Ectopics

Question 1

Definition of an ectopic pregnancy

Answer 1

Gestation that implants outside the endometrial cavity

Question 2

Why is an ectopic pregnancy important to detect?

Answer 2

Fourth leading cause of maternal mortality overall

Leading cause of maternal morality in first tri

Question 3

What is the most important risk factor?

Answer 3

Prior pelvic inflammatory disease

Question 4

Other causes of ectopic pregnancy

Answer 4

Prior ectopic pregnancy
Prior tubal surgery
Hx of infertility and assisted reproductive therapy
IUD

Question 5

Symptoms

Answer 5

Abdominal/pelvic pain
Vaginal bleeding
Amenorrhea
Abdominal distention
Signs of hypovolemia

Question 6

To dx what must you have?

Answer 6

High index of suspicion

Question 7

Gold standard dx

Answer 7

S-hCG and Endovaginal US

Quantitative S-hCG should double every 48 hours in normal pregnancy

Question 8

Tx of ectopic

Answer 8

Methotrexate if mass less than 3.5 cm, not ruptured, no fetal cardiac motion, pt desires future fertility, no CIs
Follow until S-hCG is negative. Should decrease by day 7. If not declining give second dose or surgery