Ectopics Flashcards
a preg. that is implanted in a place other than uterine lining
ectopic preg
ectopic affects __-% of all pregnancies
1.5-2%
what 3 factors are increasing incidence of ectopic?
- More ART
- More preg post tubal surg
- Increase in STDs
fallopian tube is site of more than __% of ectopics
95%
__is most common position within the tube of an ectopic
ampulla
8 RF for ectopic
- Trauma to tubes (prior surg etc)
- Inflammatory (PID - GC/CZ)
- Endometriosis
- Functional: abnormal tubal mvmt
- IUD
- Congenital: long narrow tube
- Hx prior ectopic preg
what can cause abnormal tubal mvmt?
smoking
Possible Ectopic Outcome
- Tubal extrusion
- Tubal abortion
- Tubal Rupture
- Secondary abdominal pregnancy
tubal extrusion def
when fetus extrudes from tube and can actually move into abdomen and set up shop there
RARE
classic traid of ectopic
- absence of reg. menses
- lower abdominal/pelvic pain
- vaginal bleeds
less than 50% have this triad
why vaginal bleeding if pregnancy isn’t in uterus?
- progesterone effect on uterus still present
lining outgrows its blood supply and falls away as vaginal bleeding
rule #1 of women with bleeding and abdominal pain
always consider and R/O ectopic pregnancy
possible findings + for ectopic on vaginal exam
- cervical motion tenderness
- unilateral pelvic mass
- unilateral tenderness with cervical motion
def. cervical motion tenderness
cervix is soft and severe pain occurs when it is moved from side to side
t/f some ppl remain asymptomatic till shock from rupture
true!
heterotopic pregnancy def
occasionally a patient will have both an intrauterine and extrauterine pregnancy at the same time
___ is the discriminatory zone for visualizing a pregnancy by transvaginal ultrasound..
1500 (bhCG)
what size of ectopic and BhCG level is most likely at time of rupture?
over 4cm
BhCG over 5,000
why would ectopic sx be shoulder pain?
blood tracking up the paracopic gutter to the subdiaphragmatic recess
most common surg for ecoptic
laparoscopy
when is laparotomy used?
if visibility is hindered
Ex: sig hemperitoneum
what med can be used for medical ectopic management?
Methotrexate 50mg / kg IM
repeat in 3 days if BhCG doesn’t drop
5 relative CI to medical management
- fetal cardiac act. on U/S
- BhCG over 5000
- Size over 4 cm on U/S
- Refusal to accept blood transfusion
- Not willing to f/u
lower ___ level mean higher medical success rate
lower HCG
smaller ectopic size on U/S suggests higher success rate with __
MTX
when can medical tx of ectopic follow ups stop?
f/u until BhCG # are under 5
when does Rh sensitization of mom occur?
Mom is Rh-
Infant is Rh+
if pts is Rh- and not sensitized give__
anti-D serum
9 absolute CI to medical management of ectopic
- Intrauterine preg
- Mom is IC
- Mod-Severe anemia, leukopenia or thrombocytopenia
- Sensitivity to MTX
- Active pulm dz
- active PUD
- clinical hepatic dys
- Clinical renal dys
- Breast feeding
what is rhogam?
Immunoglobulin D for Rh
(Rho) prvts immune dysfunction against Rh +
3 labs to check for MTX monitoring
renal function
liver function
CBC
Follow those (and BHCG levels)
on day 4 post MTX check…
bHCG..
if rising by 2/3 or 50% means tx failure… SURG!!
