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OB > ECTOPIC PREGNANCY > Flashcards

ECTOPIC PREGNANCY Flashcards

1
Q

Most frequent sites of tubal pregnancy

A

Ampulla

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2
Q

Risks of Ectopic Pregnancy

A

surgeries for a prior tubal pregnancy, for fertility restoration, or for sterilization – HIGHEST RISK

after one previous ectopic pregnancy - chance of another is ↑ fivefold

prior STD or other tubal infection

one episode of salpingitis - can be followed by a subsequent ectopic pregnancy in up to 9 % of women

peritubal adhesions subsequent to salpingitis, appendicitis, or endometriosis

congenital fallopian tube anomalies - secondary to in utero diethylstilbestrol exposure

ovulation induction and ART

smoking

atypical implantations - cornual, abdominal, cervical, ovarian, and heterotopic pregnancy

history of STIs or PID
prior ectopic pregnancy
previous tubal surgery
prior pelvic or abdominal surgery resulting in adhesions
endometriosis
IVF or assisted reproductive techniques
congenital fallopian tube anomalies (DES exposure in utero)
smoking 
contraceptive method failure (IUD use)
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3
Q

Common in fimbrial and ampullary pregnancies

A

Abortion

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4
Q

Common in tubal isthmus

A

Rupture

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5
Q

Classic presentation of Ectopic Pregnancy

A

delayed menstruation
pain
vaginal bleeding or spotting

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6
Q

Reported by 60 to 80 % of women with tubal pregnancy

A

vaginal spotting or bleeding

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7
Q

Performed to look for findings indicative of intrauterine or ectopic pregnancy

A

Transvaginal sonography

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8
Q

Reliable diagnosis in most cases of suspected ectopic pregnancy

A

Laparoscopy

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9
Q

Methotrexate

A

Highly effective against rapidly proliferating tissue such as trophoblast, and overall ectopic tubal pregnancy

binds to dihydrofolate reductase

TOXIC to HEPATOCYTES
renally excreted

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10
Q

Used to counteract bone marrow depression d.t. MTX

A

Leucovorin

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11
Q

Predictors of MTX Treatment Failure

A

fetal cardiac activity

size and volume of gestational mass (> 4 cm)

high initial hCG concentration (> 5,000 mIU/mL)

hemoperitoneum

rapidly increasing hCG concentrations (> 50% over 48 hrs) before MTX treatment

continued rapid rising of hCG concentrations during MTX therapy

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12
Q

Criteria for Medical Management in Ectopic Pregnancy

A 
stable patient
β-hCG <1,500 mIU/mL
size <3.5 cm
AOG < 6 weeks
no fetal heartrate/beat
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13
Q

The single best prognostic indicator of successful treatment with single-dose methotrexate

A

initial serum β-hCG level

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14
Q

The preferred surgical treatment for ectopic pregnancy unless a woman is hemodynamically unstable

A

Laparoscopy

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15
Q

Defined by cervical glands noted histologically opposite the placental attachment site and by part or all of the placenta found below the entrance of the uterine vessels or below the peritoneal reflection on the anterior uterus

A

Cervical Pregnancy

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16
Q

Characteristic Clinical Findings in Cervical Pregnancy

A

uterine bleeding after amenorrhea w/o cramping pain

softened cervix that is disproportionally enlarged

complete confinement and firm attachment of the products of conception

closed internal OS

17
Q

Rubin and Colleague’s Criteria (Cervical Pregnancy)

A

attachment of the placenta to the cervix must be intimate

cervical glands must be present opposite the placental attachment

placenta must be below the entrance of the uterine vessels or below the peritoneal reflection of the anteroposterior surface of the uterus

fetal elements must NOT be present in the corpus uteri

18
Q

Secondary to tubal abortion with secondary implantation in the peritoneal cavity

A

Abdominal Pregnancy

19
Q

Studdiford’s Criteria For Abdominal Pregnancy

A

fallopian tubes and ovaries must be normal (no evidence of recent or past injury)

no evidence of uteroplacental fistula

pregnancy must be related only to the peritoneal surface and early enough in gestation to eliminate the possibility of secondary implantation after primary tubal ligation

20
Q

Clinical Criteria of Ovarian Pregnancy

A

ipsilateral tube is intact and distinct from the ovary

ectopic pregnancy occupies the ovary

ectopic pregnancy is connected by the uteroovarian ligament to the uterus

ovarian tissue can be demonstrated histologically amid the placental tissue

21
Q

Spiegelburg’s Criteria For Ovarian Pregnancy

A

tube and fimbria must be intact and separate from the ovary

gestational sac must occupy the normal position of the ovary

the sac must be connected to the uterus by the ovarian ligament

ovarian tissue should be demonstrable in the walls of the sac

22
Q

Contraceptive method failures with increased relative number of ectopic pregnancies

A

Tubal sterilization
Copper and Progestin releasing Intrauterine Devices (IUD)
Progestin Only Contraceptives

23
Q

Outcomes of Ectopic Pregnancy

A

tubal rupture
tubal abortion
pregnancy failure with resolution

24
Q

Classic presentation of ectopic pregnancy

A

delayed menstruation
pain
vaginal bleeding or spotting

25
Q

Nongynecological sources of lower abdominal pain in early pregnancy

A

appendicitis
cystitis
renal stone
gastroenteritis

26
Q

Key components in the algorithms for ectopic pregnancy

A

physical findings
transvaginal sonography
serum b-hCG level measurement
diagnostic surgery - uterine curettage, laparoscopy and laparotomy

27
Q

Ruptured ectopic pregnancy

A

hypotension
tachycardia
signs of peritoneal irritation sec to hemoperitoneum

28
Q

Endometrial Findings (Ectopic Pregnancy)

A

trilaminar endometrial pattern
anechoic fluid collections
pseudosac
decidual cyst

29
Q

Direct visualization of the fallopian tubes and pelvis

A

Laparoscopy

30
Q

Specific risk factor of INTERSTITIAL PREGNANCY

A

previous ipsilateral salpingectomy

31
Q

Methotrexate Contraindications

A 
sensitivity to MTX
tubal rupture
breastfeeding
intrauterine pregnancy
PUD
active pulmonary disease
immunodeficiency
hepatic, renal or hematologic condition

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