breastfeeding
intrauterine pregnancy 
peptic ulcer disease
active pulmonary disease 
immunodeficiency
hepatic renal or hematologic dysfunction
22
Q

Increase MTX drug level

A

phenytoin, tet­racyclines, salicylates, sulfonamides , NSAIDs, aspirin, probenecid, or penicillins

23
Q

Medical therapy indication

A
  • asymptomatic, motivated, and compliant
  • small ectopic pregnancy size ectopic mass was<3.5cm,
  • absent fetal cardiac activity
  • hemodynamically stable
  • serum -hCG concen­trations <5000 mIU/mL
24
Q

incision is left unsu­tured to heal by secondary intention

A

Salpingostomy

25
Q

complete excision of the fallopian tube

A

salpingectomy

26
Q

expectant management criteria

A

ectopic pregnancies measuring <3 cm

B-hCG levels < 1 500 mIU/mL

27
Q
  • an empty uterus
  • a gestational sac seen separate from the endometrium and > 1 cm away from the most lateral edge of the uterine cavity
  • a thin, <5-mm myometrial mantle surrounding the sac
A

interstitial pregnancy

28
Q

conception that develops in the rudimentary horn of a uterus with a mullerian anomaly
angular preg­nancy

A

Cornual pregnancy

29
Q

Spiegelberg criteria

A

(1) the ipsilateral tube is intact and distinct from the ovary;
(2) the ectopic pregnancy occu­pies the ovary; 

(3) the ectopic pregnancy is connected by the uteroovarian ligament to the uterus;

(4) ovarian tissue can be demonstrated histologically amid the placental tissue