Ectopics

Question 1

a preg. that is implanted in a place other than uterine lining

Answer 1

ectopic preg

Question 2

ectopic affects __-% of all pregnancies

Answer 2

1.5-2%

Question 3

what 3 factors are increasing incidence of ectopic?

Answer 3

1. More ART
2. More preg post tubal surg
3. Increase in STDs

Question 4

fallopian tube is site of more than __% of ectopics

Answer 4

95%

Question 5

__is most common position within the tube of an ectopic

Answer 5

ampulla

Question 6

8 RF for ectopic

Answer 6

1. Trauma to tubes (prior surg etc)
2. Inflammatory (PID - GC/CZ)
3. Endometriosis
4. Functional: abnormal tubal mvmt
5. IUD
6. Congenital: long narrow tube
7. Hx prior ectopic preg

Question 7

what can cause abnormal tubal mvmt?

Answer 7

smoking

Question 8

Possible Ectopic Outcome

Answer 8

1. Tubal extrusion
2. Tubal abortion
3. Tubal Rupture
4. Secondary abdominal pregnancy

Question 9

tubal extrusion def

Answer 9

when fetus extrudes from tube and can actually move into abdomen and set up shop there

RARE

Question 10

classic traid of ectopic

Answer 10

1. absence of reg. menses
2. lower abdominal/pelvic pain
3. vaginal bleeds

less than 50% have this triad

Question 11

why vaginal bleeding if pregnancy isn’t in uterus?

Answer 11

1. progesterone effect on uterus still present

lining outgrows its blood supply and falls away as vaginal bleeding

Question 12

rule #1 of women with bleeding and abdominal pain

Answer 12

always consider and R/O ectopic pregnancy

Question 13

possible findings + for ectopic on vaginal exam

Answer 13

1. cervical motion tenderness
2. unilateral pelvic mass
3. unilateral tenderness with cervical motion

Question 14

def. cervical motion tenderness

Answer 14

cervix is soft and severe pain occurs when it is moved from side to side

Question 15

t/f some ppl remain asymptomatic till shock from rupture

Answer 15

true!

Question 16

heterotopic pregnancy def

Answer 16

occasionally a patient will have both an intrauterine and extrauterine pregnancy at the same time

Question 17

___ is the discriminatory zone for visualizing a pregnancy by transvaginal ultrasound..

Answer 17

1500 (bhCG)

Question 18

what size of ectopic and BhCG level is most likely at time of rupture?

Answer 18

over 4cm

BhCG over 5,000

Question 19

why would ectopic sx be shoulder pain?

Answer 19

blood tracking up the paracopic gutter to the subdiaphragmatic recess

Question 20

most common surg for ecoptic

Answer 20

laparoscopy

Question 21

when is laparotomy used?

Answer 21

if visibility is hindered

Ex: sig hemperitoneum

Question 22

what med can be used for medical ectopic management?

Answer 22

Methotrexate 50mg / kg IM

repeat in 3 days if BhCG doesn’t drop

Question 23

5 relative CI to medical management

Answer 23

1. fetal cardiac act. on U/S
2. BhCG over 5000
3. Size over 4 cm on U/S
4. Refusal to accept blood transfusion
5. Not willing to f/u

Question 24

lower ___ level mean higher medical success rate

Answer 24

lower HCG

Question 25

smaller ectopic size on U/S suggests higher success rate with __

Answer 25

MTX

Question 26

when can medical tx of ectopic follow ups stop?

Answer 26

f/u until BhCG # are under 5

Question 27

when does Rh sensitization of mom occur?

Answer 27

Mom is Rh-

Infant is Rh+

Question 28

if pts is Rh- and not sensitized give__

Answer 28

anti-D serum

Question 29

9 absolute CI to medical management of ectopic

Answer 29

1. Intrauterine preg
2. Mom is IC
3. Mod-Severe anemia, leukopenia or thrombocytopenia
4. Sensitivity to MTX
5. Active pulm dz
6. active PUD
7. clinical hepatic dys
8. Clinical renal dys
9. Breast feeding

Question 30

what is rhogam?

Answer 30

Immunoglobulin D for Rh

(Rho) prvts immune dysfunction against Rh +

Question 31

3 labs to check for MTX monitoring

Answer 31

renal function
liver function
CBC

Follow those (and BHCG levels)

Question 32

on day 4 post MTX check…

Answer 32

bHCG..

if rising by 2/3 or 50% means tx failure… SURG!!