TEST 3 STUDY GUIDE ECTOPIC PREG & MORALS Flashcards
ectopic pregnancy:
- Location of pregnancy outside uterus
- 10% maternal deaths related to ectopic pregnancy
- Effect on future fertility & recurrance
true or false? A woman capable of conceiving is capable of having a pregnancy in a location other than the uterine cavity
true
clinical findings ectopic pregnancy:
- Positive pregnancy test
- Pain 97%
- Shoulder, generalized abd, lower abd, lower quadrant ipsilateral to ectopic, lower quadrant contralateral to ectopic, back, vaginal
- Vaginal bleeding
- Palpable adnexal mass
- Clinical Triad – Pain, Bleeding, Adnexal mass – 45%
- Not specific for ectopic pregnancy – 14% confirmed ectopic
- Ovarian cysts (27%), PID (15%), DUB (4%), Spont Ab (5%)
- Present at 5-6 weeks
ectopic prenancy occurs in fallopian tubes in almost __ of patients
95%
when ectopic pregancy is located in the _____ portion of the ____ ____ near the ___ ___, an increased risk of massive hemorrhage exists, which may lead to hysterectomy or even death.
interstitial
fallopian tube
uterine cornua
true or false?
serum beta hCG levels in an ectopic pregancy do not increase as they do in a normal pregnancy
true
what is the clinical triad found w/ ectopic pregnancy?
Pain, Bleeding, Adnexal mass – 45%
- Not specific for ectopic pregnancy – 14% confirmed ectopic
- Ovarian cysts (27%), PID (15%), DUB (4%), Spont Ab (5
when are clinical findings present for ectopic pregnancy?
5-6 weeks
Pregnancy Testing w/ hCG: what is 2IS
2IS (Second International Reference)
- Introduced in 1960’s
- 800 - 1000 IU/L - normal intrauterine gest sac can be seen
slight risk factors for ectopic pregnancy:
- Previous pelvic/abd surgery (.9-3.8),
- smoker (2.3-2.5),
- Vaginal douching (1.1-3.1),
- early age 1st intercourse <18 yrs (1.6)
Moderate Risk factors for Ectopic Pregnancy:
- Infertility (2.5-21),
- Previous genital infections (2.5-3.7),
- Multiple sexual partners (2.1)
High risk factors for Ectopic Pregnancy:
- Tubal Surgery (21.0),
- Sterilization (9.3,
- Previous ectopic (8.3),
- DES daughter (5.6),
- Use of IUD (4.2-45.0),
Documented tubal disease (3.8-21.0)
Pregnancy Testing with hCG: what is 1st IRP
(First International Reference Preparation)
- Purer standard – main standard used today
- 1000 - 2000 IU/L - normal intrauterine gest sac can be seen
what is the minimum lwvel of hCG in normal pregnancy?
2000 mIU/mL, IRP
- If no gest sac seen ≥ these levels=suspect ectopic
- Differential dx -> possible early IUP, miscarriage, ectopic
- As many as 19% may have IUP on followup
- Guideline only – use clinical indications and f/u if stable
Serial quantitative beta hCG levels
- hCG levels double every 2 days in normal preg
- & 21% of ectopic
- 90% ectopic preg nonviable -> beta hCG levels low
- Falling hCH levels may indicate missed or incomplete abortion
TRUE OR FALSE?
90% ectopic preg nonviable -> beta hCG levels low
true
Falling hCH levels may indicate:
missed or incomplete abortion
common sites of ectopic pregnancy
- Tubal 95-97%
- Ampullary – most common
- Isthmus – second most common
Uncommon Sites of Ectopic Pregnancy
- Interstitial (Cornual) – rare 2-5%
- Ovary – rare 0.5 – 1.0% (text states <3%)
- Fimbria – very rare
- Cervix – very rare 0.1%
- Abdominal – very rare
image: sites of ectopic preg
A
Interstitial (cornual)
B
isthmus
C
abdominal
***D
ampullary
**E
fimbrial
**F
Ovary
**G
cornual (interstitial)
**H
fornix
**I
cervical
**J
body of uterus
**K
abdominal peritoneum
true or false? a increased risk of a complete hysterectomyexists when an ectopic pregnany is located in the uterine cervix.
a combination of ___ ___ and an ___ ___ is the best correlation in dagnosis of an ectopic pregnancy.
free fluid; adnexal mass
echogenic free fluid is related to a __% risk of ectopic pregnancy.
92% (86%-93%)
what are the Sonographic Findings: Ectopic
-
Determine if normal early intrauterine pregnancy
- Intrauterine gestational sac preferably with heart beat
- Extra-ovarian Adnexal mass
-
Fluid in cul-de-sac
- Echogenic fluid (86-93% for ectopic)
- Check kidneys for hemoperitoneum
-
Pseudogestaional sac
- Differentiate betwn normal IUP & pseudo
- 20% ectopic preg demonstrate pseudo gest sac
- Finding of live embryo within adnexa (specific)
- Extrauterine gestational sac or ring in adnexa - 71%
- 26.3% ectopic preg with a normal sonogram
what is a pseudogestational sac?
located in middle of endometrium, does not have a yolk sac, has internal echoes, and a high resistive spectral waveform
EARLY IUP: shape, location, margins, decidual reaction, sac
round
eccentric location in endometrium
well defined margins
well defined decidual reaction
possible double decidual sac sign
Pseudosac: shape, location, margins, decidual reaction, sac
ovoid shape
cebtral location in endometrium
poorly defined margins
absent decidual reaction
single decidual layer
pseudogestational sac characteristics
- No living embryo
- No yolk sac
- Sac central endometrium
- Low level echos
- Best seen endovaginal
- High resistance pattern
* (low diastolic flow) with low peak velocities
decidual cast - pseudosac
gestational sac
echogenic ring - classic chorionic ring
Double decidual sac sign
–Inner ring – echogenic chorionic vili
–Outer ring- deeper layer of decidua vera (D)
gestational sac
Double decidual sac sign plus yolk sac
Adnexal Masses with Ectopic
Complex adnexal mass
- Extrauterine gest sac
- Hematoma within peritoneal cavity
- Within fallopian tube or broad ligament
- Ovarian Cyst: Corpus luteum cyst
- Differentiate with surrounding ovarian tissue
- Quantitative beta-hCG levels
- 80% with ectopic have @25 ml blood pooling in peritoneum
- 60% Intraperitoneal fluid - moderate to large quantities
- Check abd gutters to eval extent of fluid present
what is the most frequent sonographic finding in an ectopic pregancy?
adnexal mass
Pregnancy Testing w/ hCG: what is 1st IRP
1st IRP (First International Reference Preparation)
- Purer standard – main standard used today
- 1000 - 2000 IU/L - normal intrauterine gest sac can be seen