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Year Three - Reproductive System > Ectopic Pregnancy > Flashcards

Ectopic Pregnancy Flashcards

1
Q

What is an ectopic pregnancy?

A

It is defined as a pregnancy implanted outside the uterus

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2
Q

What is the most common location of an ectopic pregnancy?

A

Ampulla of the fallopian tube

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3
Q

In what four other locations do ectopic pregnancies commonly occur?

A

Isthmus of the fallopian tube

Ovaries

Cervix

Peritoneal cavity

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4
Q

In which location is there an increased risk of ectopic pregnancy rupture?

A

Isthmus

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5
Q

What are the seven risk factors of ectopic pregnancy?

A

Previous Ectopic Pregnancy

Pelvic Inflammatory Disease

Endometriosis

Fallopian Tube Surgery

Intrauterine Devices

Progesterone Only Pill

In Vitro Fertilisation

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6
Q

When do clinical features of ectopic pregnancies present?

A

6-8 weeks

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7
Q

What are the six clinical features of ectopic pregnancy?

A

Unilateral Lower Abdominal Pain

Dark Brown Vaginal Bleeding

Amenorrhoea

Shoulder Tip Pain

Cervical Motion Tenderness

Syncope

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8
Q

What is the first clinical feature patients present with in ectopic pregnancies?

A

Lower abdominal pain

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9
Q

What is the cause of lower abomdinal pain in ectopic pregnancies?

A

Tubal spasm

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10
Q

Why does vaginal bleeding occur in ectopic pregnancy?

A

There is decidual breakdown in the uterine cavity due to suboptimal B-HCG levels

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11
Q

How long is amenorrhoea present for in ectopic pregnancies?

A

6 - 8 weeks from the start of the last period

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12
Q

Why does shoulder tip pain occur in ectopic pregnancies?

A

This is due to the pelvic diaphragm being irritated by blood in the peritoneal cavity

The supraclavicular and the pelvic diaphragm share the C3-C5 dermatomes

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13
Q

What is cervical motion tenderness?

A

This is defined as pain when moving the cervix during a bimanual examination

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14
Q

What three investigations are used to diagnose ectopic pregnancies?

A

Vaginal Examination

Pregnancy Test

Ultrasound Scan

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15
Q

On examination, what are the two features of ectopic pregnancies?

A

Abdominal tenderness

Cervical motion tenderness

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16
Q

What should not be examined for in suspected ectopic pregnancies?

A

Adnexal mass

This is due to the risk of rupture

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17
Q

Which ultrasound scan is preferred to investigate ectopic pregnancies - transabdominal or transvaginal?

A

Transvaginal

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18
Q

What are the two features of ectopic pregnancies on ultrasound scans?

A

A Gestational Sac With Yolk Sac/Fetal Pole In Fallopian Tube

Empty Uterus

19
Q

What are pregnancies of unknown location?

A

When a pregnancy cannot be identified on an ultrasound scan, however the pregnancy test is positive

20
Q

What are three differential diagnoses of pregnancies of unknown location?

A

Early intrauterine pregnancy

Miscarriage

Ectopic pregnancy

21
Q

How do we investigate patients with pregnancies of unknown location?

A

Serum HcG levels

22
Q

How do we manage patients with a pregnancy of unknown location and beta-HCG levels >1500?

A

This should be considered an ectopic pregnancy

A diagnostic laparoscopy should be offered

23
Q

How do we manage patients with a pregnancy of unknown location and beta-HCG levels <1500?

A

A further blood test is taken 48 hours later

24
Q

At what serum hCG level should a pregnancy be visible on an ultrasound scan?

A

> 1500

25
Q

In 48 hours, how would the serum HcG levels change in viable pregnancies?

A

They would increase more than 63%

26
Q

In 48 hours, how would the serum HcG levels change in miscarriages?

A

It would be expected to fall more than 50%

27
Q

In 48 hours, how would the serum HcG levels change in ectopic pregnancies?

A

It would be expected to increase less than 63%

28
Q

What is the most appropriate management step in cases where individuals present with suspected ectopic pregnancy - positive pregnancy test and either abdominal, pelvic or cervical motion tenderness?

A

Immediate referral to the ealry pregnancy assessment unit

29
Q

What is the conservative management option of ectopic pregnancies?

A

It involves watchful waiting of the patient, while allowing the ectopic to terminate naturally

There should be close monitoring of the patient over 48 hours and if serum beta-hCG levels rise or clinical features manifest, intervention should be performed

30
Q

In which five circumstances is conservative management of ectopic pregnancies recommended?

A

Ectopic Pregnancy < 35mm

Unruptured Ectopic Pregnancy

Asymptomatic

No Fetal Heartbeat

Serum beta-hCG < 1000IU/L

31
Q

What is the pharmacological management option of ectopic pregnancies?

A

IM Methotrexate

32
Q

How is methotrexate used to treat ectopic pregnancies?

A

It highly teratogenic drug that halts the progress of the pregnancy and results in spontaneous termination

33
Q

Once methotrexate has been administered, how do we monitor these ectopic pregnancies?

A

The serum beta-hCG should be monitored every 48 hours to ensure that it is falling by more than 15% in day four to five

If this decline is not evident, a repeat dose is administered

34
Q

How long should patients treated with methotrexate wait, before becoming pregnant again? Why?

A

Three months

This is because the harmful effects of methotrexate persist this long

35
Q

In which five circumstances is pharmacological management of ectopic pregnancies recommended?

A

Ectopic Pregnancy < 35mm

Unruptured Ectopic Pregnancy

No Significant Pain

No Fetal Heartbeat

Serum beta-hCG < 1500/L

36
Q

What are the two surgical management options of ectopic pregnancies?

A

Laparoscopic Salpingectomy

Laparoscopic Salpingotomy

37
Q

When is laparoscopic salpingectomy recommended to manage ectopic pregnancies?

A

In women with no other risk factors for infertility

38
Q

What is laparoscopic salpingectomy?

A

It involves removal of the affected fallopian tube, along with the ectopic pregnancy inside the tube

39
Q

When is laparoscopic salpingotomy recommended?

A

In women with risk factors for infertility, such as contralateral tube damage to infection, disease, etc

40
Q

What is laparoscopic salpingotomy?

A

This procedure involves a cut being made in the affected fallopian tube and the ectopic pregnancy being removed from it

41
Q

What is a disadvantage of larparoscopic salpingotomy?

A

There is an increased risk of failure to remove the ectopic pregnancy

These patients may need further treatment with methotrexate

42
Q

In which five circumstances is surgical management of ectopic pregnancies recommended?

A

Ectopic Pregnancy > 35mm

Ruptured Ectopic Pregnancy

Significant Pain

Visible Fetal Heartbeat

Serum beta-hCG > 5000IU/L

43
Q

After surgical management of ectopic pregnancies, what do we administer to all rhesus negative women?

A

Anti-D prophylaxis

Year Three - Reproductive System (52 decks)

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