Ectopic Pregnancy Flashcards
What are the most common loctions for ectopic Pregnancy?
Tubal (70% ampulla, 12% isthmus)
Ovarian
Interstitial (rare)
Abdominal (rare)
What is the most common cause of first trimester pregnancy related death?
Ectopic Pregnancy
What are the High risk factors for Eptopic Pregnancy?
Prior Ectopic
Prior Tubal surgery, revesal, reconstruction
History of tubal ligation, esp cautery
Intrauterine Device
What are the Moderate risk factors for Ectopic Pregnancy?
Pror PID
Infertility
Multiple Sexual Partners
Smoking
How is Ectopic Pregnancy Diagnosed?
No pregnancy seen on trans vaginal US when you SHOULD see something…
Quantitative BHCG 1500-2000
What do the different Progesterone levels tell you?
25ng/ml: 97% viable pregnancies
What can different BHCG levels tell you about the location of the gestational sac?
2500: intrauterine gestational sac
6000: Gest sac by abdominal probe
What is the Cul-de-sac in the female pelvis?
The area behind the uterus where fluid can accumulate
What is a common cause of a mass in pregnancy?
Corpus luteum cyst
What is the medical management of Ectopic pregnancy?
Methotrexate to end the pregnancy. still can take a couple weeks.
What is the Surgical management of Ectopic Pregnancy?
Salpingectomy: Take it out
Salpingotomy: make an opening
What are absolute indications for methotrexate?
Hemodynamically stable Non-laparoscopic Diag Pt desires future fertility Gen anesthesia poses a risk Pt able to comply with followup No contra to methotrexate
What are the absolute CONTRAINDICATIONS to Methotrexate?
Breastfeeding Immune Def disorder Chronic Liver disease Blood Dyscrasia Known sensitivity Acute pulm disease PUD
What are the relative contraindications to methotrexate?
Unruptured mass >3.5 cm
Fetal Cardiac Activity
Quant BHCG Greater than pre determined level
WHat are the signs of Methotrexate treatment failure?
Worsening Abd pain
Hemo instability
BHCG no declining by day 7
Inc or plateau of BHCG after day 7
