Ectopic Pregnancy

Question 1

ectopic pregnancy is the leading cause of . . .

Answer 1

maternal death due to hemorrhage in the first trimester

Question 2

what is the biggest risk factor for ectopic pregnancy?

Answer 2

previous ectopic pregnancy

Question 3

where do most ectopic pregnancies occur?

Answer 3

fallopian tube (ampulla)

Question 4

what are the 3 classic symptoms of ectopic pregnancy?

Answer 4

abdominal pain
amenorrhea
vaginal bleeding

Question 5

we should have a high index of suspicion for ectopic pregnancy in any woman who presents with these symptoms: (4)

Answer 5

pelvic tenderness
enlarged uterus
adnexal mass
tenderness

Question 6

we should always order a pregnancy, except in these 3 instances:

Answer 6

no uterus (hysterectomy)
confirmed menopause
young prior to menarche

Question 7

the evaluation of a pregnant women with suspected ectopic gestation begins and is established with which 2 diagnostics?

Answer 7

beta HCG
transvaginal ultrasound

Question 8

in 85% of viable intrauterine pregnancies, the beta HCG concentration rises by at least _____ every 48 hours during the first 40 days of pregnancy

Answer 8

66%

Question 9

how does the beta HCG concentration rise in most ectopic and nonviable intrauterine pregnancies?

Answer 9

slower rate

Question 10

the serum HCG level above which a gestational sac should be visualized by US exam if an intrauterine pregnancy is present

Answer 10

discriminatory zone

Question 11

a serum beta HCG level at _____ or _____ is diagnostic with a transvaginal ultrasound

Answer 11

1500
2000

Question 12

a serum beta HCG level at _____ is diagnostic with a transabdominal ultrasound

Answer 12

6500

Question 13

what finding is highly suggestive of an extrauterine gestation and is the most common sonographic abnormality? (3)

Answer 13

complex adnexal mass + positive pregnancy test + empty uterus

Question 14

what is the medical treatment for ectopic pregnancy?

Answer 14

methotrexate

Question 15

what are the 3 surgical treatment options for ectopic pregnancy?

Answer 15

laparoscopy
exploratory laparotomy
salpingectomy/ostomy

Question 16

how does methotrexate treat ectopic pregnancy?

Answer 16

folic acid antagonist that inhibits DNA synthesis and cell proliferation

Question 17

what are 4 indications to be treated with methotrexate?

Answer 17

hemodynamically stable
beta HCG < 5,000
no fetal cardiac activity
ectopic mass < 3-4 cm

Question 18

what is the standard surgical approach for ectopic pregnancy?

Answer 18

laparoscopic surgery

Question 19

surgical incision into a fallopian tube

Answer 19

salpingostomy

Question 20

removal of a fallopian tube

Answer 20

salpingectomy

Question 21

what is the potential risk of salpingostomy?

Answer 21

recurrent ectopic pregnancy

Question 22

the presence of simultaneous pregnancies at two different implantation sites; most commonly intrauterine and ectopic

Answer 22

heterotopic pregnancy

Question 23

what diagnostic is used for a heterotopic pregnancy?

Answer 23

ultrasound

Question 24

how does a patient with a heterotopic pregnancy present? (2)

Answer 24

complex adnexal mass
OR
fluid in the pelvis

Question 25

what treatment is contraindicated in a heterotopic pregnancy if there is a viable intrauterine gestation?

Answer 25

methotrexate

Question 26

what is the standard of therapy for a coexisting tubal pregnancy?

Answer 26

salpingectomy