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Ectopic Pregnancy Flashcards

1
Q

What is an ectopic pregnancy?

A

Implantation of fertilised ovum outside the uterus

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2
Q

What is the first symptom of an ectopic pregnancy present?

A

Constant unilateral lower abdominal pain

Can radiate to shoulder tip

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3
Q

What is the constant unilateral lower abdominal pain due to?

A

Tubal spasm

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4
Q

What other symptoms does an ectopic pregnancy present with?

A

Vaginal Bleeding
Amenorrhoea- 6-8 weeks since last period

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5
Q

How is the vaginal bleeding described?

A

Less than a normal period

Dark brown in colour

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6
Q

What might happen to the patient due to the blood loss?

A

They may become haemodynamically unstable

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7
Q

What investigations might you carry out for an ectopic pregnancy?

A

Transvaginal ultrasound

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8
Q

Will a pregnancy test be positive or negative in an ectopic pregnancy?

A

Positive

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9
Q

What is the main risk for an ectopic pregnancy?

A

Anything slowing the ovum’s passage to the uterus

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10
Q

What types of things slow the passage of the ovum to the uterus?

A

Pelvic Inflammatory Disease- Previous chlamydia
Endometriosis
Progesterone Only Pill
IVF

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11
Q

What does expectant management of an ectopic pregnancy mean?

A

You expect the ectopic pregnancy to resolve naturally without any intervention

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12
Q

What is the criteria for expectant management of an ectopic pregnancy?

A

Adnexal mass size <35mm
Unruptured
Asymptomatic
No fetal heartbeat

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13
Q

What level should the B-hCG be at to allow expectant management of an ectopic pregnancy?

A

Low

Serum B-hCG <1,000IU/L (and declining)

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14
Q

What is the medical management of an ectopic pregnancy?

A

Give the patient a one off dose of IM methotrexate

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15
Q

What would you do if the medical management of an ectopic pregnancy didn’t work?

A

A second dose of methotrexate

Surgery

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16
Q

What is the criteria for medical management of an ectopic pregnancy?

A

Adnexal mass size <35mm
Unruptured
No significant pain
No fetal heartbeat

17
Q

What level should the B-hCG be at to allow medical management of an ectopic pregnancy?

A

serum B-hCG <1,500IU/L

18
Q

What is the surgical management of an ectopic pregnancy?

A

Salpingectomy or Salpingotomy

19
Q

What is the criteria for surgical management of an ectopic pregnancy?

A

Adnexal mass size >35mm
Can be ruptured
Pain
Visible fetal heartbeat

20
Q

What level should the B-hCG be at to allow surgical management of an ectopic pregnancy?

A

Serum B-hCG >5,000IU/L

21
Q

An ectopic pregnancy in which part of the fallopian tube is most associated with rupture?

A

The Isthmus

22
Q

What is a typical history of someone presenting with an ectopic pregnancy?

A

Female with a history of 6-8 weeks amenorrhoea who presents with lower abdominal pain and later develops vaginal bleeding

23
Q

What other symptoms might an ectopic pregnancy present with?

A

dizziness, fainting or syncope may be seen
symptoms of pregnancy such as breast tenderness

24
Q

What examination findings might there be in someone with an ectopic pregnancy?

A

abdominal tenderness
cervical excitation (also known as cervical motion tenderness)
adnexal mass (DO NOT EXAMINE FOR DUE TO RISK OF RUPTURE)

25
Q

Why would you not examine for an adnexal mass?

A

Due to teh risk of rupture

26
Q

What is the main differential of an ectopic pregnancy?

A

Miscarriage
(bleeding is minor in an ectopic in comparison to a miscarriage)

27
Q

What is the first line surgical management of an ectopic pregnancy?

A

Salpingectomy is first-line for women with no other risk factors for infertility

28
Q

What is first line surgical management of an ectopic pregnancy in women with other RF for infertility?

A

Salpingotomy

29
Q

How is the dose of methotrexate administered?

A

IM

30
Q

What is salpingectomy?

A

The surgical removal of one (unilateral) or both (bilateral) fallopian tubes.

31
Q

What is salpingotomy?

A

Removal of the product of an ectopic pregnancy from the fallopian tube without removing the fallopian tube

32
Q

Where is an ectopic pregnancy most likely to occur?

A

In the ampulla of the fallopian tube

Reproduction (88 decks)

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