By the Numbers
Risk of recurrence of ectopic
What is 10%?
(If history of 2, up to 25%)
This almost always eliminates the possibility of ectopic
What is a IUP?
hemodynamically stable, who have an unruptured mass, and who do not have absolute contraindications to methotrexate administration
Who are candidates for medical management?
Risk of tubal ectopic if ectopic pregnancy
What is >90%?
(implantation in the abdomen (1%), cervix (1%), ovary (1–3%), and cesarean scar (1–3%))
This plus the bHCG level will guide whether you expect to see a IUP
What is LMP of 5 weeks and 6 weeks of gestation?
a folate antagonist that binds to the catalytic site of dihydrofolate reductase
What is methotrexate
Risk factors for ectopic (name 2)
What is Infertility independent of cause, ART (if multiple embryo transfer or tubbal factor), smoking, and AMA?
What is 49%?
(40% for an initial hCG level of 1,500–3,000 mIU/mL, and 33% for an initial hCG level greater than 3,000 mIU/mL)
Embryonic cardiac activity detected by transvaginal ultrasonography
High initial hCG concentration
Ectopic pregnancy greater than 4 cm in size as imaged by transvaginal ultrasonography
what are relative CI to methotrexate?
53% of these pregnancies are Ectopic
What is pregnancy with IUD in place? (although Women who use an intrauterine device (IUD) have a lower risk of ectopic pregnancy than women who are not using any form of contraception)
This on TVUS has a positive predictive value of 80% for ectopic (hint it's not a gestational sac, yolk sac, or fetal pole in the adenexa)
What is mass or a mass with a hypoechoic area that is separate from the ovary?
In a single dose protocol for methotrexate, beta HCG are obtained
What is on day 4 and day 7 post treatment?
If decrease is less than 15%, readminister methotrexate at a dose of 50 mg/m2 intramuscularly and repeat hCG level
If hCG does not decrease after two doses, consider surgical management
If you do uterine aspiration and repeat bHCG in 12-24 hours, what should the level do to confirm evacuation of IUP?
What is fall by >50%? However define plateau by 10-15% inbetween and you need more info
otherwise you have incomplete evacuation or ectopic
One study 29 noted 55.6% of patients with ectopic pregnancies had an hCG decrease of more than 10%, 23.5% had a decrease of more than 30%, and 7.1% had a decrease of more than 50%.