Ectopic pregnancy Flashcards
What is an ectopic pregnancy?
Ectopic pregnancy is a pregnancy that occurs outside the uterus, most commonly in the fallopian tube, but can also occur in the cervix, cornual region, ovary, abdomen, or within a hysterotomy scar.
What are the risk factors for ectopic pregnancy?
Prior ectopic pregnancy, prior bilateral tubal ligation (BTL), and current use of an intrauterine contraceptive device (IUCD).
What is the classic triad of symptoms for ectopic pregnancy?
Abdominal pain, amenorrhea, and vaginal bleeding.
What are the key examination findings suggestive of ectopic pregnancy?
Tenderness, adnexal mass, and possibly shock if the ectopic pregnancy has ruptured
What investigations are used to diagnose ectopic pregnancy?
Vital signs, urine pregnancy test, and transvaginal ultrasound (preferred). Blood tests for cross-match are also sent.
What ultrasound findings are diagnostic or suggestive of ectopic pregnancy?
Extrauterine gestational sac, yolk sac, fetal pole, extraovarian mass, and echogenic fluid in the cul-de-sac or abdomen.
What is the initial management of an ectopic pregnancy?
Obtain IV access with two large-bore cannulae, resuscitate with IV fluids and/or blood transfusion if in shock, and organize an emergency laparotomy if necessary.
How is ectopic pregnancy managed if the patient is stable and the pregnancy is unruptured?
Consider urgent laparoscopy or laparotomy, or conservative management with inpatient monitoring, serial abdominal exams, and repeat ultrasound in 2 days if surgery has not yet been performed.
What is the recommended dosing of Methotrexate (MTX) for the treatment of ectopic pregnancy?
The treatment uses an intermediate MTX dose of 50 mg/m² body surface area (BSA) or 1 mg/kg body weight, with a maximum dose of 100 mg in patients with normal renal function. No studies have evaluated the maximum dose of MTX specifically for ectopic pregnancy.
What is the follow-up protocol after Methotrexate (MTX) treatment for ectopic pregnancy?
After day 7, hCG testing is repeated weekly. On day 14, if there is a ≥15% decline in hCG from days 7 to 14, continue weekly hCG tests until undetectable. If the decline is <15%, an additional dose of MTX 50 mg/m² IM is given. If hCG is rising, a transvaginal ultrasound should be performed.
What is the next step if the hCG levels decline <15% from days 7 to 14 after MTX treatment for ectopic pregnancy?
Administer an additional dose of MTX 50 mg/m² IM.
What is the maximum number of MTX doses typically administered in the treatment of ectopic pregnancy?
A maximum of three doses of MTX is usually given. If there is an insufficient decline in hCG after the third dose, surgical intervention (e.g., laparoscopic salpingostomy or salpingectomy) may be considered.
What is the dosing and follow-up protocol in the two-dose MTX treatment for ectopic pregnancy?
MTX 50 mg/m² BSA is given on day 1 and day 4. Serum hCG levels are checked on days 1, 4, and 7. If hCG declines >15% by day 7, treatment stops and weekly hCG monitoring begins. If hCG decline is <15%, a third dose may be administered on day 7, and if needed, a fourth dose on day 11.
What should be considered if there is still an insufficient decline in hCG after a fourth dose of MTX in the two-dose protocol?
Surgery should be considered if there is still an insufficient decline in hCG after a fourth dose.
