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Obstetrics and Gynecology > Ectopic Pregnancy > Flashcards

Ectopic Pregnancy Flashcards

1
Q

95% of ectopic pregnancy is situated in

A

fallopian

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2
Q

The most common area of ectopic implantation is the

A

Ampulla bec it is the most dilated part

Isthmus

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3
Q

Risk factors for Ectopic Pregnancy

A

History of surgery to the fallopian tube
Sexually transmitted disease
Salpingitis isthmica nodosa
DES
Infertility and ART (atypical; cornual, abdominal, cervical)
Smoking - independent risk factor
Contraceptive Method Failures - tubal sterilization, IUD, and progestin-only contraceptives

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4
Q

Epithelium-lined diverticula extend into a hypertrophied muscularis layer (diverticula in uterine walls)

There are diverticula in the fallopian tube and pregnancy insinuates in these pouches

A

Salphingitis isthmica nodosa

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5
Q

Independent risk factor for ectopic pregnancy

A

Smoking

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6
Q

More common
Present with dramatic abdominal pain and vaginal bleeding
High serum B HCG and rapid growth
Higher risk of tubal rupture

A

Acute Ectopic Pregnancy

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7
Q

Abnormal trophoblast which die early
Negative or low, static serum B HCG
Accumulation of fluid in the cul-de-sac diagnostic surgery
Rupture late

A

Chronic ectopic pregnancy

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8
Q

Delayed menstruation
Pelvic pain
Vaginal bleeding

A

Ectopic Pregnancy

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9
Q

Severe pain
Abdominal tenderness
Cervical motion tenderness

A

Tubal rupture

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10
Q 
Pain in the neck or shoulder
Hemodynamic changes
Vasomotor changes
Vertigo 
Syncope
A

Hemoperitoneum

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11
Q

Neither intrauterine or extrauterine
Positive for pregnancy but when you do ultrasound, there are no signs of pregnancy

Pain or bleeding but nothing on UTZ

A

Pregnancy of Unknown Location

ectopic pregnancy because they manifest too early in the pregnancy to be visualized on UTZ

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12
Q

Empty uterus on TVS + bHCG of >3510 mIU/ml

A

Discriminatory zone
Failed uterine pregnancy
Complete abortion
Ectopic pregnancy

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13
Q

TVS Endometrial findings

A

Trilaminar endometrial pattern
Anechoic fluid collections
Pseudogestational sac and decidual cyst
Caution advised in diagnosing uterine pregnancy in abscence of a definite yolk sac or embryo

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14
Q

Not all adnexal masses represent ectopic pregnancy

Placental blood flow within the periphery of the complex adnexal mass can aid in diagnosis, but it can also be seen with a corpus luteum of pregnancy

A

Adnexal findings

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15
Q

Ectopic pregnancy Dx

A

Laparoscopy

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16
Q

Given to women with ectopic pregnancies who are asymptomatic

Folic acid antagonist
Antimetabolite chemotherapy
Lyses the pregnancy
90% resolution of ectopic tubal pregnancy when given IM

Oral a lot of side effects, not given (stomatitis)
Only effective in DEAD pregnancies or non-viable pregnancies

A

Methotrexate

17
Q

Indications for Methotrexate

A 
Unruptured ectopic mass <3.5 cm on UTZ
NO FETAL CARDIAC ACTIVITY
Asymptomatic
Motivated
Compliant
18
Q

Classic predictors of methotrexate success

A

Low initial serum B HCG
small ectopic pregnancy size
Absent fetal cardiac activity

19
Q

Single best prognostic factor of successful treatment with single dose methotrexate

A

Low initial serum B-hCG

20
Q

Removes unruptured pregnancy <2cm in length and located in the distal third of the fallopian tube

10-15mm linear incision is made on the antimesenteric border over the pregnancy

A

Salpingostomy

21
Q

Radical approach

Removing the whole segment of fallopian tube because it is prone to another event of ectopic pregnancy

A

Salpingectomy

22
Q

Implant within tbe proximal tubal segment that lies within the muscular uterine wall

Rf: previous ipsilateral salpingectomy

Ruptures late 8-16 weeks gestation due to distensibility of myometrium covering the fallopian tube

A

Cornual pregnancy

Interstitial pregnancy

23
Q

Represents on TVS the interstitial portion of the fallopian tube connecting to the uterine cavity and is highly sensitive and specific

A

Interstitial line sign

24
Q

Medial to the uterotubal junction and round ligament since the wall is thicker it can be carried to term but with increased risk of abdominal placentation

A

Angular pregnancy

25
Q

Spirlberg Criteria to diagnose ovarian pregnancy

A

Ipsilateral tube intact and distinct from ovary
Ectopic pregnancy occupies the ovary
Ectopic pregnancy is connected by the uteroovarian ligament to the uterus
Ovarian tissue demonstrated histologically

Tx
Wedge resection
Cystectomy
Oophorectomy

26
Q

Risk factors for ovarian pregnancy

27
Q

Cervical pregnancy tx

A

Methotrexate IM

Hysterectomy

28
Q

Which of the following sites of tubal pregnancy is known to rupture very early in gestation?

Obstetrics and Gynecology (18 decks)

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