Ectopic Pregnancy

Epidemiology/Risk

100

What are the most common locations of ectopic pregnancy? 

Fallopian tube 90% (specifically, ampulla)

Cervix

Ovary

Abdomen cavity

C-section scar 

200

What percentage of total pregnancies are ectopic? 

Roughly 2%

300

Smoking is a 

modifiable risk factor of ectopic pregnancy

400

Name four risk factors of ectopic pregnancy.

Prior ectopic pregnancy, fallopian tube scarring,  pelvic inflammation disease, fallopian tube surgery, infertility, smoking, and age greater than 35.

500

Which contraceptive method increases the risk of ectopic pregnancy most?

Progestin-only IUD.

or IUDs

Diagnosis

100

How is ectopic pregnancy diagnosed?

Transvaginal ultrasound

Radioimmunoassay for hCG

Laparoscopy

200

Indication of ruptured ectopic pregnancy

light vaginal bleeding and pelvic pain

300

The clinical triad of ectopic pregnancy 

abdominal pain, amenorrhea, and vaginal bleeding

400

What is the transvaginal ultrasound used for?

Useful for identifying where the embryo is implanted.

500

Radioimmunoassay is used to measure?

hCG level

Medical Management

100

Medical Management for Ectopic

Methotrexate 

When diagnosed early.

The patient must be hemodynamically stable, with no sign of bleeding in the peritoneal cavity, a low beta-hCG level, and a mass that measures less than 4cm.

200

Mechanism of action of methotrexate

Inhibits DNA synthesis.

Releases prostaglandin and cytokines, causing uterine contractions to expulse all trophoblastic tissue.

Methotrexate is a folic acid antagonist that inhibits cell division in the developing embryo

300

Medical management is indicated for 

Unruptured tubal pregnancy

400

Medication with a similar effect

Prostaglandins, Misoprostol, Mifepristone, Actinomycin

500

Method of administering methotrexate?

Single Dose IM injection

Surgical Management

100

Surgical management includes

Linear Salpingostomy-  pregnancy is removed, and the tube is left to heal independently.

 Prevents maternal death, preserves fallopian tubes, and facilitates rapid recovery

In Laparotomy (Salpingectomy)  the ectopic pregnancy and the tube are both removed.

200

This surgery removes the fallopian tube.

Laparotomy (Salpingectomy)

300

Laparotomy involves? 

making a small incision in the abdomen either near or inside the navel

400

In what instances is salpingectomy preferred

significant tubal damage

both the pregnancy and the tube are removed

500

When is surgery indicated?

For ruptured ectopic pregnancy. 

This is to prevent possibly uncontrollable hemorrhage.