Ectopic preg, misc points Flashcards

1
Q

Triad of ectopic preg

A

abdominal pain
amenorrhea
vaginal bleeding

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2
Q

Beta HCG levels in normal vs ectopic preg

A

Normal preg:
1. Doubles every 2-3 days
2. 10-20KmIU/ml maximum

Ectopic:
1. B hCG levels lower than normal preg

Discriminatory B hCG levels: (normally BhCG levels vs gestational sac visualisation)
1500-1800mIU/ml = Transvag USG (2300 in twins) 6000-6500mIU/ml = abd USG

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3
Q

Inv for ectopic preg

A
  1. B HCG vs transvag/abd usg
  2. Transvag USG = sac within 5wks
    Abd scan = sac within 6wks
  3. Colour flow doppler USG
  4. Laparoscopy
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4
Q

Mx of ectopic

A
  1. Expectant mx
  2. Methotrexate - IM single dose in
    Hemodynamic stability No severe or persisting abdominal pain
    The ability to follow up multiple times Normal baseline liver and renal function test results

Absolute C/I to methotrexate therapy:
Existence of an intrauterine pregnancy Immunodeficiency
Moderate to severe anemia, leukopenia, or thrombocytopenia Sensitivity to methotrexate
Active pulmonary or peptic ulcer disease Clinically important hepatic or renal dysfunction
Breastfeeding Evidence of tubal rupture

Avoid:
1. Sex
2. Contraception for 3 months
3. Folic/folinic acid in single dose rx

Mc S/e:
Stomatitis, conjunctivitis
Methotrexate dermatitis under sun

  1. Laparoscopy
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5
Q

Methotrexate regimen in ectopic preg

A

●The single-dose regimen:
Methotrexate 50 mg/m2 1 dose,
followed by a repeat β-HCG @4th day,

another dose of methotrexate 50 mg/m2 if
β-HCG has declined <15% between days 4 and 7 or <20% between 7 and 10days
`weekly check until 0

●Multiple-dose regimen:
Methotrexate 1 mg/kg, daily IM with leucovorin (folinic acid, which reduces side effects) given on alternating days
`until there is a 15% decline in β-HCG over 2 days.

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6
Q

Shoulder tip pain is seen when in ectopic preg

A

Rupture..
Peritonitis..
irritation of diaphragm..
irritation of phrenic nerve..
Shoulder tip pain

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7
Q

Influenza vaccine in preg, when to take? C/I?

A

Can take at any time

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8
Q

What food to avoid in preg

A

Soft cheese - listeria bacteria in unpasteurised milk

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9
Q

DM1 mc effect on baby

A

Macrosomia

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10
Q

Renal failure in mum, mc effect on babt

A

IUGR

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11
Q

Vaccines to avoid in preg

A
  1. Chicken pox
  2. Rubella
    (live vaccines)
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