Ectopic Pregnancy Flashcards
where is the most common site
ampulla of fallopian tube
name some common sites for implantation
ovaries, peritoneum, other organs scars
when do symptoms generally appear
usually first trimester, often 6-8 weeks after last menstrual period
some areas can accomodate the pregnancy for longer thna others
in whch site can ectopic pregnancies last for a long time
peritoneal pregnancies - can present with failure to induce labour in 3rd triemster
why is it so important to eliminate pregnancy before insertion of IUD or sterilization
if there is a pregnancy already taking place, can result in an ectopic pregnancy
how do ectopic pregnancies tend to present
unilateral lower abdominal pain
bleeding/amenorrhoea
how does rupture of ectopic pregnancy present
unstable vial signs - tachycardia, tachypnoea, low blood pressure
signs of intraperitoneal bleeding - peritonism, acute abdomen
where does pain from an irritated diaphragm get referred to
shoulder tip
what are some risk factors
tubal surgery, infection
PID or chlamydia
smoking
does IVF increase the risk of ectopic pregnancy
yes
what is a classical US sign seen
donut or tubal ring sign
how does the endometrium appear on US
thickened due to oestrogen release during pregnancy
how does hCG normally change during pregnancy
rise by >49% over 48 hours - reaches between 10,000 and 20,000 IU/L
what does a steady decrease in HCG levels indicate
a failing pregnancy
what usually happens to hCG levels during ectopic pregnancy
sub optimal increase - how much they increase affects management plan
what are the clinical indicators for expectant managemenet
only really do if very small, beta hCG levels are low and falling
has to be no foetal heart sounds or symptoms
what comprises the medical management of ectopics
methotrexate - folic acid antagonist
how long does the process of medical management take
methotrextae is given and then hCG levels are monitored after, should take 2-4 weeks to return to normal
name the contraindications to methotrexate
immunodeficiency, liver disease, renal disease, active peptic ulcer disease, significant pulmonary disease (causes pneumonitis), haematological abnormalities, intrauterine pregnancy (teratogenic)
when is salpingotomy preferred to salpingectomy
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
