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A. MLA Map Obstetrics and Gynaecology > Ectopic Pregnancy > Flashcards

Ectopic Pregnancy Flashcards

1
Q

Ectopic pregnancy is when an ovum has been fertilised and implants outside of the uterine cavity. Can this be dangerous?

A
  • yes
  • obstetric emergency
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2
Q

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

A

5 - vagina

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3
Q

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

A

2 - ampulla region of fallopian tube
- accounts for 97% of cases

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4
Q

Which age group are most commonly affected by ectopic pregnancies?

1 - 15-20
2 - 20-30
3 - 30-40
4 - >40

A

3 - 30-40

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5
Q

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

A

5 - Age

Tubal impairments are main cause:
- PID
- Smoking
- Genetic abnormalities
- Endometriosis

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6
Q

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

A

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.
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7
Q

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

A

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
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8
Q

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

A

4 - constant unilateral lower abdominal pain

  • pain is due to tubular spasm
  • typically 1st line and explains unilateral pain
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9
Q

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?

A
  • inevitable miscarriage
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10
Q

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

A

1 - pain on defecation
3 - tenesmus (urge to pass stool)

  • blood pools in pouch of Douglas and can cause these symptoms
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11
Q

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

A

2 - phrenic nerve
- innervates the diaphragm, which can be irritated by blood in abdomen

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12
Q

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

A

1 - loss of blood if rupture

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13
Q

In an ectopic pregnancy, do patients typically experience pregnancy symptoms?

A
  • yes
  • patient is pregnant so symptoms should present
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14
Q

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

A

3 - CRP and ESR
- all other tests should be done routinely

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15
Q

Is a single human chorionic gonadotrophin (hCG) diagnostic of an ectopic pregnancy?

A
  • no
  • cannot distinguish between ectopic and normal pregnancy
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16
Q

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%

A

3 - 200%
- should double every 2 days

17
Q

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

A

3 - 10

18
Q

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

A

1 - 1,500 - 2,000 mIU/mL

19
Q

What is the 1st line imaging technique in a patient with suspected ectopic pregnancy?

1 - abdominal ultrasound
2 - MRI
3 - transvaginal ultrasound
4 - CT

A

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
20
Q

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

A

3 - expectant management
- patient monitored for hCG levels and potentially transvaginal ultrasound

  • eventually patient passes gestational sac
21
Q

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

A

2 - medical management
- hCG and transvaginal ultrasound may be required to monitor

  • patient will be given medication and must attend for a follow up
22
Q

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

A

2 - methotrexate
- given via IM
- cytotoxic and teratogenic
- impairs cell replication
- must avood getting pregnant for >6 months

23
Q

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

A

1 - surgical management
- laparoscopy will be performed

24
Q

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

A

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)
25
Q

All of the following are complications of ectopic pregnancy. Which is the most serious?

1 - Haemoperitoneum
2 - Tubal rupture
3 - Persistent trophoblastic tissue
4 - Infection
5 - Damage to reproductive organs
6 - Rh sensitization

A

2 - Tubal rupture
- patients present with severe intraperitoneal haemorrhage.
- sudden, severe abdominal pain
- hypovolemic shock (tachycardia, hypotension, pallor)
- peritoneal irritation
- prompt surgical intervention is crucial to prevent maternal mortality.

A. MLA Map Obstetrics and Gynaecology (29 decks)

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