Ectopic

Question 1

What is ectopic pregnancy

Answer 1

Implantation of pregnancy at a site other than endometrial lining in body of uterus

Question 2

Types of ectopic gestation

Answer 2

Extrauterine
. Tubal
. Ovarian
. Abdominal
Uterine
. Interstitial
. Rudimentary horn of bicornuate uterus
. Cervical
. Caeserean scar
. Hetertropic

Question 3

Occurence rate of ectopic pregnancy

Answer 3

1:80

Question 4

Etiology of tubal ectopic pregnancy

Answer 4

Previous pid( Chlamydia)
Genital tb
Endometriosis
Previous ectopic pregnancy
Pelvic adhesions
Congenital elongation,accessory ostia,diverticula
Transmigration
Previous tubal surgery(madlener)
IVF
IUCD
Pop

Question 5

Why is most comman site of ectopic pregnancy the ampulla

Answer 5

Plicae are most numerous here and previous salphingitjs is more likely to produce crypts here

Question 6

Triad of symptoms of ectopic pregnancy and others

Answer 6

. Pain lower abdomen
. Spotting pv
. Fainting spells
. Amenorrhea
. Acute retention of urine
. Fever

Question 7

DD of chronic ectopic pregnancy

Answer 7

Pyosalphinx
Septic abortion
Twisted ovarian cyst
Rupture of choclate cyst
Uterine fibroid
Corpus luteal hematoma
Acute appendicitis

Question 8

Inv for ectopic

Answer 8

. Urine and serum HCG
. Beta HCG
.usg
Blob sign(blood clot with trophoblastic tissiey)
Bagel sign(empty gestational sac in fallopian tube)
Doppler,ring of fire
TVS clearer image
Lap

Question 9

Medical management of ectopic pregnancy

Answer 9

Methotrexate therapy
Folate antagonist,inactivates dihydrofolate reductase enzym,leading to fall in tetrahydrofolate,which is essential cofactor in synthesis of DNA and RNA during cell division).
Single dose 50 mg/M2
Injection mtx 25-50 mg injected into gestational sac under USG or lap guidance

Question 10

Criteria for mtx therapy

Answer 10

. Hemodynamically stable
. Should be unruptured
. Serum beta HCG should not exceed 6500-10000mIU/ml
. Size of gestational sac should not exceed 3-5 cm
. Fetal cardiac activity should be absent
. Willing for follow up
. No liver disease,anemia
Desirous of future fertility

Question 11

Other surgically administered medical drugs

Answer 11

Mifepristone
Prostaglandins
20% kcl solution
Glucose solution

Question 12

Types of surgery on fallopian tube

Answer 12

Salphingectomy- if sac> 4 cm
Partial salphingectomy-if more than 6 cm of tube is preserved
Salphingostomy

Question 13

Spielgelberg criteria to diagnose ovarian pregnancy

Answer 13

. Pregnancy is in close relation to ovary
. Fallopian tube on affected side is normal
. Mass is attached to uterus by ovarian ligament
. Histologically chorionic tissue is in intimate contact with ovarian tissues