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GYN/OBS > Ectopic PG > Flashcards

Ectopic PG Flashcards

OBS

1
Q

Ectopic PG

A

Implantation of the PG outside the normal uterine cavity

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2
Q

Sites of ectopic PG

A

Fallopian tube - 95%
Ovaries- 3%
Peritoneal cavity- 1%

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3
Q

MC site of ectopic PG is

A

Ampullary portion of the fallopian tube

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4
Q

Other sites of ectopic PG

A
  • Infundibulum/Fimbriae
  • Cornual/ interstitial
  • Broad ligament
  • Isthmus
  • Abdomen
  • Cervix
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5
Q

Risk factors of ectopic PG

A
  • PID
  • Endometriosis
  • Previous ectopic PG
  • B/L tubal ligation
  • Copper IUD
  • Smoking
  • Assisted reproductive techniques
  • subfertility
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6
Q

T/F Questions

  1. Ectopic PG is a direct cause of maternal death
  2. Smoking is not associated with ectopic PG
  3. IUDs are a known risk factor for ectopic PG
  4. U/L tubal ligation is a risk factor for ectopic PG
  5. heterotropic PG is rare and hard to Dx
  6. 5% of IVF can lead to ectopic PG
  7. Ectopic PG is an obstetric emergency
A
  1. T
  2. F
  3. T
  4. F- B/L is a risk factor
  5. T ( coz of a IUP, hard to Dx)
  6. F (only 1%)
  7. T
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7
Q

When is ectopic PG Diagnosed

A

between 5- 12 weeks of POA ( NEARLY ALL)

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8
Q

Classic triad of presentation of ectopic PG

A
  • Amenorrhea
  • Abdominal pain
  • Irregular bleeding
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9
Q

Difference between the vaginal bleeding due to ectopic PG and miscarriage bleeding

A
  • Miscarriage- fetus products. Bleeding heavy clots
  • Vaginal bleeding- light bleeding
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10
Q

Describe the vaginal bleeding in ectopic PG

A

Dark, red, scanty

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11
Q

Describe the abdominal pain in ectopic PG

A

Sharp pain in the iliac fossa

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12
Q

Sx of ectopic PG

A
  • Vaginal bleeding
  • abdominal pain
  • Faintishness
  • Urinary Sx
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13
Q

ectopic PG

Signs of ectopic PG

A
  • Adnexal tenderness
  • Guarding and rigidity
  • Cervical excitation
  • Shoulder tip pain
  • Acute abdomen
  • Shock and collapse
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14
Q

ectopic PG

Cervical excitation?

A

Put 2 fingers through the cervix and push to either sides. When pushing from the Right side, the left fallopian tube stretches and cause pain on the left side and vice versa

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15
Q

ectopic PG

Dx of ectopic PG

A
  • Trans vaginal USS (TVS)
  • beta HCG
  • FBC
  • Group and save
  • Sr. Progesterone
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16
Q

ectopic PG

Heterotropic PG

A

Combined occurence of intrauterine and extra uterine

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17
Q

ectopic PG

3 options of Mx of ectopic PG

A
  • conservative Rx
  • Pharmacological Mx
  • Surgical Mx
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18
Q

ectopic PG

Criteria for conservative Mx

A
  • Clinically stable- pain free
  • beta HCG - initial presentation <1500 IU/L
  • Adenxal mass <3.5cm in TVUSS
  • No visible heart beat
  • No or minimal free fluid in pelvis
    ALL SHOULD BE PRESENT
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19
Q

ectopic PG

Medical Mx of ectopic PG

A

Methotrexate IM

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20
Q

ectopic PG

MTX?

A

folic acid antagonist. Inhibits DNA synthesis in trophoblastic cells

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21
Q

ectopic PG

MTX given in ectopic PG will be

A

Multiple or single doses

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22
Q

ectopic PG

MTX dose

A

50mg/m2 (body surface area)

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23
Q

ectopic PG

Monitoring after MTX

A

3 times in the first week and weekly thereafter until Beta HCG becomes zero

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24
Q

ectopic PG

Tests done during MTX Therapy

A

FBC and liver enzymes before treatment and on Day 7

25
Q

ectopic PG

Criteria for medical Mx

A
  • Clinically stable - pain free
  • Unruptured tubal ectopic PG w an adnexal mass <35mm w/ no heart beat
  • beta HCG <1500 IU/L
  • No Intrauterine PG (upon USS)
  • No evidence of hemoperitoneum on USS
  • Pt consents for medical Mx
  • Pt is able to come for regular follow up
26
Q

ectopic PG

Surgical methods

A
  • Salpingectomy
  • Salpingotomy
27
Q

ectopic PG

Salpingectomy

A

removal of the tube

28
Q

ectopic PG

Salpingotomy

A

incision into the tube to remove an ectopic PG

29
Q

ectopic PG

Criteria for surgical Mx

A
  • Ectopic w/ significant pain
  • Adnexal mass >3.5cm
  • Sr. beta HCG >5000 IU/L
  • FHB +
  • Pt is not willing to undergo medical MX
  • Pt is unable to return for follow- up
30
Q

ectopic PG

When to offer a salpingectomy

A

to women undergoing surgery for an ectopic PG unless they have other risk factors for infertility- Other tube is normal

31
Q

ectopic PG

When to offer Salpingotomy

A

as an alternative to salpingectomy for women with risk factors for infertility such as contralateral tube damage

32
Q

ectopic PG

Surgical Methods done

A
  • Laparoscopic - better, 1st line if stable
  • Laparotomy- if hemodynamically stable
33
Q

ectopic PG

How long should you avoid PG after MTX Rx

A

for 3 months

34
Q

ectopic PG

Better reproductive outcome for a woman with a subfertility Hx

A

Conservative and medical Mx

35
Q

Ectopic PG

TVS findings

A
  • Empty uterus
  • Pseudo sac
  • Adnexal mass
  • Presence of free fluids
36
Q

Ectopic PG

how to differentiate IUP and ectopic PG from beta HCG levels

A

Viable IUP beta HCG levels doubles every 2 days

37
Q

Ectopic PG

Group and save

A

Cross match 1 unit of blood and keep in case it’s needed

38
Q

Ectopic PG

Ectopic PG implanted on…. can go unruptured upto >= 12 weeks

A

Cornual/ interstitial

39
Q

Ectopic PG

Ectopic PG implanted on the isthmus can get ruputured as early as ….

A

4 weeks

40
Q

Ectopic PG

Most prominent Sx

A

Abdominal pain

41
Q

Ectopic PG

Describe the pain in a ruptured Ectopic PG

A
  • Sudden onset of pain
42
Q

Ectopic PG

Describe the pain in chronic Ectopic PG

A

Aching type of pain

43
Q

Ectopic PG

Sx and signs Patient will present with if the ectopy is ruptured

A

General condition will be poor with pallor, tachycardia and low BP

44
Q

Ectopic PG

Patient’s general condition if the ectopy is not ruptured

A

will be satisfactory

45
Q

Ectopic PG

Signs suggesting ruptured ectopy

A
  • Adnexal tenderness
  • Guarding and rigidity
  • Shock
  • Collapse
46
Q

Ectopic PG

Is a PV examination essential in Dx ectopic PG

A

not essential but helpful

47
Q

Ectopic PG

PV exam should be done in the hospital due to the risk of

A

rupture

48
Q

Ectopic PG

Significant fluid in the pelvis suggests

A

Ruptured ectopic PG

49
Q

Ectopic PG

MTX second dose is given if

A

the beta hCG levels on D7 compared to D4 hasn’t dropped by 15%

50
Q

Ectopic PG

After giving MTX what tests are done

A

beta hCG tested on D4 and D7 after the first dose

51
Q

Ectopic PG

Most appropriate surgical procedure

A

salpingectomy

52
Q

Ectopic PG

Ectopic PG should be suspected in women of childbearing age, who complains of abdominal pain even in the absence of POA. (T/F?)

A

TRUE

53
Q

Ectopic PG

Bets hCG should be tested on… after surgical procedure

A

1 week post- op and weekly until the levels become negative

54
Q

Ectopic PG

If the pt presents with Sx of ectopy and the TVS cannot detect it whats the next step

A

do a beta hCG testing and repeat TVS and beta hCG again after 48h

55
Q

Ectopic PG

If the rise between the two beta hCG testing done when TVS cannot detect the ectopy is less than 63% and there is no IUP.

A

suspect Ectopy or PG in an unknown location. confirm by laparoscopy

56
Q

Ectopic PG

If the rise between the two beta hCG testing done when TVS cannot detect the ectopy is** more than 63% and there is no IUP.**

A

confirm a developing IUP. and repeat TVUS in 3- 7 days

57
Q

Ectopic PG

If the rise between the two beta hCG testing done when TVS cannot detect the ectopy falls by more than 50% and there is no IUP.

A

Dx as a non viable PG

58
Q
A

GYN/OBS (6 decks)

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