Ectopic preg Flashcards
1
Q
Early preg assessment should include
A
- Hx and examination
- USS
- BHCG
+/- progesterone
2
Q
High risk factors for early scan
A
- Prev ectopic
- Prev molar
- Recurrent miscarrigae
3
Q
Signs of ectopic- pt
A
- Abdo/pelvic pain
- PV bleeding
- Dizziness
- Shoulder tip pain
- Pain on defecation
Always do a preg test- pt might not have done one
4
Q
Diagnosis for ectopic
A
TV USS
Lap is no longer gold standard
TA if enlarged uterus, pt does not accept TV
5
Q
Signs of ectopic on scan
A
- Adnexal mass, moving separate to ovary - Sliding sign +
- Might contain gestational sac and fetal pole
- Empty GS- tubal ring or bagel sign
- Empty uterus
- Free fluid +/-
6
Q
Cervical ectopic signs
A
- Empty uterus
- Barrel shaped cervix
- Gest sac below the int os
- No sliding sign - if + it is miscarriage
- Blood flow in the gest sac
7
Q
CS Scar ectopic rate
A
1:2000 preg
8
Q
Scar ectopic signs
A
- Empty uterus
- Gest sac/mass anteriorly at level of int os - in the prev CS scar
- Mass has + blood flow on doppler
- Thin myometrium bet gest sac and bladder
- Empty endocervical canal
9
Q
Further imaging for scar ectopic
A
MRI
10
Q
Interstitial ectopic
A
- Empty uterus
- RPOC/Gest sac in interstitial part of the tube surrounded by <5mm myometrium
- Interstitial line present
11
Q
Incidence of interstital ectopic
A
1-6.3%
12
Q
Cornual ectopic signs
A
- Single interstitial portion of tube in the main uterine body
- Gest sac separate to the uterus and completely surrounded by myometrium
- Vascular pedicle adjoinging the gest sac to unicornuate uterus
13
Q
Abdominal preg
A
- Empty uterus
- No tubal mass/dilation
- Gest sac surrounded by bowel loops
- Wide mobility of sac w pressure
14
Q
Expectant mx of ectopic
A
- Clinicall stable and pain free
- Ectopic <35mm and no FH
- HCG <1000, 1000-1500 - consider
- Able to return for f/u
- F/u- HCG on day 0, 2, 4 and 7 then weekly till negative.
- Expect 15% drop each time
15
Q
Medical mx of ectopic- Methotrexate
A
- No pain
- Unruptured ectopic <35mm w no FH
- HCG <1500
- HCG 1500-5000- consider and discuss
- No IUP
- Can come for f/u
- F/u HCG day 0, 2, 4 and 7 then weekly till negative.
- DO NOT need anti D
16
Q
Dose and sucess rates of methotrexate
A
- 50mg IM
- 65-95% success
- Higher success w lower HCG <1000
- Lower if HCG >10 000
17
Q
Methotrexate and future preg
A
- Wait 3 months before trying
18
Q
Surgical mx of ectopic
A
- Sig pain
- Adnexal mass >35mm
- FH on cans
- HCG >5000
- Give anti D
19
Q
Salpingectomy vs sapingotomy
A
- Salpingectomy 1st line unless
- Infertility, other tube damaged
- Salpingotomy- 1 in 5 will need further rx
- metho/surgery
- HCG on D7 then weekly till negative
20
Q
Anti D
A
- All surgical mx
- Medical if very heavy bleeding
- Ruptured ectopic
21
Q
Ectopic mx w hx of sub-fertility
A
- Expectant or medical mx inc reproductive outcomes in future
