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Oral board studying Prep book > Ectopic pregnancy > Flashcards

Ectopic pregnancy Flashcards

1
Q

In a stable patient can you diagnose an ectopic pregnancy with 1 hcg value?

A

No

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2
Q

What is the rise pattern of hcg during the first trimester?

A

Initial hcg <1500= 50% rise
Initial hcg 1500-3000= 40% rise
Initial hcg 3000= 33%rise

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3
Q

What is the discriminatory level to see an IUP?

A

3500

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4
Q

Does the discriminatory level change to see an IUP from a singleton to a multiple gestation?

A

Yes the discriminatory zone can be higher in a multiple gestation to see an IUP

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5
Q

What is a pregnancy of unknown location?

A

Transition state where the patient has a positive pregnancy test but pregnancy has not been identified

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6
Q

What would you expect to see with hcg levels after a uterine aspiration for pregnancy of unknown location if there was a intrauterine process?

A

If there was an intrauterine process you would expect the hcg level to decrease by 50% by 24hrs

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7
Q

What is the management for ectopic pregnancy?

A

Expectant management
Medical management
Surgical management

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8
Q

What is the medical management for ectopic pregnancy?

A

Methotrexate

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9
Q

What is the mechanism of action of methotrexate?

A

Folate antagonist
Inhibits the binding of dihydropholic acid to dihydrofolate reductase which inhibits DNA synthesis

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10
Q

What are adverse reactions to methotrexate?

A

Stomatitis, conjunctivitis, gastritis, enteritis, dermatitis

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11
Q

What should you avoid while taking methotrexate?

A

Sunlight, NSAIDS, vitamins with folate, vigorous activity, sexual activity

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12
Q

How long should you wait before getting pregnant after taking methotrexate?

A

1-3 months

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13
Q

What are the absolute contraindications to methotrexate therapy?

A
  1. Significant liver disease
  2. Significant renal disease
  3. Active pulmonary disease
  4. Inability to follow up
  5. Hemodynamically unstable
  6. Rupture ectopic
  7. Allergy to methotrexate
  8. Immunosuppressed
  9. IUP
  10. Blood dyscrasia
  11. Breastfeeding
  12. Active peptic ulcer disease
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14
Q

What are the relative contraindications to methotrexate?

A
  1. Fetal cardiac activity
  2. Fetal mass >4cm
  3. bhcg >5000
  4. Declines blood transfusion
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15
Q

What is the single dose regime for methotrexate?

A

Single dose regime= 50mg/m2 IM on day 1
After 2 doses consider surgery

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16
Q

What is the two dose regime for methotrexate?

A

Single dose of methotrexate 50mg/m2 IM on day 1 and day 4.
After 4 doses consider surgery

17
Q

What is the multiple dose regime for methotrexate?

A

Methotrexate 1mg/kg on days 1,3,5,7
Leucovorin 0.1mg/kg on days 2,4,6,8
After 4 doses consider surgery

18
Q

When is the multiple dose regime for ectopic pregnancy recommended?

A

Cornual or cervical ectopic pregnancies if medically managed

19
Q

What is the follow up for single dose regime for methotrexate?

A

Check bhcg level on Day 1 Day 4 and Day 7. hcg level should drop >15% between day 4 and day 7 after treatment and >15% weekly thereafter.

20
Q

What is the follow up for two dose regime for methotrexate?

A

Check bhcg level on Day 1 Day 4 and Day 7. hcg level should drop >15% between day 4 and day 7 after treatment and >15% weekly thereafter.

21
Q

What is the follow up for multi dose regime for methotrexate?

A

hcg level checked on the odd days after administration and hcg level should drop >15%. If it does no further methotrexate administered and weekly monitoring begins

22
Q

What is a heterotopic pregnancy?

A

Simultaneous IUP and ectopic pregnancy

23
Q

When should you consider heterotopic pregnancy?

A

IVF transfers
Unexplained bleeding or pain in early pregnancy

24
Q

What are the proposed mechanisms for heterotopic pregnancies?

A
  1. Transfer of multiple embryos with inadvertent flushing of one into cornua or Fallopian tube
  2. IVF transfer and spontaneous conception simultaneously with the spontaneous pregnancy arising as ectopic
25
Q

What is the incidence of ectopic pregnancy with ART?

A

5%

26
Q

What is the risk of ectopic pregnancy with history of 1 ectopic pregnancy?

A

10%

27
Q

What is the risk of ectopic pregnancy with history of 2 ectopic pregnancies?

A

> 25%

28
Q

What is the risk of ectopic pregnancy with tubal surgery?

A

20%

29
Q

What is the risk of ectopic pregnancy with IUD?

A

<20%

30
Q

what is the risk of ectopic pregnancy with s/p tubal ligation?

A

50%

31
Q

What is the reason you would get a false positive hcg result?

A

Heterophilic antibodies that interact with hcg antibody

32
Q

What is the evaluation for suspected false positive hcg result?

A

Urine pregnancy test
(heterophilic antibodies are not present in urine)
rerun the serum using a different assay

33
Q

Where are the heterophilic antibodies found?

A

In the assay not in the serum or urine

Oral board studying Prep book (50 decks)

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