Ectopic Pregnancy Flashcards
what is the leading cause of pregnancy related maternal death in T1?
ectopic pregnancy
what is the most common site of ectopic pregnancy? be specific
fallopian tube (ampulla)
what is the biggest risk factor for ectopic pregnancy?
prior ectopic
t or f: ectopic pregnancy is the leads cause of pregnancy related deaths
true
what is the location of the most dangerous ectopic pregnancy and why?
cornual pregnancies are most dangerous b/c they have the highest risk of uterine rupture
t or f: increased age places mothers at higher risk for ectopic pregancy
true
what are some risk factors associated with ectopic pregnancies? @ least 5
previous ectopic, PID, hx of STI, scarring of fallopian tubes or TB, cmoking, uterine malformations, DES exposure (diethylstilbestrol), current IUD use, assisted reproduction technology
why is PID/hx of STI a risk factor for ectopic pregnancies?
b/c they cause scarring of the fallopian tubes
what are three signs that an ectopic has ruptured?
hypotension, tachycardia and abdominal exam with rebound and guarding
at what level of bHcg will a pt produce a positive urine pregnancy test?
25
at what levels of bHcg is an IUP detectable on abdominal US?
5000 - remember, via TVU the levels must be between 1100-2000
t or f: bHcg levels correlate with both the size of the ectopic and the gestational age
FALSE: it also does NOT detect the potential for rupture or the location of the ectopic
t or f: bHcg levels from the urine are qualitative
TRUE: remember, the bHcg levels via plasma is QUANTITATIVE
what is the modality of choice for diagnosis of an ectopic?
TVUS
what are some of the US findings of an ectopic?
absence of intrauterine gestational sac, ectopic gestational sac, complex adnexal mass, FLUID IN THE CUL DE SAC
fluid in the cul de sac represents what in terms of an ectopic pregnancy?
may represent blood from the rupture of an ectopic
t or f: you must administer anti-d immunoglobulin if a patient is D negative upon discovery of an ectopic pregnancy
TRUE
what is the treatment of choice for early un-ruptured ectopic?
MTX (methotrexate)
what are the functions of MTX that make it a good treatment for early ectopic?
antimetabolic, interferes with DNA synthesis.
what are the 3 main criteria for administration of MTX in an ectopic?
stable pt, small ectopic (smaller than 3.5cm), pt compliance.
what are 3 absolute contraindications to MTX in an ectopic?
hemodynamically unstable pt, leukopenia, thrombocytopenia, active renal/hepatic disease, active peptic ulcer disease, presence of ruptured ectopic
t or f: the DOC for pain in ectopics being treated with MTX are NSAIDs
FALSE: NEVER give NSAIDs and MTX as it can potentiate nephrotoxicity
surgical tx for ectopics include laparotomy and laparoscopy - which is indicated for unstable pts?
laparotomy!
salpingectomy vs. salpingostomy - which allows for sparing of the tube?
OSTOMY
what is the post operative procedure for salpingostomy? and why?
bHcg must be trended down to zero as some pregnancy tissue may be left behind and continue to grow which leads to chronic ectopics
