Ectopic Pregnancy Flashcards Preview

Gynaecology > Ectopic Pregnancy > Flashcards

Flashcards in Ectopic Pregnancy Deck (72)
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31

What are the 3 possible differentials for pregnancy of unknown location?

- Very early intrauterine pregnancy
- Miscarriage
- Ectopic pregnancy

32

What additional test should be taken in pregnancy of unknown location?

Serum beta-HCG

33

What is assumed if serum beta-HCG for pregnancy of unknown location is >1500 iU

Ectopic pregnancy until proven otherwise

34

What should be offered if serum beta-HCG suggests ectopic pregnancy?

Diagnostic laparoscopy

35

What should be done if initial serum beta-HCG for pregnancy of unknown location is <1500 iU?

A further serum beta-HCG 48 hours later

36

What would happen to the serum beta-HCG level over 48 hours if there is a viable pregnancy?

It should double

37

What would happen to the serum beta-HCG level over 48 hours if there is a miscarriage?

It should halve

38

When can an ectopic pregnancy not be excluded based on serial serum beta-HCG result?

If there is less than a double or half in the level over 48 hours

39

Where should any patient with a suspected ectopic pregnancy be managed?

In hospital

40

What may be needed if the patient is systemically unwell?

A-E approach to resuscitation possible including blood products

41

What are the three types of definitive management for ectopic pregnancy?

- Conservative
- Medical
- Surgical

42

What does conservative management of ectopic pregnancy involve?

Watchful waiting of the stable patient while allowing the ectopic to resolve naturally

43

Is conservative management of ectopic pregnancy first line?

No, it is only suitable for a small number of patients and should be discussed at a senior level

44

What should be performed to monitor progress of conservative management of
ectopic pregnancy?

Serum beta-HCG every 48 hours to ensure it is falling by at least 50% every 48 hours

45

At what level is beta-HCG satisfactory in conservative management of ectopic pregnancy?

<5mlU/ml

46

Who can conservative management for ectopic pregnancy be offered to?

- Unlikely to rupture
- Stable
- Well controlled pain
- Low baseline beta-HCG
- Small, unruptured ectopic on USS

47

What advice should be given to patients having conservative management of ectopic pregnancy?

- 24/7 access to gynae services
- Informed of symptoms of rupture

48

What are the advantages of conservative management of ectopic pregnancy?

- Avoids risks of medical and surgical management
- Can be done at home

49

What are the disadvantages of conservative management of ectopic pregnancy?

- Failure or complications may necessitate need for surgery or medical management

50

What percentage of patients receiving conservative ectopic pregnancy management require surgical or medical intervention?

25%

51

What is the medical management of ectopic pregnancy?

IM methotrexate

52

How does methotrexate work to treat ectopic pregnancy?

It is an anti-folate cytotoxic agent that disrupts folate dependent cell division of the developing fetus

53

What monitoring should a patient on methotrexate for ectopic pregnancy receive?

Regular serum beta-HCG to ensure levels decline

54

What is done if beta-HCG levels don't decline after initial dose of IM methotrexate in ectopic pregnancy?

Administer another

55

Who can receive methotrexate to treat ectopic pregnancy?

- Stable patients
- Well controlled pain
- Beta-HCG <1500iU/ml
- Ectopic pregnancy unruptured without visible heartbeat

56

What advice should women undergoing medical management of ectopic pregnancy be given?

- 24/7 access to gynae services
- Symptoms of rupture

57

What are the advantages of medical management of ectopic pregnancy?

- Avoids complications of surgery
- Patient can be at home after injection

58

What are the disadvantages of medical management ectopic pregnancy?

- Potential side-effects of methotrexate
- Teratogenic and so patients should use contraception for 3-6 months after
- Treatment can fail - need surgery

59

What are the potential side-effects of methotrexate?

- Abdominal pain
- Myelosuppression
- Renal dysfunction
- Hepatitis

60

What is involved in surgical management of ectopic pregnancy?

Surgical removal of the ectopic (this seems a bit too obvious but I'll leave it in)