Ectopic Pregnancy Flashcards
Ectopic pregnancy is when an ovum has been fertilised and implants outside of the uterine cavity. Can this be dangerous?
- yes
- obstetric emergency
All of the following are sites where ectopic pregnancies are typically found, EXCEPT which one?
1 - ovary
2 - fallopian tube
3 - cervix
4 - abdominal cavity
5 - vagina
5 - vagina
All of the following are sites where ectopic pregnancies are typically found. Which is most common?
1 - ovary
2 - ampulla region of fallopian tube
3 - cervix
4 - abdominal cavity
2 - ampulla region of fallopian tube
- accounts for 97% of cases
Which age group are most commonly affected by ectopic pregnancies?
1 - 15-20
2 - 20-30
3 - 30-40
4 - >40
3 - 30-40
Which of the following is a risk factor for ectopic pregnancies?
1 - Tubal factors
2 - PID
3 - Previous ectopic pregnancy
4 - Assisted reproductive technology
5 - Age
6 - Intrauterine device (IUD)
7 - Endometriosis
8 - Smoking
5 - Age
Tubal impairments are main cause:
- PID
- Smoking
- Genetic abnormalities
- Endometriosis
The pathophysiology of ectopic pregnancies includes 3 key features, which of the following is NOT one of these?
1 - Malignancy
2 - Abnormal embryo migration
3 - Impaired tubal environment
4 - Embryo-tubal interactions
1 - Malignancy
- Abnormal embryo migration = Disrupted tubal motility, due to factors such as PID, endometriosis, or smoking.
- Impaired tubal environment = Inflammatory processes, including infection or endometriosis, can alter the tubal milieu, promoting ectopic implantation
- Embryo-tubal interactions = Alterations in the expression of adhesion molecules and chemokines, such as integrins and L-selectin, may affect the embryo-tubal relationship, leading to ectopic pregnancy.
Which of the following is a typical presentation of an ectopic pregnancy?
1 - female with oligomenorrhea
2 - female with 6-8 weeks of amenorrhea
3 - female with 12-16 weeks of amenorrhea and abnormal bleeding
4 - female with 6-8 weeks of oligomenorrhea
2 - female with 6-8 weeks of amenorrhea
- can experience bleeding with abdominal pain
- amenorrhea is due to pregnancy or ectopic pregnancy in this case
Which of the following is MOST likely to indicate an ectopic pregnancy?
1 - intermittent unilateral lower abdominal pain
2 - intermittent bilateral lower abdominal pain
3 - constant bilateral lower abdominal pain
4 - constant unilateral lower abdominal pain
4 - constant unilateral lower abdominal pain
- pain is due to tubular spasm
- typically 1st line and explains unilateral pain
Ectopic pregnancies can cause bleeding, which typically can be less than a normal period and be darker in colour. Amenorrhea is common, but which has amenorrhea for longer, an ectopic pregnancy or inevitable miscarriage?
- inevitable miscarriage
In ectopic pregnancies patients can experience which 2 of the following abdominal symptoms?
1 - pain on defecation
2 - bowel obstruction
3 - tenesmus (urge to pass stool)
4 - ovarian torsion
1 - pain on defecation
3 - tenesmus (urge to pass stool)
- blood pools in pouch of Douglas and can cause these symptoms
Ectopic pregnancies can cause shoulder pain that is deferred. Which nerve is commonly affected?
1 - recurrent laryngeal nerves
2 - phrenic nerve
3 - pudendal nerve
4 - sciatic nerve
2 - phrenic nerve
- innervates the diaphragm, which can be irritated by blood in abdomen
Why can dizziness, fainting or syncope present in an ectopic pregnancy?
1 - loss of blood if rupture
2 - underlying neural defect
3 - encephalopathy due to infection
4 - all of the above
1 - loss of blood if rupture
In an ectopic pregnancy, do patients typically experience pregnancy symptoms?
- yes
- patient is pregnant so symptoms should present
Which of the following is least important when trying to diagnose an ectopic pregnancy?
1 - pregnancy test
2 - serum hCG
3 - CRP and ESR
4 - group and save + crossmatch
5 - FBC
3 - CRP and ESR
- all other tests should be done routinely
Is a single human chorionic gonadotrophin (hCG) diagnostic of an ectopic pregnancy?
- no
- cannot distinguish between ectopic and normal pregnancy
Human chorionic gonadotrophin (hCG) can be measured to try and identify if a patient is pregnant or has an ectopic pregnancy using serial hCG testing. How much should hCG levels rise every 2 days?
1 - 10%
2 - 25%
3 - 200%
4 - 1000%
3 - 200%
- should double every 2 days
Human chorionic gonadotrophin (hCG) can be measured to try and identify if a patient is pregnant or has an ectopic pregnancy using serial hCG testing. The hCG should double every 2 days, before peaking and plateauing around which week?
1 - 6
2 - 8
3 - 10
4 - 16
3 - 10
Although not definitive if hCG does not rise as much as expected, this may suggest an ectopic pregnancy. What is value used to identify a hCG level that is associated with a viable (non-ectopic) uterine pregnancy?
1 - 1,500 - 2,000 mIU/mL
2 - 3000 - 4000 mIU/mL
3 - 5000 - 7000 mIU/mL
4 - >10,000 mIU/mL
1 - 1,500 - 2,000 mIU/mL
What is the 1st line imaging technique in a patient with suspected ectopic pregnancy?
1 - abdominal ultrasound
2 - MRI
3 - transvaginal ultrasound
4 - CT
3 - transvaginal ultrasound
- if unable to confirm, described as pregnancy of unknown location
- abdominal ultrasound if transvaginal is not possible
- doppler ultrasonography can compliment transvaginal and show blood flow around trophoblasts
Which of the following management options would be suitable for the following:
- no foetal HR
- hCG <1000 mIU/mL
- asymptomatic patient
- non-ruptured
- gestational sac <35mm
1 - surgical management
2 - medical management
3 - expectant management
3 - expectant management
- patient monitored for hCG levels and potentially transvaginal ultrasound
- eventually patient passes gestational sac
Which of the following management options would be suitable for the following:
- no foetal HR
- hCG <1500 mIU/mL
- no significant pain
- non-ruptured
- gestational sac <35mm
1 - surgical management
2 - medical management
3 - expectant management
2 - medical management
- hCG and transvaginal ultrasound may be required to monitor
- patient will be given medication and must attend for a follow up
In a patient who needs to have medical management of an unruptured ectopic pregnancy, which medication are they given?
1 - misoprostol
2 - methotrexate
3 - mifepristone
4 - metoclopramide
2 - methotrexate
- given via IM
- cytotoxic and teratogenic
- impairs cell replication
- must avood getting pregnant for >6 months
Which of the following management options would be suitable for the following:
- viable foetal HR
- hCG >5000 mIU/mL
- significant pain
- may or may not be ruptured
- gestational sac >35mm
1 - surgical management
2 - medical management
3 - expectant management
1 - surgical management
- laparoscopy will be performed
Surgical management may be needed in ectopic pregnancies. Which of the following is typically the first line surgical approach?
1 - salpingectomy
2 - salpingotomy
3 - hysterectomy
1 - salpingectomy
- used for low risk women
- salpingotomy considered for women with risk factors for infertility such as contralateral tube damage
- if salpingotomy 1 in 5 may need medication as well )methotrexate)
