Ectopic Flashcards
Types of Ectopic Pregnancy
Tubal
Ovarian
Abdominal
Cervical
Heterotopic
Tubo-uterine
Tubo-abdominal
Most common site (95%) of implantation of ectopic pregnancy
Tubal
Pregnancy occurs when a fertilized egg implants on the surface of the
ovary.
Ovarian
Extremely rare type (1/15,000);
Abdominal
Present with vaginal bleeding, which can be profuse and is often
painless.
Cervical
Existence of two simultaneous pregnancies with separate implantation
sites.
Heterotopic
Results from the gradual extension into the uterine cavity of products of
conception that originally implanted in the interstitial portion
Tubo-uterine
A zygote that is originally implanted at the end of the fallopian tube
gradually extends into the peritoneal cavity.
Tubo-abdominal
A zygote that is partly implanted in the tube & partly in the ovary
Tubo-ovarian
Diagnosis & Tests for ectopic
TVUS
Serial HCG
Determination
Pregnancy Test
Serum
Progesterone
Levels
Colpotomy
Culdocentesis
CBC
Reveals extrauterine pregnancy
TVUS
Direct visualization of the oviducts & ovaries.
Colpotomy
Extraction of fluid from the rectouterine pouch posterior to the
vagina through a needle.
Diagnose the presence of ruptured ectopic pregnancy
Culdocentesis
For unruptured EP what is performed
therapeutic abortion
Methotrexate (chemotherapy agent; immune suppressant)
Methotrexate has been associated with
stomatitis,
gastritis, hepatic enzyme elevation, pneumonitis, &
hematologic toxicity
given on alternate days to decrease the hematologic toxicity of Methotrexate.
IM leucovorin (like folic acid)
Management of Ectopic Pregnancy
For ruptured EP
Salpingectomy
Hysterectomy
Oophorectomy
Management for uncontrollable hemorrhage & severely damaged tube ; removal of one or both fallopian tubes
Salpingectomy
Management for often for ruptured interstitial or cervical
pregnancy
Hysterectomy
A benign disorder of the placenta characterized by
degeneration of the chorion & death of the embryo.
Hydatidiform Mole
Types of Molar Pregnancy
Complete Molar
Partial Molar
Embryo can’t grow
Sperm fertilizes an empty egg
The tissue produces HCG, which gives a (+) pregnancy
test.
Complete Molar
An extra set of chromosomes
comes from the father (two
sperm fertilized one egg).
Mother’s 23 chromosomes
remain intact.
The embryo has 69 instead of
the normal 46 chromosomes.
Growing embryos start to
develop but can’t SURVIVE!
Partial Molar
Diagnosis and Tests for hmole
USS of the uterus
HCG levels in the blood
shows fluid-filled sacs instead of the placenta
USS of the uterus
Management & Treatment
D&C
Methotrexate for 1 year
Characterized by persistent trophoblastic proliferation after
H-mole evacuations
GESTATIONAL TROPHOBLASTIC TUMORS
GESTATIONAL TROPHOBLASTIC TUMORS 3 KINDS
Choriocarcinoma
Invasive Mole
Placental Site Trophoblastic
most severe malignant complication;
requires chemotherapy or radiation.
Choriocarcinoma
locally invasive developing during the 1st
six months
Invasive Mole
*Management of all trophoblastic tumors is
hysterectomy!
Premature separation of normally transplanted placenta
after 20 weeks of gestation
Abruptio Placenta
Abruptio Placenta occurs later in
3rd trimester, begins around
28 weeks & lasts until delivery.
Placental abruption often happens suddenly. (T/F)
True
Causes of abruptio placenta
Trauma to the uterus
Short umbilical cord
smoking
Types Based on Placental Separation
Partial placental abruption
total placental abruption
placenta does not completely detach from the uterine wall.
Partial placental abruption
placenta completely detaches from the uterine
wall—more vaginal bleeding.
total placental abruption
Types Based on the Presence of Vaginal Bleeding in abruptio placenta
Revealed abruption/Overt
Concealed abruption/Covert
dissection occurs along the uterine wall & blood escapes
through the cervix
Revealed abruption/Overt
blood is retained behind the placenta & does not communicate with cervix.
Concealed abruption/Covert
Classifications Based on Signs & Symptoms of abruptio placenta
Grade 0
Grade 1
Grade 2
Grade 3
some external bleeding, uterine tetany &
tenderness (may/may not be noted), absence of fetal
distress & shock (minimal separation).
Grade 1
external bleeding, uterine tetany, uterine
tenderness, & fetal distress (moderate separation)
Grade 2
internal & external bleeding (more than
1000cc), uterine tetany, maternal shock, probably
fetal death & DIC what classification of
hmole
Grade 3
dark red vaginal bleeding in abruptio placenta
concealed AP
bright red vaginal bleeding in abruptio placenta
revealed AP
The MD will recommend treatment for placntal abruption based on:
severity of the abruption.
signs of distress from the fetus.
amount of blood you’ve lost.
The two most important factors in determining treatment for abruptio placenta
abruption’s severity and the fetus’s gestational age.
MD may give the patient ___ to help the fetus’s lungs mature.
Corticosteroids
placenta completely
or partially covers the
uterus (cervix) opening in
the last months of
pregnancy.
Placenta Previa
Placenta Previa is the most common bleeding
disorder during which trimester
3rd
trimester
In early pregnancy, it’s common for the placenta to be
low in the uterus. (T/F)
True
when should the placenta move to the top of your uterus.
3rd trimester (weeks 28 to 40),
Types of Placenta Previa
Marginal placenta previa
Partial placenta previa
total placenta previa
placenta is positioned at the edge of the
cervix.
Marginal placenta previa
a placenta previa more likely to resolve on its own before your baby’s due date.
Marginal placenta previa
a placenta previa that is less likely to correct itself.
Complete or total placenta previa
in placental previa when does the most significant sign occur
(begins 24-30
weeks)
the earliest & safest diagnostic
tool for PP.
*Ultrasound
contraindicated in PP
risk of provoking life-threatening hemorrhage.
*Internal Examination (IE)
placenta grows too deeply in the wall of your uterus,
causing severe bleeding after delivery.
Placenta accreta
Goal of treatment in PP is to get the mother as close to the
due date as possible. (T/F)
True
If the placenta is near or covering just part of the cervix and no bleeding, the MD may
recommend:
Reducing strenuous activities,
Bed rest at home.
No sexual intercourse,
