Ectopic Pregnancy

Question 1

what is the leading cause of pregnancy related maternal death in T1?

Answer 1

ectopic pregnancy

Question 2

what is the most common site of ectopic pregnancy? be specific

Answer 2

fallopian tube (ampulla)

Question 3

what is the biggest risk factor for ectopic pregnancy?

Answer 3

prior ectopic

Question 4

t or f: ectopic pregnancy is the leads cause of pregnancy related deaths

Answer 4

true

Question 5

what is the location of the most dangerous ectopic pregnancy and why?

Answer 5

cornual pregnancies are most dangerous b/c they have the highest risk of uterine rupture

Question 6

t or f: increased age places mothers at higher risk for ectopic pregancy

Answer 6

true

Question 7

what are some risk factors associated with ectopic pregnancies? @ least 5

Answer 7

previous ectopic, PID, hx of STI, scarring of fallopian tubes or TB, cmoking, uterine malformations, DES exposure (diethylstilbestrol), current IUD use, assisted reproduction technology

Question 8

why is PID/hx of STI a risk factor for ectopic pregnancies?

Answer 8

b/c they cause scarring of the fallopian tubes

Question 9

what are three signs that an ectopic has ruptured?

Answer 9

hypotension, tachycardia and abdominal exam with rebound and guarding

Question 10

at what level of bHcg will a pt produce a positive urine pregnancy test?

Answer 10

25

Question 11

at what levels of bHcg is an IUP detectable on abdominal US?

Answer 11

5000 - remember, via TVU the levels must be between 1100-2000

Question 12

t or f: bHcg levels correlate with both the size of the ectopic and the gestational age

Answer 12

FALSE: it also does NOT detect the potential for rupture or the location of the ectopic

Question 13

t or f: bHcg levels from the urine are qualitative

Answer 13

TRUE: remember, the bHcg levels via plasma is QUANTITATIVE

Question 14

what is the modality of choice for diagnosis of an ectopic?

Answer 14

TVUS

Question 15

what are some of the US findings of an ectopic?

Answer 15

absence of intrauterine gestational sac, ectopic gestational sac, complex adnexal mass, FLUID IN THE CUL DE SAC

Question 16

fluid in the cul de sac represents what in terms of an ectopic pregnancy?

Answer 16

may represent blood from the rupture of an ectopic

Question 17

t or f: you must administer anti-d immunoglobulin if a patient is D negative upon discovery of an ectopic pregnancy

Answer 17

TRUE

Question 18

what is the treatment of choice for early un-ruptured ectopic?

Answer 18

MTX (methotrexate)

Question 19

what are the functions of MTX that make it a good treatment for early ectopic?

Answer 19

antimetabolic, interferes with DNA synthesis.

Question 20

what are the 3 main criteria for administration of MTX in an ectopic?

Answer 20

stable pt, small ectopic (smaller than 3.5cm), pt compliance.

Question 21

what are 3 absolute contraindications to MTX in an ectopic?

Answer 21

hemodynamically unstable pt, leukopenia, thrombocytopenia, active renal/hepatic disease, active peptic ulcer disease, presence of ruptured ectopic

Question 22

t or f: the DOC for pain in ectopics being treated with MTX are NSAIDs

Answer 22

FALSE: NEVER give NSAIDs and MTX as it can potentiate nephrotoxicity

Question 23

surgical tx for ectopics include laparotomy and laparoscopy - which is indicated for unstable pts?

Answer 23

laparotomy!

Question 24

salpingectomy vs. salpingostomy - which allows for sparing of the tube?

Answer 24

OSTOMY

Question 25

what is the post operative procedure for salpingostomy? and why?

Answer 25

bHcg must be trended down to zero as some pregnancy tissue may be left behind and continue to grow which leads to chronic ectopics