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Year 2 OBGYN > Ectopic pregnancy > Flashcards

Ectopic pregnancy Flashcards

1
Q

how common are ectopic pregnancies?

A

2% of all pregnancies

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2
Q

what explains the rising incidence of ectopic pregnancies?

A
  • rising incidence of PID
  • IVF
  • early diagnosis
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3
Q

what is the most common cause of first trimester pregnancy related deaths? why?

A

ectopic pregnancy

(concealed, intraperitoneal) hemorrhage

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4
Q

ectopic pregnancy is the most common cause of pregnancy related death during which trimester? what is the direct cause?

A

first

(concealed, intraperitoneal) hemorrhage

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5
Q

black women are how many times more likely to have an ectopic pregnancy compared to white women?

A

5x

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6
Q

what are the HIGH risk factors for ectopic pregnancy?

A
  • prior ectopic
  • prior tubal surgery (reversal, reconstruction)
  • history of tubal ligation, especially cautery
  • IUD
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7
Q

what are the MODERATE risk factors for ectopic pregnancy?

A
  • prior IUD
  • infertility
  • multiple sexual partners
  • smoking
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8
Q

what are the SLIGHT risk factors for ectopic pregnancy?

A
  • IVF
  • age over 35
  • prior spontaneous abortion
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9
Q

what is the presentation for ectopic pregnancy?

A
  • first trimester bleeding
  • abdominal / pelvic pain
  • asymptomatic
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10
Q

what test is used to diagnose ectopic pregnancy? what is “seen”?

A

ultrasound - no intrauterine pregnancy by trans-vaginal US at a time when you SHOULD seen something

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11
Q

what lab test is used to help diagnose ectopic pregnancy? what is the level?

A

quantitative B-hCG: 1500-2000

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12
Q

what test is generally required before any significant decisions are made about ectopic pregnancy?

A

quantitative B-hCG: 1500-2000

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13
Q

BHCG levels rise rapidly in what trimester? how often do they double?

A

first

double every 48 hours

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14
Q

when do BHCG levels plateau?

A

around 10 weeks

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15
Q

progesterone levels under what value indicate that the pregnancy is NOT normal?

A

less than 5 ng/mL

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16
Q

at what BHCG level will you see a gestational sac by abdominal probe US?

A

6000

17
Q

what is the discriminatory zone?

A

zone in which you should reasonably be able to determine if the pregnancy is normal or not

18
Q

at a BHCG level of 6000 what should you be able to see by abdominal US?

A

gestational sac

19
Q

what is the medical management for (unruptured) ectopic pregnancy in STABLE patients?

A

methotrexate

20
Q

what are the two surgical treatment options for ectopic pregnancy?

A
  • salpingectomy

- salpingotomy

21
Q

what are the indications for methotrexate in (unruptured) ectopic pregnancy?

A
  • hemodynamically stable
  • non-laparoscopic diagnosis
  • patient desires future fertility
  • general anesthesia poses a risk
  • patient able to comply with follow up
  • no contraindications
22
Q

what are the absolute contraindications for methotrexate in (unruptured) ectopic pregnancy? IMPORTANT

A
  • breastfeeding
  • immune deficiency disorder
  • chronic liver disease
  • preexisting blood dyscrasias
  • known sensitivity
  • acute pulmonary disease
  • peptic ulcer disease
23
Q

what are the RELATIVE contraindications for methotrexate in (unruptured) ectopic pregnancy?

A
  • unruptured mass over 3.5 cm
  • fetal cardiac activity seen
  • quantitative BHCG greater than predetermined level (6k - 15k)
24
Q

BHCG levels should decline by what % following methotrexate administration?

A

15%

25
Q

what are the signs of methotrexate treatment failure for (unruptured) ectopic pregnancy?

A
  • significantly worse abdominal pain
  • hemodynamic instability
  • BHCG not declining by 15% by day 7
  • increase or plateau of BHCG after day 7
26
Q

is risk of repeat ectopic pregancy higher following a salpingotomy or salpingectomy?

A

salpingotomy

27
Q

what puts a woman at the highest risk for an ectopic pregnancy?

A

prior tubal surgery

Year 2 OBGYN (33 decks)

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