Ectopic + molar

Question 1

What is an ectopic pregnancy?
Mc presenting age?
Incidence?

Answer 1

When a pregnancy implants outside the uterine cavity
around 8 weeks
11/1000 births, 2-3% incidence

Question 2

RF for Ectopics?

Answer 2

PID, Endometriosis, IUS/IUD, pHx ectopic, assisted reproduction (IVF)

Question 3

Sx of Ectopics?

Answer 3

Unilateral RIF/LIF painwith light brown PV bleeding in amenorrhoeic Female 6-8 weeks

Dyschezia (difficulty pooping) + dysuria (pain urinating)

POSITIVE Kehr sign - shoulder tip referred pain due to bleeding irritating the diaphragm - RUPTURE

Haemodynamically Unstable - shock - blood loss due to RUPTURE

N+V

Cervical motion tenderness (excitation) - chandelier sign on bimanual exam - less specific than PID

Question 4

Location of ectopics?

Answer 4

97% Tubal
mc - ampulla
mc rupture - isthmus
2% Ovary
1% abdomen

Question 5

Diagnosis of ectopic?

Answer 5

Transvaginal USS - Visualise extrauterine pregnancy

Serial bhCG - Increase by 63% or less

Question 6

What are the 3 different types of treatment?

Answer 6

Conservative (observe)
Medical
Surgical

Question 7

What are the requirements for conservative management?

Answer 7

ALL of these
<35mm
1500 IU/L bhCG or less
No fetal HB
No pain

Question 8

What are the requirements for medical management?

Answer 8

IM Methotrexate
ALL of these
<35mm
1500-5000 IU/L bhCG
No fetal HB
No pain

Question 9

What are the requirements for surgical management?
what are the treatments?

Answer 9

1 of the following:
>35mm
>5000IU/L bhCG
fetal hb
PAIN

Salpingotomy - Fallopian tube preserved, small slit to remove ectopic

SalpingECTOMY - remove Fallopian tube

Question 10

What is the treatment for Rutured (unstable) ectopics?

Answer 10

ABCDE
NBM
Group and save
anti d if Rh -

Question 11

What is a complication of ectopics?

Answer 11

18.5% RECURRENCE
Fallopian tube rupture
early maternal death 2^ to shock
Infertility with surgery

Question 12

What is a molar pregnancy?
how many pregnancies does this occur in?
when is it usually detected?

Answer 12

Also known as a hyatidiform mole, forms spectrum of disorders known as gestational trophoblastic disease

1/1000 pregnancies

6-16 weeks

Question 13

What are the 2 types of molar pregnancies?

Answer 13

complete - MC
diploid sperm —-> empty egg

Incomplete
2 sperm —–> egg

Question 14

Sx of molar pregnancies?

Answer 14

1/3 PV bleeding
N+V
Hyperemesis gravidarum (high high bhCG)
1/3 HTN (or 20+ weeks)
Thyrotoxicosis (high bhCG mimics TSH)
large for gestational age uterus (+/- 2cm/week) eg. 28 weeks 26-30 cm SFH

Question 15

Dx of molar pregnancies?

Answer 15

Bloods -
U+Es (hyperemetic)
High T3/T4
HIGH bhCG (often >100,000)

TV USS - snowstorm or grape like masses appearance

Question 16

Is there sign of a baby?
what is there seen?

Answer 16

No sign of BABY
pure abnormal cell growth, hydrophic vasculature, trophoblast hyperplasia

Question 17

Tx of molar pregnancies?

Answer 17

Suction D+C under general (follow up bhCG 48hr later)

Question 18

Complication of untreated molar pregnancy?

Answer 18

choriocarcinoma (invasive molar pregnancy - MC in complete)

Recurrence (2nd - 1%, 3rd = 15-20%)

Question 19

Treatment of choriocarcinoma?

Answer 19

Chemotherapy (IM Methotrexate or Dactinomycin)
based on FIGO 2000 scoring