Show:
The Basics
Diagnosis
Pathology
Medical Management
Surgical Management
100
The _____ rate of ectopic pregnancy is 1.5 per 1000 in women 15-40
What is Incidence
100
DAILY DOUBLE!!!! The HCG value associated with appearance of normal singleton IUP
What is 1500-2000 usually possible at 1500, always possible at 2000 Higher levels may be needed or multiples In both singleton and multiple gestations a GS should be seen on US by 24 days after conception, 38 days gestational age
100
Hormone that can interfere with tubal motility and contractility
What is Progesterone (estrogen)
100
These are contraindications to medical therapy (relative and absolute)- give one of each
What is 1.GS >3.5 cm 2.Embryonic cardiac motion Absolute 1.Breastfeeding 2.Overt lab evidence immunodeficiency 3.Alcoholism, alcoholic liver disease, other chronic liver disease 4.Preexisting blood dyscrasias (BM hypoplasia, leukopenia, thrombocytopenia, significant anemia
100
Can be used to aid in diagnosis and determine if GS is present when HCG levels are more than 1500, the gestational age exceeds 38 days, or the serum progesterone level is less than 5 and no intrauterine sac is seen with TVUS
What is Endometrial sampling
200
DAILY DOUBLE!!!! This has caused the incidence of ectopic pregnancy to steadily increase over the past 40 years
What is 1.Salpingitis from CT and other STIs 2.Improved diagnostic techniques
200
Best determinant of when a normal pregnancy should be seen in the uterus
What is accurate dating
200
Most common location for ectopic pregnancy to implant
What is Oviduct 97.7 (ampullary 81, isthmus 12%, fimbrial 5%) Abdominal 1.4% <1% ovarian or cervical
200
DAILY DOUBLE!!! Approximate failure rate of methotrexate if the HCG is <5000, approximate failure rate of methotrexate if the HCG is >5000
What is 3.7%, 14.3%
200
This kind of management includes salpingostomy or segmental resection
What is Conservative management
300
Most common cause of maternal death in the 1st trimester
What is ectopic pregnancy
300
Serum progesterone value that with 100% specificity confirms an abnormal pregnancy AND Serum progesterone greater than this number ususally associated with normal IUP
What is 5, 20 Values between 5-20 considered equivocal Most ectopics are associated with progesterone level between 10-20
300
This kind of ectopic pregnancy is associated with severe morbidity because symptoms may occur later in pregnancy, are more difficult to diagnosis, can cause massive hemorrhage if they rupture
What is Interstitial pregnancy (pregnancy implanted in the interstitial portion of the oviduct)
300
For a pt that is a candidate for treatment with methotrexate, these lab values must be normal
What is 1.Serum Cr (BMP) 2.Liver transaminases (CMP) 3.BM function (CBC) (anemia, leukopenia, thrombocytopenia)
300
This kind of management includes salpingectomy +/- oophorectomy or hysterectomy
What is Radical management
400
Percentage of Assisted Reproductive Technology (ART) pregnancies that are ectopic
What is 5%
400
Serial HCGs can be used to evaluate an ongoing pregnancy. With 99% sensitivity, and increase in HCG of less than this percentage in 48 hrs confirms abnormal pregnancy
What is 53% Normal pregnancy- HCG doubles every 2 days
400
True cornual pregnancy definition
What is Implantation in the rudimentary horn of bicornuate uterus
400
In a pt treated with single dose therapy, evidence of successful treatment is seen with what lab value
What is 15% drop in HCG from day 4 to day 7, must continue HCG weekly until back to nonpregnancy levels
400
Treatment of ectopic pregnancy after tubal sterilization
What is b/l salpingectomy
500
Two risk factors of ectopic pregnancy
What is 1. ART 2. Infertility 3. Smoking 4. Previous abdominal/pelvic surgery
500
When the HCG is above this number an adnexal mass/GS can be identified in the oviduct
What is 2500
500
DAILY DOUBLE!!!!! 1/200 ectopics are true ovarian pregnancies. What are Speigelburg’s criteria (4)
What is 1.the tube and the fimbria must be intact and seperated from the ovary 2.The gestational sac must occupy the normal position of the ovary 3.The sac must be connected to the uterus by the ovarian ligament 4.Ovarian tissue should be demonstrable in the walls of the sac
500
This medication should be given with the multidosing regimen to minimize side effects
What is Folinic acid (reduced folic acid) can reduce GI symptoms, AST/ALT abnormalities, stomatitis, mouth sores Given because MTX interferes with the cellular utilization of folic acid *no compelling evidence that folic acid causes decrease in lab values Folic acid 1 mg/d Folinic acid 2.5 mg/w
500
DAILY DOUBLE!!!!! In this conservative surgical technique for ectopic the tubal incision is closed primarily
What is salpingotomy