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Gynaecology > Ectopic Pregnancy > Flashcards

Ectopic Pregnancy Flashcards

1
Q

In which contraceptive methods is an ectopic pregnancy more likely to occur?

A
  1. Progestin only oral contraceptive or progestin only implants or IUCD
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2
Q

What are the risk factors that lead to the development of ectopic pregnancy?

A

Woman:

  1. Smoking
  2. Above 40
  3. Diethylstilboestrol exposure
  4. Sexual promiscuity

Tubal:

  1. Documented Tubal pathology
  2. Sterilisation
  3. Previous Genital infection
  4. Previous tubal surgery

Previous pregnancy:

  1. Previous ectopic, miscarriage or abortion
  2. Assisted pregnancy
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3
Q

What is the earliest confirmation of an intra-uterine pregnancy on ultrasound?

A
  1. A gestational sac surrounded by a double echogenic ring (deciduous capsular is and parietalis)
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4
Q

What is the triad that diagnoses ectopic pregnancy?

A
  1. Lower abdominal pain
  2. , amenorrhea
  3. Vaginal bleeding
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5
Q

What percentage of ectopic pregnancies have no symptoms?

A

9%

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6
Q

What are the 3 factors that help us diagnose ectopic pregnancy?

A
  1. Clinical
  2. B-hCG
  3. Transnational ultrasound
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7
Q

How do ectopic pregnancies differ when it comes to the rise of the B-HCG?

A

It rises much slower than intra-uterine pregnancies and tends to be lower

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8
Q

What is highly suggestive of an ectopic pregnancy on transvaginal ultrasound?

A

Empty uterus with free fluid in the pouch of Douglas and complex cystic mass

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9
Q

What is the discrimatory zone?

A

It is the lowest level of B-hCG that is used to estimate when we will be able to see a viable pregnancy on ultrasound
This is usually 1500 IU

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10
Q

What are the other serum markers that we use to diagnose ectopic pregnancy?

A
  1. Progesterone
    >22 then it is a intra-uterine pregnancy
    <15 ectopic
  2. PAPP-A(Pregnancy associated plasma protein A)
  3. CK(Creatinine kinase)
  4. CA125
  5. VEGF(vasoactive endothelial growth factor)
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11
Q

What is the management of a patient with an unruptured ectopic pregnancy?

A
  1. Expectant therapy (watchful waiting)
  2. Medical
  3. Surgery
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12
Q

What does expectant therapy entail?

A

The patient is offered this if the initial B-hCG level is <175 IU

  • the bhcg is decreasing
  • there is no evidence of a ruptured ectopic pregnancy
  • the BHCG is <1000
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13
Q

What must the patient do in order to do expectant therapy well?

A

The patient must be willing to abstain from sex

The patient must be willing to come in twice a week for BHCG check ups

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14
Q

What is the gold standard medical treatment for ectopic pregnancy?

A

Methotrexate 1mg/kg IM

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15
Q

What are the other agents we can give the patient that are not good at working alone?

A
  • hyperosmolar glucose

- potassium chloride

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16
Q

When do we consider medical treatment?

A
  1. If there is no rupture and they are haemodynamically stable
  2. Have B-hcg levels of less than 3000 IU
  3. Make sure there is no foetal cardiac activity
  4. And they must have normal FBC,LFT, UE bloods
17
Q

What is the single dose regimen of medical management?

A

Methotrexate 1mg/kg IM

And repeat doses of methotrexate if the BHCG is not <15% after 4-7 days

18
Q

How many maximum doses of methotrexate do you use in medical management?

A

4 doses

19
Q

What is the multi dose regimen for the management of unruptured ectopic pregnancy?

A
  1. Start with methotrexate 1mg/kg one day 1,3,5,7
  2. Then give 0,1mg/kg dose of leucovorin on day 2,4,6,8
  3. Continue until the bhcg drops by >15 in 48 hours
  4. Repeat course if the concentration is not 40% of the original by day 14
20
Q

How long should women avoid pregnancy after methotrexate use?

A

3 months because it is teratogenic

21
Q

What are the indications for surgery in an unruptured ectopic pregnancy?

A
  1. BHCG of >3000IU
  2. Cardiac activity
  3. Heterotopic pregnancy (IUP with ectopic pregnancy)
    4.
22
Q

How do we decide between a salpingotomy and a salpingectomy?

A
  1. We do a salpingostomy when we have a pathological contralateral Fallopian tube and we want to preserve the moms fertility
  2. We can do either a salpingostomy or salpingectomy if the contralateral tube is healthy
23
Q

When do we decide to do a laparoscopy?

A

If the patient is haemodynamically unstable

Gynaecology (18 decks)

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