Ectopic preg, misc points

Question 1

Triad of ectopic preg

Answer 1

abdominal pain
amenorrhea
vaginal bleeding

Question 2

Beta HCG levels in normal vs ectopic preg

Answer 2

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

Question 3

Inv for ectopic preg

Answer 3

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

Question 4

Mx of ectopic

Answer 4

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

3. Laparoscopy

Question 5

Methotrexate regimen in ectopic preg

Answer 5

●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.

Question 6

Shoulder tip pain is seen when in ectopic preg

Answer 6

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

Question 7

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

Answer 7

Can take at any time

Question 8

What food to avoid in preg

Answer 8

Soft cheese - listeria bacteria in unpasteurised milk

Question 9

DM1 mc effect on baby

Answer 9

Macrosomia

Question 10

Renal failure in mum, mc effect on babt

Answer 10

IUGR

Question 11

Vaccines to avoid in preg

Answer 11

1. Chicken pox
2. Rubella
   (live vaccines)