Ectopic Pregnancies

Question 1

What is the most common location of an ectopic pregnancy?

Answer 1

Tubal–ampullary part

Question 2

True or false: generally, ectopic pregnancies do not survive

Answer 2

True

Question 3

Which part of the tube do tubal pregnancies generally end up in?

Answer 3

Ampulla

Question 4

What is the prevalences of ectopic pregnancies?

Answer 4

2% of all pregnancies

Question 5

What are risk factors for the development of an ectopic pregnancy?

Answer 5

• PID
• IVF
• Prior ectopic
• Prior tubal surgery

Question 6

What is the most common cause of first trimester pregnancy related deaths

Answer 6

Ectopic pregnancies

Question 7

What percent of 1st semester bleeding is the result of ectopic pregnancies?

Answer 7

6-16%

Question 8

What type of bleeding is seen in tubal rupture 2/2 ectopic pregnancy?

Answer 8

Hemoperitoneum (no vaginal bleeding)

Question 9

Women of color have a (__)x higher risk of mortality from ectopic pregnancies.

Answer 9

5x

Question 10

Ectopic pregnancies have a (__)x greater risk of maternal death than abortion.

Answer 10

50x

Question 11

Ectopic pregnancies have a (__)x greater risk of maternal death than childbirth

Answer 11

10x

Question 12

What is the relationship between IUD use and the incidence of ectopic pregnancies?

Answer 12

Lower overall pregnancy rate, but if pregnant, then higher chance of ectopic

Question 13

True or false: smoking increases the risk for an ectopic pregnancy

Answer 13

True

Question 14

True or false: multiple sex partners increases the risk for ectopic pregnancies

Answer 14

True

Question 15

Why are prior PID, multiple sex partners, and prior tubal surgery all risk factors for the development of an ectopic pregnancy?

Answer 15

Prior uterine damage and scarring from trauma or infection

Question 16

What are the three common presentations of an ectopic pregnancy?

Answer 16

• 1st trimester bleeding
• Abdominal/pelvic pain
• Asymptomatic

Question 17

How do you diagnose an ectopic pregnancy?

Answer 17

• US see no live pregnancy

- hCG levels are high (1500-2000)

Question 18

When should an ectopic pregnancy be suspected?

Answer 18

• 5-6 weeks from LMP

- 2 weeks after positive UPT

Question 19

What is the usual trend of beta-hCG throughout pregnancy?

Answer 19

Rapid rise in the first trimester, doubling about every 48 hours.

Plateau around 10 weeks, the slowly fall

Question 20

What, generally, occurs with hCG levels in an ectopic pregnancy?

Answer 20

Rise, but not as fast as normal pregnancy

Question 21

What level of progesterone levels are indicative of a normal and ectopic pregnancy?

Answer 21

• Less than 5ng/ml = no normal pregnancies

- More than 25 ng/ml 97% of viable pregnancies

Question 22

At what level of hCG should you be able to detect a pregnancy with TVUS? Abdominal?

Answer 22

2500 with TVUS

6000 with abdominal US

Question 23

When can the gestational sac be seen with TVUS?

Answer 23

4.5 weeks

Question 24

When can the yolk sac be seen with TVUS?

Answer 24

5 weeks

Question 25

When can the embryo be seen with TVUS?

Answer 25

6 weeks

Question 26

When can fetal heart tones be seen with TVUS?

Answer 26

6 weeks

Question 27

When is hemolysis from Rh status a concern?

Answer 27

When mother is Rh - with an Rh + fetus

Question 28

What is the uterine cul-de-sec?

Answer 28

Space between the rectum and the uterus

Question 29

What happens to the ovary with ovulation?

Answer 29

May develop a luteal cyst that is visible on US

Question 30

What is the drug that can be used to abort a fetus in case of maternal distress? Is it useful for ruptured pregnancies?

Answer 30

Methotrexate Useless for ruptured pregnancies

Question 31

Does the use of methotrexate preserve fertility?

Answer 31

Yes

Question 32

Is methotrexate safe for BF mothers?

Answer 32

No

Question 33

Can methotrexate be used in patients with immunodeficiencies?

Answer 33

No

Question 34

What are the GI diseases that contraindicates methotrexate use? (2)

Answer 34

PUDs | Chronic liver disease

Question 35

Can methotrexate be used in patients with acute pulmonary disorders?

Answer 35

No

Question 36

An unruptured mass of greater than (__)cm is a contraindication to methotrexate.

Answer 36

3.5 cm

Question 37

True or false: fetal cardiac activity is an aobsoulte contraindication to methotrexate use

Answer 37

False-- relative. will not be as effective

Question 38

Quant hCG level greater than what amounts is a relative contraindication to methotrexate use?

Answer 38

6000-15000

Question 39

What is the dose used for methotrexate?

Answer 39

Single IM dose of 50 mg/m^2

Question 40

How do you follow methotrexate use?

Answer 40

Serial quant beta-hCG should decline by 15% by day 7. Repeat or move to surgery

Question 41

What are the side effects of Methotrexate use?

Answer 41

GI s/sx, including abdominal pain-thus should warn pt

Question 42

What happens to hCG levels with methotrexate use?

Answer 42

Rises initially, but should decline after 4 ish days

Question 43

What are the signs that methotrexate treatment is failing? (3)

Answer 43

- Significantly worse abdominal pain - Hemodynamic instability - beta hCG not declining 15% by day 7

Question 44

What is a salpingotomy, and what are the risks benefits of it compared to a salpingectomy?

Answer 44

Making a hole in the fallopian tube to remove ectopic pregnancy. increases the risk of a second ectopic

Question 45

What is the recurrence rate of ectopic pregnancies after salpingotomy/salpingectomy? What should be done to monitor these patients in future pregnancies?

Answer 45

- 15-20% | - Monitor with early US and hCG levels