Ectopic Pregnancy

Question 1

ectopic pregnancy incidence UK and % of direct maternal deaths

Answer 1

11.1 per 1000, 7.5% direct maternal deaths

Question 2

false negative rate of diagnostic laparoscopy for ectopic pregnancy

Answer 2

3-4%s

Question 3

false positive rate of diagnostic laparoscopy for ectopic pregnancy

Answer 3

5%

Question 4

percentages of isthmus, ampulla, fimbrial

Answer 4

25%, 55%, 17%

Question 5

percentages of cornual, ovarian or intra-abdominal ectopics

Answer 5

2% cornual
0.5% ovarian
0.1% intra abdominal

Question 6

risk factors for ectopic pregnancy

Answer 6

PID, IUCD, sterilisation, tubal surgery, previous ectopic, ART, mini-pill

Question 7

contraceptive with the lowest risk of ectopics

Answer 7

COCP < depo < mini-pill

Question 8

what is the discriminatory zone of HCG - the level above which an imaging scan should visualise gestational sac within uterus in normal IUP

Answer 8

1500-1800 with TVUS, but up to 2300 in multips

6000-6500 with TAUS

Question 9

what gestation may be offered expectant management

Answer 9

less than 6 weeks gestation with bleeding and NO pain - repeat pregnancy test in 7-10 days

Question 10

criteria for expectant managemebt

Answer 10

clinically stable, pain free

tubal ectopic <35mm with no heartbeat on TVUSS

serum hcg <1000-1500

able to return for follow-up

Question 11

when are hcg levels to be repeated

Answer 11

days 2, 4, 7 after the original test

Question 12

resolving ectopic - hcg should drop by how much

Answer 12

15% or more from previous value on day 2, 4, 7 - then repeat weekly until negative «20)

Question 13

there is no difference following expectant or medical management in what?

Answer 13

rates of ectopic ending naturally

risk of tubal rupture

need for additional treatment

health status, depression or anxiety

future fertility outcomes

Question 14

criteria for offering methotrexate

Answer 14

no signficant pain
unruptured tubal ectopic with mass smaller than 35mm no heart bead
serum hcg less than 1500
no intrauterinepregnacy
able to follow-up

Question 15

surgery first line criteria

Answer 15

signficant pain
adnexal mass over 35mm
fetal heartbeat visible on ultrasound
hcg 5000 or more

Question 16

salpingotomy rate of further treatment

Answer 16

1 in 5 women may need further treatment - methotrexate and/or salpingectomy

Question 17

when is hcg taken in salpingotomy

Answer 17

7 days after urgery, then 1 serum hcg per week unti negative

Question 18

dose of anti-D rhesus prophylaxis for rhesus negative women

Answer 18

250IU (50 micrograms)

Question 19

percentage of women who experience tubal rupture after medical treatment?

Answer 19

7%

Question 20

important advice after methotrexate

Answer 20

fluids, avoid intercourse, contraception for 3 months

Question 21

ipsilateral patency rates after medical treatment

Answer 21

80%

Question 22

intrauterine pregnancy rate after methotrexate

Answer 22

54%

Question 23

recurrent ectopic rate after methotrexate

Answer 23

8-10% - like salpingosstomy

Question 24

dose of intramuscular methotrexate

Answer 24

50mg per metre squared of body area

Question 25

complications associated with methotrexate

Answer 25

stomatitis, alopecia, haematosalpinx, neutropenia, pneumonitis, multiple ovarian cysts, failure

Question 26

in PUL; how much should hcg increase in 48 hours for likely developing intrauterine pregnancy?

Answer 26

over 63% in 48hrs - offer tvus 7-14 days later or earlier if hcg>1500

Question 27

in PUL, pregnancy unlikely to continue if hcg decrease is

Answer 27

over 50% in 48 hours

Question 28

likelihood of spontaneous heteroptopic

Answer 28

1 in 20,000 - 30,000 but after ART could be 1:100

Question 29

what is an interstitial pregnancy

Answer 29

absence of intrauterine pregnancy with presence of trophoblastic tissue located outside of the endometrial cavity

surrounded by a thin myometrial mantle or continuous rim of myometrium

Question 30

when do interstitial pregnancies rupture

Answer 30

8-16 weeks, highly vascular with blood supply from ovarian and uterine vessels - haemorrhage is profuse

Question 31

incidence of cervical pregnancy

Answer 31

1 in 8600-12400

Question 32

sign of cervical pregnancy on ultrasound

Answer 32

GS at level of uterine arteries - below the internal cervical os
absence of sliding sign

Question 33

CSEP incidence

Answer 33

1 in 1800-2200

Question 34

CSEP types

Answer 34

1) endogenic - implantation on the scar and the GS towards the uterine cavity
2) exogenic - GS grows towards bladder, a layer of myometrium may be seen between GS and bladder

Question 35

CSEP recurrence rik

Answer 35

3.2-5% in women with one previous CSEP treated by D&C

Question 36

what may happen following initial dose of methotrexate for CSEP management

Answer 36

hCG levels may go up and the size of the mass may increase due to trophoblastic necrosis and haemorrhage around the sac