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Gyne > Ectopic > Flashcards

Ectopic Flashcards

1
Q

What are the differential diagnosis of 1st trimester bleeding

A 
1- ectopic pregnancy
2- abortion 
3- infection 
4- trauma 
5- molar pregnancy
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2
Q

What is ectopic pregnancy?

A

The embryo implants outside endometrium cavity

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3
Q

Where is the normal zygote usually gets implanted?

A

In the uterus (endometrium)

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4
Q

What are the extrauterine sites for implantation of uterus?

A
  • tubal
  • ovarian
  • abdominal
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5
Q

What are the subtypes of tubal ectopic pregnancy

A

1- interstitial
2- isthmus
3- infundibular
4- ampulla

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6
Q

Where is the commonest site for implantation in ectopic pregnancy? And why?

A

Ampulla
because
- it’s the widest diameter
- fertilization site

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7
Q

What is the least extra-uterine site?

A

Abdominal

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8
Q

What are the intra-uterine sites for implantation in ectopic pregnancy?

A
  • cervical

- cornual

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9
Q

can the ectopic pregnancy in the ampulla continue to full term?

A

No the tube is very small

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10
Q

Which implantation shows signs and symptoms earlier

  • ampulla
  • interstitium
  • infundubular
  • isthimus
A

Isthimus

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11
Q

Which implantation shows signs and symptoms later

  • ampulla
  • interstitium
  • infundubular
  • isthimus
A

Ampulla

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12
Q

Cornual and cervical ectopic pregnancies are very difficult to manage, that is due to:

A

The great vascularity.

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13
Q

What is the presentation of ectopic pregnancy

A

Pain due to serosa enlargement causing peritoneal irritation

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14
Q

What is the fate of untreated ectopic pregnancy (late presentation to the hospital)

A

Rupture and internal bleeding, could lead to shock

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15
Q

What are the risk factors for ectopic pregnancy

A 
1- prev ectopic pregnancy 
2- previous genital infection 
3- abnormalities of fallopian tube or uterus
4- infertility - IVF
5- tubual sterilization - IUCD 
6- mutliple sexual parteners 
7- advanced age 
8- previous pelvic surgery 
9- ciliary dyskinesia
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16
Q

What is the characterstic of blood in ectopic pregnancy?

A

Dark and scanty

17
Q

What is the presentation of ectopic pregnancy

A

1- pain
2- missed period
3- bleeding
4- pregnancy sx (breast tenderness, urination, nausea)

18
Q

What is the characteristic of pain in ectopic pregnancy

A

Constant cramp like, may radiate to shoulder or associated with fainting.

19
Q

What causes the fainting in ectopic pregnancy?

A

Blood tracks to the diaphragm and irritate the phernic nerve

20
Q

The patient presented with positive pregnancy test, missed period and few spotting of dark blood, you will suspect

A

Ectopic pregnancy

21
Q

If ectopic pregnancy was not detected, what could be the complications?

A

Shock or peritonitis

22
Q

What are the symptoms of shock

A

Tachycardia, hypotension, loss of consiousness

23
Q

What are the symptoms of peritoneal irritation?

A

Gardening - fever - frequency micturation

24
Q

What are the findings you will see in severe internal bleeding when you preform pelvic examinaition

A

Adnexal fullness and extreme tenderness on cervical motion

25
Q

How to diagnose ectopic pregnancy

A

1- history of LMP, lower abdominal pain, delayed menses, spotting
2- positive pregnancy test
3- US if B-HCG >1000
4- laparoscopy

26
Q

When to preform laproscopy for ectopic pregnancy

A

In hemodynamically stable patient, if we can’t detect pregnancy by US

27
Q

What are the ddx of ectopic pregnancy

A

1- salpingitis
2- abortion
3- appendicitis
4- ovarian cyst (torsion of the pedicle)
5- rupture of corpus luteum\follicular cyst
6- perforation of peptic ulcer

28
Q

what is the general approach for management of ectopic pregnancy?

A
  • surgical
  • medical (methotrexate)
  • resucitation if unstable
29
Q

When to start investigating for a female with suspected ectopic pregnancy

A

Lower abdominal pain (+-bleeding) with positive pregnancy test

OR

Asymptomatic with RF for ectopic pregnancy and positive pregnancy test

30
Q

What is the next step after suspecting ectopic pregnancy?

A

Doing US (if sure of date), doing B-HCG (if unsure)

31
Q

What is the cutoff point for HCG to start suspecting ectopic pregnancy

A

> 1000

32
Q

What determines if you can give methotrexate or not?

A

If empty uterus + B-hcg >1000 + meet criteria for methotrexate treatment

33
Q

What if the patient has ectopic pregnancy but does not meet methotrexate criteria

A
  • salpingotomy: to remove product of convception
  • salpingectomy: if the tube is damaged

(By laproscopy or laprotomy)

34
Q

How to resuscitate a patient with internal hemorrhage due to ectopic pregnancy?

A

Double IV lines (RBC transfusion - volume expanders)&raquo_space; then proceed with laprotomy

35
Q

What are the indication to go for surgery in ectopic pregnancy

A

1- worsening abdominal pain
2- hemodynamically unstable
3- failed methotrexate (Hcg did not decline - increased or platued after 1st week)

Gyne (18 decks)

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