Ectopic pregnancy

Question 1

RF for ectopic pregnancy are

Answer 1

Prior ectopic
Hx of tubal surgery (ligation or reconstruction)
Hc of PID (tubal damage)

Question 2

What is an ectopic pregnancy

Answer 2

implantation of a developing oocyte outside the endometrial cavity
MC in the fallopian tube, most of which are in the ampullary portion

Question 3

How does an ectopic pregnancy present

Answer 3

Pelvic/abdominal pain
vaginal bleeding
orthostatic Sx (dizzy, fainting, weakness)
signs of shock on vital signs

Question 4

How do you treat an ectopic pregnancy medically

Answer 4

• Admin RhoGAM if mom is Rh-
• Give methotrexate IM (inhibit DNA synthesis and cell reproduction)
• HCG should be <5000, with no cardiac activity, and sac <4 cm
• Repeat HCG on days 4-7 after methotrexate, HCG should decrease by 15% (if not. methotrexate didn’t work; either repeat admin or surgery

Question 5

Contraindications to Methotrexate include

Answer 5

renal, liver, or pulmonary compromise
breast feeding
heterotropic pregnancy (two pregnancies basically)
immunodeficient

Question 6

How do you surgically manage an ectopic pregnancy

Answer 6

-Give RhoGAM if mom is RH-
Laparoscopy vs Laparotomy
Salpingostomy vs Salpingectomy
-Does not affect future reproduction bc the contralateral tube and ovary still work

Question 7

When is surgical Tx of an ectopic indicated

Answer 7

Hemodynamically unstable
Impending or active rupture
Methotrexate failure
Heterotopic pregnancy