ectopic pregnancy ppt Flashcards
About _____ in ______ pregnancies results in ectopic implantation.
1 in 150
whats the leading cause of maternal death
ectopic pregnancy
what is the death rate of ectopic pregnancy
1/1000
If you have an ectopic are you likely to have another one
yes
1 out of 4 chance of reoccurence
what are the most common locations of ectopic pregnancy
ampullary and isthmus makes up 95-97%
does ectopic pregnancy produce HCG
yes but at a lower rate than IUP
- surgical incision through naval
Laparoscopy
- aspiration of non-clotting blood from the posterior cul-de-sac
Culdocentesis
________- for microscopic evaluation of the endometrium
D&C
Sonographic evaluation - Confirm IUP, screen for masses
how often does Simultaneous occurrence of an intrauterine pregnancy and an extrauterine gestation occur
it is rare (1:30,000)
two echogenic rings separated by a hypoechoic region
Double Decidual Sac -
Inner ring of DDSS is called
chorionic villi
outer ring of DDSS is called
Decidua vera
Composed of a single echogenic ring surrounding intra-endometrial fluid
Pseudo Gestational Sac
ddss vs pseudosac
It protects the pregnancy from the maternal immune system.
decidual layer
In cases of extrauterine gestation the decidua may create a mold of the interior of the uterus formed by exfoliated mucous membrane and blood. This is called a decidual cast.
Positive Ectopic Findings
-Measurable levels of circulating hCG & no IUP demonstrated
-Demonstration of an adnexal mass or “ring”
-Fluid in the cul-de-sac
-Demonstration of a living adnexal embryo (100% specific)
examples of ectopic pregnancy
more ectopic examples
IUD In Uterus With Ruptured Ectopic and Blood
what do you see
empty uterus (U)
with thickened endometrium (red arrow)
representing decidual reaction in a patient with adnexal mass.
Echogenic fluid (red arrowhead)
is seen in the cul-de-sac.
The combination of adnexal mass and echogenic cul-de-sac fluid makes this patient very high risk for ectopic pregnancy.
A heterotopic pregnancy (an intrauterine pregnancy and left ectopic) at 7.2 weeks gestation.
Color Doppler may demonstrate peritrophoblastic flow with a low resistance pattern on pulsed Doppler waveform
Color Doppler tends to show a focal area of arterial flow adjacent to the sac that is more intense than other color flashes in the uterus
The patient must be reliable, compliant, and able to return for follow-up
Contraindications:
-gestation should not exceed 3.5 cm in its greatest dimension on ultrasound (US) measurement
-No fetal cardiac activity present
-The patient must be hemodynamically stable, with no signs or symptoms of active bleeding or hemoperitoneum
Methotrexate Therapy
what size can the gestation not exceed with methotrexate therapy
3.5cm in its greatest dimension
___________ is usually reserved for patients who are hemodynamically unstable or patients with cornual ectopic pregnancies.
Laparotomy
_____________ may be performed in a patient who has complete childbearing, has a history of ectopic pregnancy in the same tube, or a patient with severely damaged tubes.
Salpingectomy
patients are asymptomatic
no evidence of rupture or hemodynamic instability
must be objective evidence of resolution (i.e. declining bhCG levels).
patient must be fully compliant and must be willing to accept the potential risks of tubal rupture
Expectant management
Interstitial ectopic pregnancy (sometimes called ____________)
cornual
Interstitial ectopic pregnancy occurs in the interstitial portion of the fallopian tube. It accounts for ____________ of all ectopics.
2% - 4%
The diagnosis is suggested by visualization of an intrauterine gestational sac or decidual reaction located high in the fundus, that is not surrounded by more than 5mm of myometrium in all planes.
Interstitial ectopic pregnancy (sometimes called cornual)
for a Interstitial ectopic pregnancy (sometimes called cornual) the myometrium should be how thick in all planes
more than 5mm
An _______________________- is an echogenic line from the mass to the endometrial echo complex reportedly has high sensitivity (80%) and specificity (98%).
interstitial line sign
Interstitial Line Sign
what is this
cornual ectopic
Management of interstitial ectopic includes methotrexate (either systemic or local), potassium chloride injection, conservative laparoscopic surgery, uterine artery embolization, cornuectomy or hysterectomy. The latter two are usually reserved for the emergency case or for failure of other methods.
Empty uterus and any adnexal mass and/or blood with a qHCG at or above _______________is considered a need for surgery (Regional Rule for this area)
2000
what is this
Ectopic in c-section scar
