Early pregnancy Flashcards
How to dx an ectopic?
TV USS
Visualising an adnexal mass the moves separately from the ovary
how is a cervical pregnancy diagnosed?
What are the USS signs?
Empty uterus
barrel shaped cervix
GS below the level of the internal os
the absence of a sliding sign, blood flow around the GS on colour doppler
How is a caesarean scar pregnancy diagnosed?
TV USS
MRI can be used as a second line
What is the USS criteria for an interstitual pregnancy?
Empty uterine cavity
POC / GS located laterally in the interstitial (intramural) part of the tube and surrounded by less then 5 mm of myometrium in all imaging planes
interstitial line sign
1X hcg and a repeat in 48 hours may be helpful
What is the criteria for USS for a cornual ectopic
Visualisation of a single interstitual portion of the fallopian tube in the main uterine body
GS / POC seen mobile and separate from the uterus and completely surrounded by myometrium
Vascular pedicle adjoining the GS to the unicornuate uterus
need hcg +/- a repeat in 48 hours
What is the criteria for an ovarian pregnancy?
No specific agreed criteria
1 or even repeat hcg useful in dx
How to dx an abdominal pregnancy
There are defined criteria
MRI can be used to help plan approach
Who would you consider a salpingostomy for?
In women with a history of fertility-reducing factors (previous ectopic pregnancy, contralateraltubal damage, previous abdominal surgery, previous pelvic inflammatory disease), salpingotomyshould be considered
What FU for a salpingostomy?
Risk of persistent trophoblastic tissue
hcg FU
Small risk of needing MTX or salpingectomy
Is expectant management ever appropriate for ectopics?
If:
clinically stable
decreasing hcg
initially less the 1500
how to manage cervical ectopics?
Medical management with MTX should be considered for cervical pregnancy
Surgical methods have a high failure and should be reserved for woman with life threatening bleeding
How to manage caesarean scar pregnancies?
counselled they are associated with severe maternal morbidity and mortality
in T1 medical or surgical management options
Don’t recommend one over the other - currently surgical over medical
How to manage interstitial pregnancy?
Non surgical is acceptable if stable
Expectant only if low and falling hcg
MTX is effective, unknown if systemic or local
Surgery is effective
options
corneal resection, salpingostomy, hysteroscopic resection under laparoscopy,
How to manage a corneal pregnancy?
Excise the rudimentary horn
How to manage ovarian pregnancy?
Dx is made by laparoscopy
options for Tx:
Systemic MTX primarily OR OT and MTX persistence of residual disease OR persistently raised hcg levels
