ectopic prego

Question 1

what is ectopic?

Answer 1

implantation of fertilized ovum outside the uterine cavity

• fallopian (ampulla) MC site
• abdomen
• ovarian/cervix (0.15%)

Question 2

what are RF for ectopic?

Answer 2

high: previous abdominal or tubal sx (adhesions), PID, previous ectopic, hx of tubal ligation, endometriosis, IUD use, assisted reproduction
intermediate: infertility, hx of genital infextion, multiple partners

Question 3

s/sx

Answer 3

triad: unilateral pelvic/abdominal pain, vag bleed, amenorrhea
* but these can be seen with threatened abortion

Question 4

what are atypical s/sx of ectopic?

Answer 4

vague sx, menstrual irregularities, severe abdominal/shoulder pain (peritoinitis)

Question 5

what are s/sx of ruptured ectopic?

Answer 5

severe abdominal pain, dizzy, N, V

shock: syncope, tachycardia, hypotension

Question 6

PE for ectopic

Answer 6

CMT, adnexal mass, +/- mild uterine enlargement

Question 7

dx of ectopic

Answer 7

CUBA!!!

*absence of gestational sac w/ bhcg >2000 strongly suggests ectopic OR nonviable intrauterine prego

Question 8

BHCG levels in ectopic

Answer 8

normally: should double every 24-48 hrs, if this doesn’t happen more likely ectopic
* if initial value < 1500, repeat in 2-3 days

Question 9

tx for ectopic if unruptured and stabe?

Answer 9

methotrexate
laparoscopic salpingostomy or salpingectomy

*rhogam is mom is Rh negative 9–> use contraception for at least 2 mtns

Question 10

what is the MOA of methotrexate?

Answer 10

destroys trophoblastic tissue

Question 11

what are the indications of methotrexate?

Answer 11

hemodynamically stable, early gestation <4 cm, BHCG < 5000, no fetal tones

Question 12

tx for ruptured/unstable ectopic?

Answer 12

laparoscopic salingostomy (first choice)
salpingectomy
laparotomy
rhogam