Ectopic Pregnancy Flashcards
Why has the incidence of ectopic pregnancy increased in the last couple decades?
Increased incidence of PID and salpingitis
Whata re the main risk factors for having an ectopic pregnancy?
- Hx of chlamydia or GC (these can often be asymptomatic and ascend to the tubes)
- PID
- Tubal ligation
- Previous ectopic pregnancy (7% of future ectopic pregnancy)
- Pregnancy achieved through IVF
- Endometriosis b/c of scarring
- Previous tubal reanastamosis (less and less frequent as IVF becomes more and more successful)
Where does fertilizaiton normally occur?
the ampullary region of the fallopian tubes (remember that scarring of the fallopian tubes can prevent rhe mbryo from traversing the tubes to the uterus)
How does ectopic pregnancy most commonly present?
Usually around 7-8 weeks gestation, pts. will present with irregular bleeding or pain that concerns them of a miscarriage. When the pts. come in they will get a pregnancy test, which will be positive, and then an ultrasound, which will show an empty uterus
So what would be on the ddx for a positive pregnancy test and no confirmed IUP?
- Ectopic pregnancy
- Early IUP
- Spontaneous abortion
How would the diagnosis of ectopic pregnancy be confirmed if the pt. came in and got the positive preganncy test and the empty IUP via ultrasound and appeared unstable?
You’d want to look for blood in the abdomen, and typically these pts. will be tachycardic and hypotensive depending on how far along they are. a CBC will most likely show anemia
If this is confirmed, type and cross and go to the OR
How would the diagnosis of ectopic pregnancy be confirmed if the pt. came in and got the positive preganncy test and the empty IUP via ultrasound and appeared stable?
Be patient- obviously be thinking ectopic but you dont want to do anything to interrupt a normal ongoing pregnancy. Counsel the pt. about the signs of potential rupture before they leave if you discharge them!
So, the way to handle this would be to draw quantitative levels of hCG and progesterone
What is the difference between a hoem pregnancy test and quantitative hCG levels?
a home pregnancy test will be positive if the hCG is above 25millunits/ml, while a quantitative hCG draw can be used more diagnostically to determine the stage and locaiton of the pregnancy. I.e. if you draw an hCG of 2000milliunits/ml, you should DEFINITELY see something in the uterus, unless ectopic pregnancy is occurring- may even see cardiac activity
What progesteron elvels mihgt indicate that something wrong is occurring with the pregnancy?
a progesterone level less than 5 after a confirmed pregnancy test suggests either a SAB or an ectopic pregnancy
progetserone should be 20-40 normally
What would be the next thing to look for if you get a quantitative hCG draw after getting a positive pregnancy test and seeing an empty uterus and its still on the borderline (somewhere around 200), which could either indicate an ectopic pregnancy or just an early pregnancy?
Monitor hCG levels- they should double within 48 hrs if normal
What would you do if still after 48 hrs hCG levels arent where you want them to be (i.e. they might increase still but they dont double), progesterone is still low, and an UP is absent on ultrasound still?
The next step would be to cutrette the uterus (take to the OR and do a DNC) and look for products of conception (villi). If they are present, the Dx is SAB, and if not the dx is ecoptic pregnancy
What causes the pain associated with a ruptured ectopic pregnancy?
Mostly due to the accumulation of blood into the peritoneum
C.
When is the first time you should be able to see a fetus?
Typically at 5-7 weeks gestation… If not, the ddx CAN include ectopic
Should be able to see the yolk sac and maybe a heart beat
