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OB/GYNE CC > Ectopic Pregnancy > Flashcards

Ectopic Pregnancy Flashcards

1
Q

When does ectopic pregnancy mean?

A

fetal tissue/embryo implantation outside the uterus or attaches to an abnormal or scarred portion of the uterus

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2
Q

Most common site of ectopic implantation?

A

Fallopian tube

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3
Q

Mechanism as to why there is implantation of embryo outside the uterus?

A

Damage to the fallopian tube, secondary to inflammation, causes dysfunction and release of IL-1 (by tubal epithelial cells) and hence retention of oocyte or embryo.

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4
Q

Factors that causes inflammation leading to fallopian tube dysfunction

A

Toxins, infections, immunologic and hormonal factors

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5
Q

factors that negatively affect the ciliary beat frequency

A

smoking and infection

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6
Q

Possible sites of implantation by embryo aside from uterus

A

cervix, uterine cornea, myometrium, ovaries, abdominal cavity

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7
Q

What is heterotopic preganacy

A

ectopic pregnancy with intrauterine pregnancy

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8
Q

tubal ligation and post-op fallopian tube procedure increase risk of ectopic pregnancy

A

due to alteration of the native function of the fallopian tube

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9
Q

most common part of fallopian tube in which ectopic pregnancy occurs

A

ampullary region

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10
Q

What is Cesarean scar pregnancy

A

migration of the blastocysts into the myometrium due to the residual scarring defect from prior c-section

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11
Q

What is type 1 CS scar pregnancy

A

implantation at closest proximity to the uterine wall

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12
Q

What is type 2 CS scar pregnancy

A

implantation closest the bladder wall

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13
Q

Common chief complain in ectopic pregnancy

A

abdominal pain

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14
Q

Necessary test to diagnose Ectopic pregnancy

A

Transvaginal ultrasound and hCG level measurement

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15
Q

First marker of intrauterine pregnancy on ultrasound

A

double decidual sign: small sac eccentrically located within the decidua

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16
Q

What is double decidual sign

A

a small sac eccentrically located within the decidua

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17
Q

double decidual signs is apparent at what week

A

5th week

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18
Q

best diagnostic confirmation of ectopic pregnancy

A

identifying fetal heartbeat outside of the uterine cavity on ultrasound

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19
Q

Safe and effective treatment modalities

A

Administration of intramuscular methotrexate or performance of laparoscopic surgery

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20
Q

The decision of which modality to pursue is guided by

A

patient’s clinical picture, laboratory findings, and radiologic imaging

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21
Q

Patients with relatively low hCG levels would benefit from what treatment

A

single-dose methotrexate protocol

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22
Q

Patients with higher hCG levels would benefit from what treatment

A

two-dose regimens of methotrexate

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23
Q

Surgical management is necessary when

A

patients demonstrate any of the following: an indication of intraperitoneal bleeding, symptoms suggestive of ongoing ruptured ectopic mass, or hemodynamically instability

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24
Q

Surgical management including

A

salpingostomy or salpingectomy

25
Q

salpingectomy involves

A

removing the fallopian tube partially or in full.

26
Q

Salpingostomy, or salpingotomy, involves

A

removal of the ectopic pregnancy via tubal incision while leaving the fallopian tube in situ

27
Q

In cases of tubal ectopic pregnancy, contraindications for Methotrexate therapy include the following, EXCEPT:
A. Breastfeeding
B. Thrombocytopenia
C. Migraine headache
D. Intraabdominal hemorrhage

A

C. Migraine headache

28
Q

Which of the following would be most closely associated with Methotrexate therapy failure during ectopic pregnancy treatment?
A. Increased parity
B. Ectopic size of 2.5 cm
C. Prior ectopic pregnancy
D. Beta hCG >9,000 mIU/ml

A

D. Beta hCG >9,000 mIU/ml

29
Q

Risk factors for ectopic preganacy

A
  • STI, especially by C. trachomatis (CDC, 2007)
  • Earlier diagnosis of ectopic pregnancy.
  • Failed contraception.
  • Tubal sterilization.
  • Assisted reproductive technology (ART)
  • Tubal surgery (salpingotomy: tubal pregnancy & tuboplasty:
    infertility)
30
Q

TYPES OF ECTOPIC PREGNACY

A
  1. Tubal Pregnancy
  2. Heterotopic Pregnancy
  3. Cervical Pregnancy
  4. Ovarian Pregnancy
  5. Abdominal Pregnancy
  6. Cesarean Scar Pregnancy (CSP)
31
Q

Tubal pregnancy pathogenesis

A
  • Transit of fertilized ovum os blocked
  • Burrows through the tubal mucosa
  • Trophoblasts invade and erode
  • Maternal blood vessels are opened
  • Expanding conceptus leads to rupture of muscle wall
32
Q

Most common signs and symptoms

A
  • Pelvic and abdominal pain (95%)
  • Vaginal bleeding or spotting (60-80%)
33
Q

DIAGNOSIS

A
  • Serum beta-hCG (1,000-2,000 mIU/mL with intrauterine
    pregnancy)
  • Serum progesterone: 10-25 ng/ml
  • Decrease in hemoglobin and hematocrit
  • Culdocentesis
  • Ultrasound: complex adnexal mass, fluid in cul-de-sac
  • Laparoscopy: Gold standard
34
Q

Culdocentesis

A

: aspiration of non-clotting blood

35
Q

Ultrasound findings

A

complex adnexal mass, fluid in cul-de-sac

36
Q

Gold standard for diagnosis

A

Laparoscopy

37
Q

Indication for methotrexate

A

o Pregnancy is <6 weeks
o Tubal mass <3.5 cm
o No cardiac activity
o Serum B-hCG <10-15,000 mIU/ml

38
Q

Contraindication for methotrexate

A

o Active bleeding
o Breastfeeding
o Immunodeficiency
o Alcoholism
o Blood dyscrasia
o Liver or renal disease
o Pulmonary disease

39
Q

when to assume pxt has ectopic pregnancy

A

early pregnancy, bleeding and pain

40
Q

how to exclude ectopic pregnancy

A

ultrasound and labs (best hcg)

41
Q

Strongest risk factor for ectopic pregnancy

A

prior ectopic pregnancy

42
Q

Spielberg Criteria for Ovarian Pregnancy

A
  • The tube on the ipsilateral side is intact
  • The ectopic pregnancy occupies the ovary
  • The ectopic pregnancy is attached to the uterus by the utero-ovarian ligament
  • Ovarian tissue is identified histologically amid placental tissue
43
Q

Classic triad

A

Amenorrhea, Abdominal pain, Vaginal bleeding/spotting

44
Q

Diff diag Ap because

A

-if exquisite pain on the right lower quadrant

45
Q

Diff diag pid if

A

pain and wiggling tenderness

46
Q

S&S for ruptured ectopic pregnancy

A

hypotension, tachycardia and signs of peritoneal irritation due to hemoperitoneum

47
Q

Rupture occurs due to

A

maximal distention of muscularis

48
Q

Rupture cause severe hemorrhage due to

A

close proximity to uterine and ovarian arteries

49
Q

management for rupture ectopic pregnancy

A

salpingectomy

50
Q

MOA: Methotrexate

A

folic acid antagonist: binds to dihydrofolate reductase which reduces dihydrofolate to tetrahydrofolate (active form of folic acid), leading to arrest in DNA, RNA and protein synthesis of rapidly proliferating tissue such as trophoblasts.

51
Q

Indication for salpingostomy

A

Used to remove unruptured pregnancy that is <2 cm in size

52
Q

Indication for Salpingotomy

A

Used to remove unruptured pregnancy that is <2 cm in size

53
Q

Salpingotomy vs Salpingotomy

A

Same as salpingostomy, except that the incision is closed with

delayed-absorbable suture

54
Q

Tubal rupture occurs w/in first few weeks is common in

A

isthmic pregnancies

55
Q

Level of beta HCG that causes a + preg test

A

10-20 mIU/mL

56
Q

Discriminatory level of B HCG

A

1500 mIU/MI

57
Q

serum progesterone that exclides ectopic pregnancy

A

> 25ng/mL

58
Q

when to use transabdominal ultrasound

A

at uterine pregnancy at 28 days after ovulation

59
Q

(+) ectopic pregnancy via culdocentesis

A

blood collected doesn’t clot

OB/GYNE CC (4 decks)

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