Ectopic Pregnancy Flashcards
What is the leading cause of maternal death in the 1st trimester?
Ectopic Pregnancies
What is an Ectopic Pregnancy?
Gestation implants outside the uterus
Where do Ectopic Pregnancies usually present?
Fallopian Tubes
What are some risk factors for Ectopic Pregnancies?
- PID from tubal infection with chlamydia/gonorrhea
- IVF/ART
- Smoking
What are some risk factors for Ectopic Pregnancies?
- PID from tubal infection with chlamydia/gonorrhea
- Smoking
- IVF/ART
Describe the risk factor of IUDs for ectopic pregnancies
The risk of IUD users is less than that of non-users but IF they become pregnant with an IUD in, they are more likely to have an ectopic pregnancy
Triad of signs of an Ectopic Pregnancy?
Missed period
Vaginal bleeding
Lower abdominal pain
3 types of Ectopic Pregnancies?
- Possible
- Probable
- Ruptured
With Possible and Probable Ectopic Pregnancies, the symptoms are similar (pain + bleeding). What will be seen on US with a Possible Ectopic?
NOTHING
With Possible and Probable Ectopic Pregnancies, the symptoms will be similar (pain + bleeding). What will be seen on US with a Probable Ectopic?
Fluid in cul-de-sac
On physical exam, what differentiates a possible to probable ectopic?
Probable = tenderness on physical exam
If a patient presents with severe abdominal pain and dizziness, what type of Ectopic is she having? What caused the dizziness?
Ruptured Ectopic
– Dizziness is due to blood loss/hemorrhage
What are some physical exam findings that will be present with a Ruptured Ectopic Pregnancy?
Distended, tender abdomen with guarding rigidity
Cervical motion tenderness
Signs of hemodynamic instability
What are some physical exam findings with a Ruptured Ectopic pregnancy?
- Distended, tender abdomen with guarding and rigidity
- Cervical motion tenderness
- Signs of hemodynamic instability
What will be seen on Ultrasound with a Ruptured Ectopic Pregnancy?
Empty uterus with free fluid
An empty uterus with free fluid on ultrasound is likely what type of Ectopic?
Ruptured
What is the treatment for a Ruptured Ectopic Pregnancy?
Surgical emergency
hCG signs that could indicate its an ectopic pregnancy?
Abnormally rising < 53% in 2 days
What is given for compliant and stable women with an Ectopic Pregnancy?
Methotrexate
What is given for compliant and stable women with an Ectopic?
Methotrexate
MOA for Methotrexate?
(-) folic acid to stop DNA synthesis
After you have given Methotrexate, what should you check and when?
hCG at days 4 and 7 to ensure it is DECREASING
If the hCG is not decreasing with Methotrexate, what is the next step?
Another dose
OR
Surgery
If a woman is stable and her symptoms of the ectopic pregnancy are resolving, what is a way to treat her?
Expectant management by following hCG levels
