Chapter 19 Ectopic Pregnancy

Question 1

Most common segment with ectopic pregnancy

A. ampulla

B. isthmic
C. fim­brial
D. interstitial

Answer 1

A. 
ampulla (70 percent) 

isthmic (12 percent)
fim­brial (1 1 percent)

interstitial tubal pregnancies (2 percent)

Question 2

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

Answer 2

Salp􏰀ingitis isthmica nodosa

Question 3

Clinical manifestation of ectopic pregnancy

Answer 3

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

Question 4

discriminatory threshold

Answer 4

1500-2000mIU/mL

Question 5

B-HCG level for PT +

Answer 5

urine: 20 to 25 mIU/mL


serum: =5 mIU/mL

Question 6

Serum progesterone excludes ectopic pregnancy

Answer 6

> 25 ng/mL

Question 7

TV-UTZ Gestational Sac

Answer 7

4 1/2 and 5 weeks

Question 8

TV-UTZ yolk sac

Answer 8

5 and 6 weeks

Question 9

TV-UTZ Fetal pole with cardiac activity

Answer 9

5 1/2 to 6 weeks

Question 10

adnexal finding of an ectopic

Answer 10

Ring of fire doppler

Question 11

Pericolic gutter near liver

Answer 11

Morison pouch

Question 12

Methorexate MOA

Answer 12

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

Question 13

Methotrexate side effects

Answer 13

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

Question 14

Methotrexate single dose dosage

Answer 14

50mg/m2 BSA

Question 15

Methotrexate multidose dosage

Answer 15

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

Leucovorin days 2,4,6,8

Question 16

Methotrexate single dose serum B-HCG monitoring

Answer 16

Days 1,4,7

Once 15% decline achieved then weekly until undetectable

Question 17

Methotrexate multidose serum B-HCG monitoring

Answer 17

Days 1,3,5,7

Once 15% decline achieved then weekly until undetectable

Question 18

Single dose indication for additional dose

Answer 18

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

Question 19

Multiple dose indication for additional dose

Answer 19

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

Question 20

Methotrexate surveillance

Answer 20

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

Question 21

methotrexate contraindications

Answer 21

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

Question 22

Increase MTX drug level

Answer 22

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

Question 23

Medical therapy indication

Answer 23

• 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

Question 24

incision is left unsu­tured to heal by secondary intention

Answer 24

Salpingostomy

Question 25

complete excision of the fallopian tube

Answer 25

salpingectomy

Question 26

expectant management criteria

Answer 26

ectopic pregnancies measuring <3 cm

B-hCG levels < 1 500 mIU/mL

Question 27

• 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

Answer 27

interstitial pregnancy

Question 28

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

Answer 28

Cornual pregnancy

Question 29

Spiegelberg criteria

Answer 29

(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