Ectopic preg, misc points Flashcards
Triad of ectopic preg
abdominal pain
amenorrhea
vaginal bleeding
Beta HCG levels in normal vs ectopic preg
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
Inv for ectopic preg
- B HCG vs transvag/abd usg
- Transvag USG = sac within 5wks
Abd scan = sac within 6wks - Colour flow doppler USG
- Laparoscopy
Mx of ectopic
- Expectant mx
- Methotrexate - IM single dose in
Hemodynamic stability
No severe or persisting abdominal painThe 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
ImmunodeficiencyModerate to severe anemia, leukopenia, or thrombocytopenia
Sensitivity to methotrexateActive pulmonary or peptic ulcer disease
Clinically important hepatic or renal dysfunctionBreastfeeding
Evidence of tubal rupture
- Laparoscopy
Methotrexate regimen in ectopic preg
●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.
●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.
Shoulder tip pain is seen when in ectopic preg
Rupture..
Peritonitis..
irritation of diaphragm..
irritation of phrenic nerve..
Shoulder tip pain
Influenza vaccine in preg, when to take? C/I?
Can take at any time
What food to avoid in preg
Soft cheese - listeria bacteria in unpasteurised milk
DM1 mc effect on baby
Macrosomia
Renal failure in mum, mc effect on babt
IUGR
Vaccines to avoid in preg
- Chicken pox
- Rubella
(live vaccines)