Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4R2 - Obstetrics I 🤰 > L9: Ectopic Pregnancy > Flashcards

L9: Ectopic Pregnancy Flashcards

1
Q

Def of Ectopic Pregnancy

A

Implantation of fertilized ovum outside normal uterine cavity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Incidence of Ectopic Pregnancy

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why is incidence of Ectopic Pregnancy increasing?

A

 ↑↑ incidence of chronic PID & STDs.

 ↑↑ use of IUCD (specially progesterone releasing IUCD).

 ↑↑ rate of ART.

 Better diagnostic tools.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

RF for Ectopic Pregnancy

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

RF for Ectopic Pregnancy

  • Contraceptive Failure
A

 Failure è use of IUCD (specially progesterone releasing IUCD).

 Failure è use of progesterone only contraceptives
(not conclusive).

 Pregnancy after tubal sterilization.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

RF for Ectopic Pregnancy

  • Previous Ectopic Pregnancy
A

Recurrence rate is 10%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

RF for Ectopic Pregnancy

  • Increased Maternal Age
A

Highest rate occurs in women aged 35-44 years.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

RF for Ectopic Pregnancy

  • Smoking
A

Due to altered tubal motility, ciliary action & blastocyst implantation process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

RF for Ectopic Pregnancy

  • Others
A
  • Previous DES exposure, previous abdominal surgery or ruptured appendix, uterine malformations & salpingitis isthmica nodosa (microscopic presence of
    tubal epithelium in myosalpinx or beneath tubal mucosa).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Types & Sites of RF for Ectopic Pregnancy

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Complications of Ectopic Pregnancy

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Complications of Ectopic Pregnancy

  • Early Complications
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Complications of Ectopic Pregnancy

  • Late Complications
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Def of Tubal Pregnancy

A

Implantation of fertilized ovum into tubal wall.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Etiology of Tubal Pregnancy

A
  • Tubal factors
  • Factors in ovum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Etiology of Tubal Pregnancy

  • Tubal Factors
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Etiology of Tubal Pregnancy

  • Mechanical Tubal factors
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Etiology of Tubal Pregnancy

  • Mechanical Tubal factors (Congenital)
A

Long tortuous tube, diverticulum or accessory ostium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Etiology of Tubal Pregnancy

  • Mechanical Tubal factors (Traumatic)
A

Microsurgery of tube or after tubal sterilization.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Etiology of Tubal Pregnancy

  • Mechanical Tubal factors (Inflammatory)
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Etiology of Tubal Pregnancy

  • Mechanical Tubal factors (Neoplastic)
A

Tumors kinking the tube (as broad ligamentary swellings).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Etiology of Tubal Pregnancy

  • Functional Tubal factors
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Etiology of Tubal Pregnancy

  • Functional Tubal factors (Tubal Spasm)
A

Due to parasympathetic overactivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Etiology of Tubal Pregnancy

  • Functional Tubal factors (Abnormal Peristalisis)
A

As in IUCD & progesterone only contraceptives use.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Etiology of Tubal Pregnancy

  • Ovum factors
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Migration theory (wandering ovum)

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Uterine Pathology in Ectopic Pregnancy

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Uterine Pathology in Ectopic Pregnancy

  • Cause
A

Due to effect of pregnancy hormones.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Uterine Pathology in Ectopic Pregnancy

  • Size & Consistency of Uterus
A
  • Enlarged (but not > size of 8 weeks).
  • Soft.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Uterine Pathology in Ectopic Pregnancy

  • Areas-Stella Reaction
A
  • Areas of hypersecretory endometrium characterized by nuclear pleomorphism & hyperchromatosis (present also in normal pregnancy, GTD & endometriosis).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Uterine Pathology in Ectopic Pregnancy

  • Most Importnat Pathology
A

Absence of chorionic villi.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Tubal Pathology in Ectopic Pregnancy

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q
  • Decidual Reaction
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Tubal Pathology in Ectopic Pregnancy

  • Unditurbed Ectopic Pregnancy
A
  • After implantation, there is picture of undisturbed ectopic pregnancy but pregnancy will not continue due to unfavorable environment (deficient decidual function & thin tubal wall which ruptures easily)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Tubal Pathology in Ectopic Pregnancy

  • Disruption of ectopic Pregnancy
A
  • disruption will occur (usually at 6-10 weeks) giving picture of disturbed ectopic pregnancy which have one of the following pathological types (fate) depending on whether disruption occurs towards lumen or towards outer surface:
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Tubal Pathology in Ectopic Pregnancy

  • If disruption occurs towards lumen, This may lead to:
A
  • Tubal mole
  • Tubal abortion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Pathogenesis of Tubal mole

A
  • Repeated attacks of slight Hge → embryo dies but is still attached to tubal wall & becomes surrounded by clotted blood forming mole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Fate of Tubal mole

A

Shrinkage & absorption, hematosalpinx or pyosalpinx (if infected).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Pathogenesis of Tubal Abortion

A
  • Separation of embryo from tubal wall followed by its expulsion into peritoneal cavity through abdominal ostium.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Incidence of Tubal Abortion

A

Most common in ampullary or fimbrial pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Fate (Types) of Tubal Abortion

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Fate (Types) of Tubal Abortion

  • Complete Tubal Abortion
A

Beeding stops & products of conception are absorbed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Fate (Types) of Tubal Abortion

  • Incomplete Tubal Abortion
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Fate (Types) of Tubal Abortion

  • Incomplete Tubal Abortion may lead to ….
A
  • Hematosalpinx: Blood collects in tube when both tubal ends are closed.
  • Peritubal hematocele: Blood collects around abdominal ostium.
  • Pelvic hematocele: Blood collects in Douglas pouch.
  • Diffuse intraperitoneal Hge.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Hematosalpinx

A
  • Blood collects in tube when both tubal ends are closed.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Peritubal hematocele

A
  • Blood collects around abdominal
    ostium.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Pelvic hematocele

A

Blood collects in Douglas pouch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Tubal Pathology in Ectopic Pregnancy

  • If disruption occurs towards Outer Surface, This may lead to:
A

…

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Incidence of Tubal rupture

A

Occurs in 55% of cases & is more common in isthmic pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

fate of Tubal rupture

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Tubal Pathology in Ectopic Pregnancy

  • Tubal Erosion
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Tubal Pathology in Ectopic Pregnancy

  • Local Signs
A
  1. Signs of early pregnancy (present in all clinical types).
  2. Tender cervical motion (Dodd’s sign): Pain on cervical mobility from side to side.
  3. Tender adnexal swelling (50%).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

CP of Ectopic Pregnancy

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Clinical Types of Ectopic Pregnancy

A
  • Subacute disturbed ectopic pregnancy
  • Acute disturbed ectopic pregnancy
  • Chronic disturbed ectopic pregnancy
  • Advanced abdominal pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Clinical Types of Ectopic Pregnancy

  • Subacute disturbed ectopic pregnancy is mostly associated with …..
A

Mostly è tubal abortion

55
Q

CP of Subacute disturbed ectopic pregnancy

A
56
Q

CP of Subacute disturbed ectopic pregnancy

  • Amenorrhea
A
  • Short period of amenorrhea or no amenorrhea if pregnancy is disturbed before time of next menstruation (specially in isthmic pregnancy)
57
Q

CP of Subacute disturbed ectopic pregnancy

  • pain
A
58
Q

CP of Subacute disturbed ectopic pregnancy

  • Vaginal Bleeding
A
  • Occurs in 70% of cases (due to shedding of decidua) & it follows pain.
59
Q

CP of Subacute disturbed ectopic pregnancy

  • Fainting attacks
A

Due to repeated attacks of Hge & colicky pain.

60
Q

CP of Subacute disturbed ectopic pregnancy

  • Bathroom Sign
A
  • Urge to have bowel action followed by sudden syncope while straining at defecation (it is due to vasomotor disturbance following peritoneal
    irritation).
61
Q

CP of Subacute disturbed ectopic pregnancy

  • General Signs
A

Pallor, tachycardia & hypotension.

62
Q

CP of Subacute disturbed ectopic pregnancy

  • Abdominal Signs
A
  1. Lower abdominal tenderness & rigidity ± shifting dullness
  2. Cullen’s sign: Bluish discoloration around umbilicus (due to intraperitoneal Hge).
63
Q

CP of Subacute disturbed ectopic pregnancy

  • Local Signs
A
64
Q

Acute disturbed ectopic pregnancy is mostly associated with ……

A

Mostly è tubal rupture.

65
Q

CP of Acute disturbed ectopic pregnancy

  • Amenorrhea
A

Short period of amenorrhea followed by acute lower abdominal pain & sudden collapse

66
Q

CP of Acute disturbed ectopic pregnancy

  • Pain
A

Shoulder pain (due to accumulation of blood under diaphragm

67
Q

CP of Acute disturbed ectopic pregnancy

  • General Signs
A

Signs of shock (rapid weak pulse, low BP & subnormal temperature

68
Q

CP of Acute disturbed ectopic pregnancy

  • Abdominal Signs
A

Marked lower abdominal tenderness & rigidity + shifting dullness.

69
Q

CP of Acute disturbed ectopic pregnancy

  • Local Signs
A
  • Doesn’t give much information because of marked vaginal tenderness, however, there is severe tender cervical motion.
70
Q

Chronic disturbed ectopic pregnancy is mostly associated with ……

A
  • Pelvic hematocele
71
Q

CP of Chronic disturbed ectopic pregnancy

A
72
Q

CP of Chronic disturbed ectopic pregnancy

  • Pain
A
73
Q

CP of Chronic disturbed ectopic pregnancy

  • Vaginal Bleeding
A
74
Q

CP of Chronic disturbed ectopic pregnancy

  • General Signs
A

Pallor

75
Q

CP of Chronic disturbed ectopic pregnancy

  • Abdominal Signs
A
  • Pelviabdominal swelling + Cullen’s sign may be present
76
Q

CP of Chronic disturbed ectopic pregnancy

  • Local Signs
A
77
Q

INVx for Ectopic Pregnancy

A
78
Q

INvx for Ectopic Pregnancy

  • Labs
A
79
Q

Lab INVx for Ectopic Pregnancy

A

..

80
Q

Lab INVx for Ectopic Pregnancy

  • Urine Pregnancy Test
A

May give false -ve results

81
Q

Lab INVx for Ectopic Pregnancy

  • Serum B-HCG
A
82
Q

Lab INVx for Ectopic Pregnancy

  • Serum B-HCG (Single Measurment)
A
83
Q

Lab INVx for Ectopic Pregnancy

  • Serum B-HCG (Serial Measurments)
A
84
Q

Lab INVx for Ectopic Pregnancy

  • Serum Progesterone
A
85
Q

INVx for Ectopic Pregnancy

  • US
A
86
Q

US Signs of Ectopic Pregnancy

A

Signs of ectopic pregnancy:

  • Empty uterine cavity
  • Cystic adnexal mass
  • Free fluid in Douglas pouch or pelvic hematocele
87
Q

US Signs of Ectopic Pregnancy

  • Empty Uterine Cavity
A
88
Q

Visualization of true intrauterine GS mostly exclude ……. (however, heterotopic pregnancy is a very rare possibility)

A

ectopic pregnancy

89
Q
  • Presence of pseudo GS (collection of fluid in uterine cavity due to bleeding from decidualized endometrium) in uterus in cases of ectopic pregnancy
  • May be confused è true GS (true GS is located eccentrically èin uterus beneath endometrial surface whereas pseudo GS fills the uterine cavity)
A

…

90
Q

presence of decidual casts in uterus in cases of ectopic pregnancy may be confused è fetal shadows

A

..

91
Q

US Signs of Ectopic Pregnancy

  • Cystic adnexal Mass
A
92
Q

Def of Comination of ultrasound & serum β-HCG level (discriminatory Level)

A
  • Serm level of β-HCG above which true GS should be seen by ultrasound inside uterus in all cases of normal pregnancy
93
Q

Levels of Comination of ultrasound & serum β-HCG level (discriminatory Level)

A
  • Using TAS: 6000-6500 mIU/ml.
  • Using TVS: 1000-2000 mIU/ml
94
Q

Result of Comination of ultrasound & serum β-HCG level (discriminatory Level)

A
  • Empty uterus + β-HCG > discriminatory level = ectopic pregnancy.
95
Q

Def of Culdocentesis

A
  • Aspiration of contents of Douglas pouch by needle inserted through posterior fornix.
96
Q

Aim of Culdocentesis

A

Diagnose of hemoperitoneum.

97
Q

Dx Criteria of Culdocentesis

A
  • Aspiration of > 0.5 ml non clotted blood.
98
Q

Indications of Endometrial curettage

A

Done only after documentation of non viable intrauterine pregnancy (serum progesterone level < 5 ng/ml).

99
Q

Aim of Endometrial curettage

A

Differentiation ( ) non viable intrauterine pregnancy & ectopic pregnancy.

100
Q

Results of Endometrial curettage

A

1) Presence of chorionic villi: Non viable intrauterine pregnancy (villi can be detected by floating in saline or histopathological examination).

2) No chorionic villi: Ectopic pregnancy

101
Q

Indications of Laparoscopy in ectopic Pregnancy

A

Doubtful diagnosis or hemodynamically unstable patient.

102
Q

Value of Laparoscopy in ectopic Pregnancy

A
103
Q

DDx of Ectopic Pregnancy

A
104
Q

TTT of Ectopic Pregnancy

A

SAM ”Surgically administered medical treatment” or no SAM “ conservative” or S “Surgical” or M “Medical”

105
Q

TTT of Ectopic Pregnancy

  • 1st Aid Measures
A

Treatment of shock if present & preparation of matched blood.

106
Q

TTT of Ectopic Pregnancy

  • Surgical TTT
A

Main line of treatment

107
Q

Main Line of TTT of Ectopic Pregnancy

A

Surgical treatment

108
Q

Approaches for Surgical TTT of Ectopic Pregnancy

A
  • Laparoscopy
  • Laparotomy
109
Q

Indications of laparoscopy in TTT of Ectopic Pregnancy

A

Recommended approach in hemodynamically stable patients.

110
Q

Indications of Laparotomy in TTT of Ectopic Pregnancy

A
111
Q

Surgical Techniques used in TTT of Ectopic Pregnancy

A
112
Q

Surgical Techniques used in TTT of Ectopic Pregnancy

  • Conservative Methods
A
113
Q

Salpingostomy

A
  • Opening the tube & evacuation of its contents & leaving wound opened to heal by granulation
114
Q

Salpingotomy

A
  • Opening the tube & evacuation of its contents
    methods: then closure of wound.
115
Q

Segmental resection & end to end anastomosis

A
  • Resection of part containing ectopic pregnancy followed by end to end anastomosis of tube.
116
Q

Surgical Techniques used in TTT of Ectopic Pregnancy

  • Non-Conservative Methods
A

Salpingectomy

117
Q

Salpingectomy

A

Resection of tube (or part of it) containing ectopic pregnancy (recommended line of TTT )

118
Q

Medical TTT of Ectopic Pregnancy

A
119
Q

Medical TTT of Ectopic Pregnancy

  • Indications
A
120
Q

Medical TTT of Ectopic Pregnancy

  • CI
A

opposite to Indications

121
Q

Medical TTT of Ectopic Pregnancy

  • Drugs Used
A
122
Q

Dose of Methotrexate in Ectopic Pregnancy

A
123
Q

SE of Methotrexate in Ectopic Pregnancy

A
124
Q

Other Drugs in Ectopic Pregnancy

A
125
Q

Principle of Expectant TTT in Ectopic Pregnancy

A

Some Cases show spontaneous resolution è death of trophoblasts → progressive ↓↓ in HCG level & absorption of products of conception è no squeals

126
Q

Selection Criteria of Expectant TTT in Ectopic Pregnancy

A
127
Q
A
128
Q
A
129
Q
A
130
Q
A
131
Q
A
132
Q
A
133
Q
A
134
Q
A

Y4R2 - Obstetrics I 🤰 (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions