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General Gynecology > Ectopic Pregnancy > Flashcards

Ectopic Pregnancy Flashcards

1
Q

What percent of pregnancies do ectopic pregnancies account for?

A

2%

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2
Q

In women presenting to the ER with bleeding or pain what percent will have an ectopic pregnancy?

A

18%

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3
Q

What percent of ectopic pregnancies are in the fallopian tube?

A

97%

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4
Q

What is the mortality rate associated with ectopic pregnacies?

A

3.8/10,000

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5
Q

Infertility and the use of infertility treatments ____ your risk of ectopic pregnancy

A

increases

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6
Q

T/F: DES exposure in utero increases your risk of ectopic pregnancy?

A

True

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7
Q

At what level should bHCG increase in 48 hrs to suggest viable pregnancy?

A

increase by 53%

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8
Q

If the initial HCG is < 1500 what is a normal percent rise in 48 hrs?

A

49%

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9
Q

If the initial HCG is between 1500 - 3000 what is the normal percent rise in 48 hrs?

A

40%

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10
Q

If the initial HCG is > 3000 what is the normal percent rise?

A

33%

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11
Q

What is the first ultrasonographic finding of a viable IUP?

A

Double ring sign, decidual reaction

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12
Q

What discriminatory zone for BHCG is is now used?

A

3500

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13
Q

In early pregnancy the _____ produces progesterone

A

Corpus luteum

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14
Q

If progesterone level is ____ that signifies normal IUP

A

> 20 ng/ml

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15
Q

If progesterone level is _____ that suggests nonviable pregnancy

A

< 5 ng/dl

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16
Q

If a pregnancy is non desired and technically a PUL, what is the next best step in management?

A

Dilation and curretage

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17
Q

A BHCG decrease of ____ 24 hrs following D&C suggests removal of normal pregnancy

A

50%

18
Q

A BHCG decrease of < _____ 24 hrs following D&C indicates an ectopic pregnancy

A

15%

19
Q

What type of drug is methotrexate?

A

Folic acid antagonist

20
Q

What is the mechanism of methotrexate?

A

inactivates dihydrofolate reductase thereby decreasing available tetrahydrofolate, essential cofactor for DNA and RNA synthesis

21
Q

What labs should be checked prior to methotrexate administration?

A

Serum creatinine, LFTs, CBC, type and Screen

22
Q

What are absolute contraindications for methotrexate therapy?

A

Breastfeeding, Immunocompromised, liver disease, pulmonary disease ,peptic ulcer disease, renal dysfunction, blood dyscrasias

23
Q

What are relative contraindications for methotrexate therapy

A

MSD > 3.5 cm, HCG > 5000, presence of fetal heart beat, CRL > 5 cm

24
Q

What are the most common side effects of methotrexate

A

Nausea, vomiting, diarrhea

25
Q

True or false: When a patient takes methotrexate you should advise them to stop taking prenatal vitamins and folic acid supplements?

A

True

26
Q

What is the dose of methotrexate given in single dose regimen?

A

50 mg/m

27
Q

When should you recheck BHCG and at what percent should you see a decrease in HCG

A

Day 4 and Day 7, 15% decrease

28
Q

After you see a 15% decrease between day 4 and 7, how long should you follow BHCG?

A

Weekly until BHCG zero

29
Q

What is the regimen for fixed multidose Methotrexate protocol?

A

MTX 1 mg/kg on days 1,3,5,7 with folinic acid (Leucovorin) administration on days 2,4,6,8

30
Q

How do you measure HCG with the multidose methotrexate regimen?

A

Measure BHCG on the MTX treatment days (1,3,5,7) until you see a 15% decrease from previous day.

31
Q

When should you consider using the multidose methotrexate regimen?

A

More advanced pregnancies with higher HCG levels

32
Q

What is the regimen for 2 dose Methotrexate protocol?

A

MTX 50 mg/m on day 1 and day 4

33
Q

How do you measure HCG with 2 dose methotrexate protocol and how much should it decrease?

A

Measure BHCG on day 4 and day 7, 15%

34
Q

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?

A

Day 7 and Day 11

35
Q

Following salpingostomy for surgical management of an ectopic pregnancy, what must be followed?

A

BHCG

36
Q

Pregnancy rates are higher after ______ than _______

A

Salpingostomy, Salpingectomy

37
Q

Ovarian pregnancy accounts for what percent of ectopic pregnancies?

A

< 3%

38
Q

What is the incidence of cornual pregnancy?

A

< 2%

39
Q

What is the standard treatment of cornual pregnancy?

A

Methotrexate

40
Q

How do you commonly treat a cervical ectopic pregnancy?

A

Methotrexate

General Gynecology (11 decks)

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