Ectopic Pregnancy Flashcards
Risk factors
Pelvic Inflammatory Disease Previous ectopic pregnancy Tubal surgery including BTL Previous pelvic or abdominal surgery Tubal Pathology In utero diethylstilbestrol (DES) exposure Intrauterine device use Smoking Infertility and infertility treatments
What is the classic triad for ectopic?
The classic triad of abdominal pain, delayed menses, and vaginal bleeding is neither sensitive nor specific for ectopic pregnancy.
What should you do if you have a positive FAST and positive pregnancy test?
The combination of positive FAST and positive pregnancy test should prompt an immediate call to OB-GYN to take the patient to the OR for a presumptive diagnosis of ruptured ectopic pregnancy.
What is the discriminatory zone?
- The discriminatory zone of β-hCG is the level at which an IUP should be visible by transvaginal ultrasonography, typically 1500-2000 mIU/mL.
- An ectopic pregnancy is highly likely in patients with a β-hCG level greater than 1500 with the absence of intrauterine pregnancy on transvaginal ultrasound.
What are ultrasound findings suggestive of an ectopic?
Ultrasound signs of an ectopic include an empty uterus, extraovarian mass, tubal ring sign (click Figure to the left), and pelvic free fluid.
What repeat beta HCG findings are suspicious for ectopic?
Patients with a rise in serum β-hCG level slower than expected are highly suspicious for ectopic pregnancy.
What culdocentesis findings are suggestive of ectopic?
Greater than 2ml of nonclotting blood is suggestive of hemoperitoneum and ruptured ectopic pregnancy.
Should you give rhogam?
Additionally, 50 �g of anti-D immunoglobulin (RhoGAM) should be administered to any Rh-negative woman in all cases of suspected ectopic pregnancy or vaginal bleeding to prevent alloimmunization of the mother.
Methotrexate?
Methotrexate is the most successful method to medically manage a patient with ectopic pregnancy and may preserve fertility better than surgical interventions. Methotrexate should only be given in conjunction with OB/GYN consultation.
Contraindications to methotrexate
hemodynamic instability, inability to return for follow-up, breastfeeding, immunodeficiency, renal, liver or pulmonary disease, peptic ulcer disease, and blood dyscrasias.
What happens to patients 3-7 days after methotrexate?
Patients receiving methotrexate often experience abdominal pain 3-7 days after administration which is thought to be secondary to tubal abortion or expanding hematoma within the fallopian tube.
What patients need to undergo laparoscopy?
Unstable patients, those with contraindications to methotrexate therapy, and patients failing medical management should undergo laparoscopy.
