Ectopic Pregnancy Flashcards
What percent of pregnancies do ectopic pregnancies account for?
2%
In women presenting to the ER with bleeding or pain what percent will have an ectopic pregnancy?
18%
What percent of ectopic pregnancies are in the fallopian tube?
97%
What is the mortality rate associated with ectopic pregnacies?
3.8/10,000
Infertility and the use of infertility treatments ____ your risk of ectopic pregnancy
increases
T/F: DES exposure in utero increases your risk of ectopic pregnancy?
True
At what level should bHCG increase in 48 hrs to suggest viable pregnancy?
increase by 53%
If the initial HCG is < 1500 what is a normal percent rise in 48 hrs?
49%
If the initial HCG is between 1500 - 3000 what is the normal percent rise in 48 hrs?
40%
If the initial HCG is > 3000 what is the normal percent rise?
33%
What is the first ultrasonographic finding of a viable IUP?
Double ring sign, decidual reaction
What discriminatory zone for BHCG is is now used?
3500
In early pregnancy the _____ produces progesterone
Corpus luteum
If progesterone level is ____ that signifies normal IUP
> 20 ng/ml
If progesterone level is _____ that suggests nonviable pregnancy
< 5 ng/dl
If a pregnancy is non desired and technically a PUL, what is the next best step in management?
Dilation and curretage
A BHCG decrease of ____ 24 hrs following D&C suggests removal of normal pregnancy
50%
A BHCG decrease of < _____ 24 hrs following D&C indicates an ectopic pregnancy
15%
What type of drug is methotrexate?
Folic acid antagonist
What is the mechanism of methotrexate?
inactivates dihydrofolate reductase thereby decreasing available tetrahydrofolate, essential cofactor for DNA and RNA synthesis
What labs should be checked prior to methotrexate administration?
Serum creatinine, LFTs, CBC, type and Screen
What are absolute contraindications for methotrexate therapy?
Breastfeeding, Immunocompromised, liver disease, pulmonary disease ,peptic ulcer disease, renal dysfunction, blood dyscrasias
What are relative contraindications for methotrexate therapy
MSD > 3.5 cm, HCG > 5000, presence of fetal heart beat, CRL > 5 cm
What are the most common side effects of methotrexate
Nausea, vomiting, diarrhea
True or false: When a patient takes methotrexate you should advise them to stop taking prenatal vitamins and folic acid supplements?
True
What is the dose of methotrexate given in single dose regimen?
50 mg/m
When should you recheck BHCG and at what percent should you see a decrease in HCG
Day 4 and Day 7, 15% decrease
After you see a 15% decrease between day 4 and 7, how long should you follow BHCG?
Weekly until BHCG zero
What is the regimen for fixed multidose Methotrexate protocol?
MTX 1 mg/kg on days 1,3,5,7 with folinic acid (Leucovorin) administration on days 2,4,6,8
How do you measure HCG with the multidose methotrexate regimen?
Measure BHCG on the MTX treatment days (1,3,5,7) until you see a 15% decrease from previous day.
When should you consider using the multidose methotrexate regimen?
More advanced pregnancies with higher HCG levels
What is the regimen for 2 dose Methotrexate protocol?
MTX 50 mg/m on day 1 and day 4
How do you measure HCG with 2 dose methotrexate protocol and how much should it decrease?
Measure BHCG on day 4 and day 7, 15%
In the 2 dose methotrexate protocol, If the BHCG on day 4 and day 7 is < 15% following 2 doses of methotrexate, when should you give more MTX?
Day 7 and Day 11
Following salpingostomy for surgical management of an ectopic pregnancy, what must be followed?
BHCG
Pregnancy rates are higher after ______ than _______
Salpingostomy, Salpingectomy
Ovarian pregnancy accounts for what percent of ectopic pregnancies?
< 3%
What is the incidence of cornual pregnancy?
< 2%
What is the standard treatment of cornual pregnancy?
Methotrexate
How do you commonly treat a cervical ectopic pregnancy?
Methotrexate
