Ectopic pregnancy Flashcards
how common are ectopic pregnancies?
2% of all pregnancies
what explains the rising incidence of ectopic pregnancies?
- rising incidence of PID
- IVF
- early diagnosis
what is the most common cause of first trimester pregnancy related deaths? why?
ectopic pregnancy
(concealed, intraperitoneal) hemorrhage
ectopic pregnancy is the most common cause of pregnancy related death during which trimester? what is the direct cause?
first
(concealed, intraperitoneal) hemorrhage
black women are how many times more likely to have an ectopic pregnancy compared to white women?
5x
what are the HIGH risk factors for ectopic pregnancy?
- prior ectopic
- prior tubal surgery (reversal, reconstruction)
- history of tubal ligation, especially cautery
- IUD
what are the MODERATE risk factors for ectopic pregnancy?
- prior IUD
- infertility
- multiple sexual partners
- smoking
what are the SLIGHT risk factors for ectopic pregnancy?
- IVF
- age over 35
- prior spontaneous abortion
what is the presentation for ectopic pregnancy?
- first trimester bleeding
- abdominal / pelvic pain
- asymptomatic
what test is used to diagnose ectopic pregnancy? what is “seen”?
ultrasound - no intrauterine pregnancy by trans-vaginal US at a time when you SHOULD seen something
what lab test is used to help diagnose ectopic pregnancy? what is the level?
quantitative B-hCG: 1500-2000
what test is generally required before any significant decisions are made about ectopic pregnancy?
quantitative B-hCG: 1500-2000
BHCG levels rise rapidly in what trimester? how often do they double?
first
double every 48 hours
when do BHCG levels plateau?
around 10 weeks
progesterone levels under what value indicate that the pregnancy is NOT normal?
less than 5 ng/mL
at what BHCG level will you see a gestational sac by abdominal probe US?
6000
what is the discriminatory zone?
zone in which you should reasonably be able to determine if the pregnancy is normal or not
at a BHCG level of 6000 what should you be able to see by abdominal US?
gestational sac
what is the medical management for (unruptured) ectopic pregnancy in STABLE patients?
methotrexate
what are the two surgical treatment options for ectopic pregnancy?
- salpingectomy
- salpingotomy
what are the indications for methotrexate in (unruptured) ectopic pregnancy?
- hemodynamically stable
- non-laparoscopic diagnosis
- patient desires future fertility
- general anesthesia poses a risk
- patient able to comply with follow up
- no contraindications
what are the absolute contraindications for methotrexate in (unruptured) ectopic pregnancy? IMPORTANT
- breastfeeding
- immune deficiency disorder
- chronic liver disease
- preexisting blood dyscrasias
- known sensitivity
- acute pulmonary disease
- peptic ulcer disease
what are the RELATIVE contraindications for methotrexate in (unruptured) ectopic pregnancy?
- unruptured mass over 3.5 cm
- fetal cardiac activity seen
- quantitative BHCG greater than predetermined level (6k - 15k)
BHCG levels should decline by what % following methotrexate administration?
15%
what are the signs of methotrexate treatment failure for (unruptured) ectopic pregnancy?
- significantly worse abdominal pain
- hemodynamic instability
- BHCG not declining by 15% by day 7
- increase or plateau of BHCG after day 7
is risk of repeat ectopic pregancy higher following a salpingotomy or salpingectomy?
salpingotomy
what puts a woman at the highest risk for an ectopic pregnancy?
prior tubal surgery
