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Obstetrics and Gynecology > First Trimester Abnormal: Ectopic Pregnancies > Flashcards

First Trimester Abnormal: Ectopic Pregnancies Flashcards

1
Q

three things we check for in first trimester scan

A
  1. mean sac diameter
  2. crown rump length
  3. nuchal
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2
Q

MSD

A

mean sac diameter

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3
Q

CRL

A

crown rump length

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4
Q

when is MSD measured

A

when the embryo is identified

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5
Q

when can the double decidual reaction be seen

A

starting at 4-5 weeks

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6
Q

mean sac diameter formula

A

(lenght x width x height)/3

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7
Q

endovaginal scan MSD size when yolk sac seen vs when embryo seen

A

8mm
vs
16mm

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8
Q

transabdominal scan MSD size when yolk sac seen vs when embryo seen

A

20mm
vs
25mm

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9
Q

GS grows how much every day

A

1.1mm

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10
Q

what is the purpose of comparing MSD to embryo

A

for early diagnosis of oligohydramnios (low fluid)

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11
Q

from 5.5-9 weeks, if the MSD - CRL is less than _____, oligohydramnios is suspected

A

5mm

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12
Q

CRL is used between ___ and ___ weeks

A

6
13

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13
Q

what is the most accurate measurement to predict gestational age and how many days off may it be

A

CRL
+/- 3 days

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14
Q

PUL

A

pregnancy of unknown location

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15
Q

three main differential diagnoses when b-HCG is positive but no pregnancy seen on US

A

very early intrauterine pregnancy
miscarriage
ectopic pregnancy

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16
Q

what are the three main symptoms of an ectopic pregnancies and how many cases present with these symptoms

A

pain, bleeding, adnexal mass

45%

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17
Q

other three symptoms of ectopic pregnancy (not the three main ones)

A

amenorrhea
adnexal tenderness
cervical tenderness

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18
Q

ectopic pregnancies usually present around what weeks

A

5 and 8 weeks

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19
Q

six risk factors of ectopic pregnancies

A

history of: ectopic pregnancy, gyn surgery, PID
endometriosis
IUCD use
congenital anomalies
assisted reproductive techniques
increased maternal age

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20
Q

PID

A

pelvic inflammatory disease

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21
Q

four ectopic sites

A

fallopian tube
cervix
ovary
peritoneal cavity

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22
Q

____ of ectopic cases occur in the isthmus or ampulla of tube

A

95%

23
Q

what is the most common location for an ectopic pregnancy

A

ampulla

24
Q

2 most dangerous places to have an ectopic pregnancy and why

A

cervix
interstitial segment of fallopian tubes

high risk of hemorrhage as very vascular areas

25
Q

2 places free fluid may be seen with ectopic pregnancy

A

pouch of Douglas
morrison’s pouch

26
Q

PCDS

A

pouch of douglas

27
Q

4 sonographic features of an ectopic pregnancy

A

adnexal mass
free fluid
absence of IUP/has pseudo sac
live ectopic pregnancy instead of adnexal mass

28
Q

you can assume the patient was at least ___ weeks pregnant at their first positive pregnancy test

A

4 weeks

29
Q

what happens to b hCG levels with ectopic pregancies

A

same or lower

30
Q

the b hCG should double every ___ days (up to ___ weeks) with a normal pregancy

A

2
8

31
Q

early gestation (less than 5 weeks) b hCG should

A

increase

32
Q

spontaneous abortion b hCG should

A

decrease

33
Q

PID b hCG should be

A

negative (not pregnant)

34
Q

complex ovarian cyst b hCG should be

A

negative

35
Q

endometriosis b hCG should be

A

negative

36
Q

Ring of Fire

A

increased blood flow around ectopic gestation but also more often seen around corpus luteum

37
Q

aborting GS doppler vs ectopic

A

aborting = avascular
ectopic = well perfused

38
Q

sliding sac sign

A

when gentle pressure from the transducer can move the GS = likely abortion in progress

39
Q

heterotopic pregnancy

A

intrauterine pregnancy with a twin ectopic pregnancy

40
Q

chances of a heterotopic pregnancy

A

1 in 30 000 natural pregnancies

41
Q

ART

A

assisted reproductive technology

42
Q

heterotopic pregnancy incidence in IVF pregnancies

A

1-3%

43
Q

if ectopic isnt ruled out, b hCG repeated in ___, scan repeated in ___

A

2 days
2-7 days

44
Q

if the intial b hCG level is low (less than ___) and the patient is stable, a further blood test can be taken ___ hours after

A

1500 iU
48

45
Q

viable pregnancy = HCG ____ every 48 hours
miscarriage = HCG ____ every 48 hours
if outside these limits =

A

double
halve
ectopic pregnancy cant be excluded

46
Q

pseudo sac is seen in ___ percent of ectopic pregnancies

A

20

47
Q

interstitial line sign (what/diagnoses)

A

hyperechoic line (fallopian tube) extending from endo canal up to center of interstitial sac or hemorrhagic mass
helps diagnose interstitial ectopic pregancies

48
Q

GS must have a minimum of ___ of myometrium surrounding them

A

5mm

49
Q

interstitial ectopic pregnancies will be located very ____ in the uterine fundus and have ____ of tissue surrounding the GS

A

superiorly
less than 5mm

50
Q

c section scar ectopic occurs where

A

where c section scar is in uterus, implanted in myometrium not endometrium

51
Q

methotrexate

A

cell growth inhibitor

52
Q

salpingostomy vs salpinectomy

A

incision in tube to remove ectopic
vs
removal of fallopian tube

53
Q

if ectopic pregnancy ruptures = blood loss called

A

hypovolemic shock

54
Q

laparatomy is what/needed when

A

incision into abdominal cavity

if ectopic is interstitial, cervical, abdominal, or if patient is severely unstable (going into shock)

Obstetrics and Gynecology (7 decks)

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