Multiple choice
All of the following are part of the classical triad of symptoms for ectopic pregnancy except:
Unilateral pelvic pain
Vaginal bleeding
Amenorrhea
Diarrhoea
4. Diarrhoea
True or false:
Smoking is a protective measure when it comes to ectopic pregnancies.
False
Fill in the blanks: hCG levels _____ every _______ hours until it reaches its peak at approximately _______ weeks
Fill in the blanks: hCG levels doubles every 48 hours until it reaches its peak at approximately 9-12 weeks
All of the following are indications for medical management using IM methotrexate except:
A. Hemodynamically stable patient
B. hCG < 3000 mIU/ml
C. Adnexal mass <50mm
D. Minimal symptoms
C. Adnexal mass <50mm- it should be less than 40mm
True or False
The most common site of ectopic pregnancy is the ovary
False- it is the fallopian tube
Name 3 common ultrasound findings you may see with ectopic pregnancy
Empty uterus, pseudo gestational sac, adnexal mass (tubal ring sign), ectopic gestational sac with or without fetal poleand cardiac activity, fluid in pouch of douglas
What is the most common surgical procedure used for the rupture of tubal ectopic pregnancy
A. Total hysterectomy
B. Salpingostomy
C. Salpingectomy
D. Salpingo-oophorectomy
E. Electrical cauterization
C. Salpingectomy
True or false:
Ectopic pregnancy rupture usually occurs between weeks 6-16
True
What biochemical investigations would you carry out for a suspected ectopic pregnancy?
Serial hCG, CBC and group& save
The most common cause of ectopic pregnancy:
A. Congenital anomalies of the tube
B. Inflammation of the tubes
C. Uterine abnormalities
D. Using OCPs
E. Pelvic adhesions
B. Inflammation of the tubes
True or False
It is highly advisable to perform a vaginal exam in the acute presentation of an ectopic pregnancy?
False
Name 3 important things you should ask or look out for in a patient whom you suspect has an ectopic pregnancy during a history and physical exam
P/C - Lower abdominal pain (99%), Generalized or localized in the pelvis, Radiate to the shoulder, Abnormal Uterine Bleeding (74%)
HPC - SOCRATES for LAP, Other symptoms: syncopal attacks, vomiting.
LMP: Amenorrhea? (At least 6 weeks)
Explore bleeding - HMB, IMB
PCB, PID? IUCD? Assisted conception?
POHx - Details of each pregnancy, Previous EP?
PMHx - Hepatic or renal dysfunction?
PSHx - Past tubal surgery?
Drug hx-OCP? Any other drugs?
SHx - Smoking?
Exam findings- febrile, abdominal tenderness, closed cervical os