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3. Y5 Zero to finals: O&G > Ectopic Pregnancy > Flashcards

Ectopic Pregnancy Flashcards

1
Q

What is an Ectopic Pregnancy?

A

Pregnancy implanted outside uterus

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2
Q

Where is the most common implantation site of an Ectopic pregnancy?

A

Fallopian tube

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3
Q

What is the prevalence of Ectopic pregnancies in the UK?

A

1/80 pregnancies

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4
Q

What are the RF for an Ectopic Pregnancy? (6 things)

A
  1. Previous EP
  2. Previous PID
  3. Previous of surgery to fallopian tubes
  4. IUD
  5. Age
  6. Smoking
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5
Q

When do the CF of EP normally present?

A

6-8 weeks gestation

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6
Q

What are the CF of EP? (4 things)

A
  1. Pain (lower abd / pelvic)
  2. Vaginal bleeding
  3. Amenorrhoea (aka missed period)
  4. Shoulder pain
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7
Q

What are the CF of EP @ examination? (2 things)

A
  1. Lower abd / pelvic tenderness
  2. Cervical motion tenderness (pain @ moving cervix @ bimanual exam)
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8
Q

What is the difference between Vaginal and Intra-abd bleeding in EP?

A
  1. Vaginal: Uterine cavity breakdown bc not enough β-HCG
  2. Intra-abd: Ruptured EP
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9
Q

How will a pt present with a Ruptured EP?

A

Haemodynamically unstable

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10
Q

Why might someone with EP present with Shoulder pain?

A

Blood in peritoneal cavity irritates diaphragm –> referred shoulder pain

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11
Q

What are some differential Dx that present similarly to EP? (6 things)

A
  1. Miscarriage
  2. Ovarian cyst haemorrhage / torsion / rupture
  3. PID
  4. UTI
  5. Appendicitis
  6. Diverticulitis
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12
Q

What is the first important investigation for sus EP?

A

Pregnancy test (β-HCG test)

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13
Q

What investigation should be performed if the Pregnancy test in sus EP is positive?

A

Pelvic US

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14
Q

What should be offered if no pregnancy is seen on the Pelvic US?

A

Transvaginal US

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15
Q

What is the term used to describe a positive pregnancy test but NO pregnancy seen on US?

A

Pregnancy of Uknown Location (PUL)

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16
Q

What are the 3 main differentials of PUL?

A
  1. Very early intrauterine pregnancy
  2. Miscarriage
  3. EP
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17
Q

What investigation should you do for PUL?

A

Serum β-HCG

18
Q

What Serum β-HCG levels are considered EP?

A

1500+ iU

19
Q

What investigation should be done to confirm the diagnosis of EP when Serum β-HCG levels are 1500+?

A

Diagnostic laparoscopy

20
Q

What investigation should be done if Serum β-HCG levels are below 1500 and pt is stable?

A

Another Serum β-HCG after 48 hours

21
Q

What are the HCG levels expected to do every 48 hours in a VIABLE pregnancy?

A

Double every 48 hours

22
Q

What are the HCG levels expected to do every 48 hours in a Miscarriage?

A

Halve every 48 hours

23
Q

What should you do if the HCG levels doesn’t double / halve every 48 hours and was initially below 1500?

A

Can’t exclude EP so manage accordingly

24
Q

How could you exclude a differential of UTI in sus EP?

A

Urinalysis

25
Q

What are the Mx options for EP? (3 things)

A
  1. Expectant (await natural termination)
  2. Medical (methotrexate)
  3. Surgical (salpingectomy / salpingotomy)
26
Q

What are the criteria for Expectant Mx of EP? (6 things)

A
  1. Follow up possible to ensure successful termination
  2. EP needs to be unruptured
  3. Adnexal mass less than 35mm
  4. No visible heartbeat
  5. No significant pain
  6. HCG level below 1500
27
Q

What are the criteria for Medical (MTX) management of EP? (2 things)

A

Same as Expectant except:

  1. HCG level below 5000
  2. Confirmed absence of IU pregnancy on US
28
Q

How does the Methotrexate work for Medical Mx of EP?

A

MTX = Anti-folate cytotoxic agent –> disrupts Folate dependant cell division of developing foetus

29
Q

How do you ensure the Methotrexate is working for EP Mx?

A

Measure HCG levels regularly (supposed to decline by 15+ % by day 5)

30
Q

What should you do if the HCG levels aren’t declining properly after you Methotrexate EP Mx?

A

Give repeat dose

31
Q

What are the Advantages of Medical Mx with MTX for EP? (2 things)

A
  1. Avoid surgical complications
  2. Pt can go home after injection
32
Q

What are the Side Fx of MTX as Medical Mx for EP? (9 things)

A
  1. N+V
  2. Stomatitis (mouth infamm)
  3. Abd pain
  4. Myelosuppression
  5. Renal dysfunction
  6. Hepatitis
  7. Vaginal bleeding
  8. Teratogenesis
  9. Failure of Tx
33
Q

What are the criteria for Surgical Mx of EP? (4 things)

A
  1. Pain
  2. Adnexal mass 35+ mm
  3. Visible heartbeat
  4. HCG level 5000+
34
Q

What is the most common surgical procedure for EP Mx?

A

Laparoscopic salpingectomy (remove ectopic + tube it’s in)

35
Q

When would you do a Salpingotomy instead of Salpingectomy for EP Mx? (2 points)

A
  1. If other tube is damaged bc infection / disease / surgery
  2. This is to preserve the EP tube to preserve future fertility
36
Q

If you do a Salpingotomy instead of Salpingectomy, what should you do you need to do?

A
  1. HCG follow up until it reaches below 5
  2. To ensure no residual trophoblast
37
Q

What is the disadvantage of doing a Salpingotomy instead of a Salpingectomy for EP Mx?

A

Risk of recurrent EP in salvaged tube

38
Q

What are the Advantages of Surgical Mx of EP? (2 things)

A
  1. Reassurance that gonna be treated for defo
  2. High success rate
39
Q

What are the Disadvantages of Surgical Mx of EP? (2 things)

A
  1. Anaesthesia risk
  2. Damaging nearby structures
  3. DVT / PE / Haemorrhage / Infection
  4. Tx failure (salpingotomy)
40
Q

What do all Rhesus Negative women who receive Surgical Mx for EP need to be offered?

A

Anti-D prophylaxis

3. Y5 Zero to finals: O&G (27 decks)

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