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Obstetrics > Early Pregnancy: Ectopic Pregnancy > Flashcards

Early Pregnancy: Ectopic Pregnancy Flashcards

1
Q

What is an ectopic pregnancy

A

pregnancy outside of the uterus

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2
Q

What three factors in women past medical history predispose to ectopic pregnancy

A
  1. PID
  2. Previous ectopic
  3. Endometriosis
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3
Q

What are 3 contraceptive factors that contribute to ectopic pregnancies

A

IUD

Progesterone-only contraceptive

Tube ligation

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4
Q

why do progesterone-only implants increase risk of ectopic pregnancy

A

Cause ciliary dysmotility

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5
Q

what surgery increases risk of ectopic

A

IVF

Previous tubal surgery

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6
Q

how will an ectopic pregnancy present clinically

A

abdominal pain with or without vaginal bleeding

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7
Q

why does bleeding occur in ectopics

A

due to insufficient bHCG to maintain the decidua causing bleeding

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8
Q

why may patient with ectopic pregnancy have amenorrhoea

A

pregnant

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9
Q

why may patient with ectopic pregnancy have shoulder tip pain

A

due to bleeding into abdominal cavity

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10
Q

why may patient with ectopic pregnancy have brown vaginal discharge

A

break-down decidua

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11
Q

what is the most common site for ectopic pregnancies

A

ampulla

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12
Q

if patient has ruptured ectopic pregnancy how will they present

A

peritonitis and haemodynamically unstable

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13
Q

what investigations may be performed initially for ectopic pregnancy

A

bHCG

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14
Q

when is TV-US performed

A

If intrauterine pregnancy is not seen on trans abdominal US

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15
Q

When is the pregnancy termed pregnancy of unknown location

A

If bHCG is high but pregnancy cannot be seen on US

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16
Q

What are the 3 differentials of pregnancy of unknown location

A
  1. Early intrauterine pregnancy
  2. .Miscarriage
  3. Ectopic
17
Q

If a pregnancy of unknown location, what investigation should be ordered

A

Serum bHCG

18
Q

If serum bHCG >1500 and no intrauterine pregnancy, what does this indicate

A

Ectopic pregnancy

19
Q

What should be offered for patients with bHCG >1500

A

Diagnostic laparotomy

20
Q

If <1500 IU and patient is haemodynamically stable what should be offered

A

bHCG 48h later

21
Q

In a viable pregnancy, what would you expect bHCG to do in a viable pregnancy

A

Expect bHCG to double every 48h

22
Q

If bHCG remains high but does not double every 48h what would you expect

A

Ectopic pregnancy

23
Q

How is a haemodynamically unstable patient with ectopic pregnancy managed

A

A-E approach

24
Q

What are the 3 methods of managing ectopic pregnancy

A
  1. Conservative
  2. Medical
  3. Surgical
25
Q

What is conservative option for ectopic pregnancy

A

Serial bHCG measurements

26
Q

Explain conservative management for ectopic pregnancy

A

It is NOT first-line, only decided at senior level

27
Q

What needs to be done for conservative management of ectopic pregnancy

A

Serial bHCG measurement every 48h until less than 50%

28
Q

What is used to manage ectopic pregnancy medically

A

Methotrexate

29
Q

What needs to monitored in medical management of ectopic pregnancy

A

bHCG to ensure decrease

30
Q

After taking methotrexate what needs to be ensured

A

Contraception 3-6m afterwards as teratogenic

31
Q

What are two surgical options for ectopic pregnancy

A

Salpingectomy

Salpingotomy

32
Q

What is a laparoscopic salpingectomy

A

Removal tube and egg

33
Q

What is salpingotomy

A

Removal egg from tube, with the tube in tact

34
Q

When is salpingotomy used

A

If contralateral tube is damage to preserve fertility

35
Q

What should all rhesus negative women having management for ectopic be offered

A

anti-D prophylaxis

36
Q

What is the main risk of ectopic pregnancy

A

rupture lead to hypovplaemia and shock

Obstetrics (27 decks)

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