Ectopic Pregnancy Flashcards

1
Q

where is the most common site

A

ampulla of fallopian tube

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2
Q

name some common sites for implantation

A

ovaries, peritoneum, other organs scars

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3
Q

when do symptoms generally appear

A

usually first trimester, often 6-8 weeks after last menstrual period

some areas can accomodate the pregnancy for longer thna others

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4
Q

in whch site can ectopic pregnancies last for a long time

A

peritoneal pregnancies - can present with failure to induce labour in 3rd triemster

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5
Q

why is it so important to eliminate pregnancy before insertion of IUD or sterilization

A

if there is a pregnancy already taking place, can result in an ectopic pregnancy

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6
Q

how do ectopic pregnancies tend to present

A

unilateral lower abdominal pain

bleeding/amenorrhoea

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7
Q

how does rupture of ectopic pregnancy present

A

unstable vial signs - tachycardia, tachypnoea, low blood pressure

signs of intraperitoneal bleeding - peritonism, acute abdomen

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8
Q

where does pain from an irritated diaphragm get referred to

A

shoulder tip

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9
Q

what are some risk factors

A

tubal surgery, infection

PID or chlamydia

smoking

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10
Q

does IVF increase the risk of ectopic pregnancy

A

yes

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11
Q

what is a classical US sign seen

A

donut or tubal ring sign

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12
Q

how does the endometrium appear on US

A

thickened due to oestrogen release during pregnancy

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13
Q

how does hCG normally change during pregnancy

A

rise by >49% over 48 hours - reaches between 10,000 and 20,000 IU/L

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14
Q

what does a steady decrease in HCG levels indicate

A

a failing pregnancy

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15
Q

what usually happens to hCG levels during ectopic pregnancy

A

sub optimal increase - how much they increase affects management plan

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16
Q

what are the clinical indicators for expectant managemenet

A

only really do if very small, beta hCG levels are low and falling

has to be no foetal heart sounds or symptoms

17
Q

what comprises the medical management of ectopics

A

methotrexate - folic acid antagonist

18
Q

how long does the process of medical management take

A

methotrextae is given and then hCG levels are monitored after, should take 2-4 weeks to return to normal

19
Q

name the contraindications to methotrexate

A

immunodeficiency, liver disease, renal disease, active peptic ulcer disease, significant pulmonary disease (causes pneumonitis), haematological abnormalities, intrauterine pregnancy (teratogenic)

20
Q

when is salpingotomy preferred to salpingectomy

A

this is opening the tube and removing teh pregnancy (as opposed to removing the whole tube)

indicated when pt doesnt have a 2nd tube and wants to remain fertile etc