Flashcards in ECTOPIC PREGNANCY AND TROPHOBLASTIC DISEASE Deck (25)
What are the likely sites of ectopic pregnancy?
Fimbriae of fallopian tube
Ampulla of fallopian tube
Isthmus of fallopian tube
Upper horns of the uterus - cornual ectopic
Why is the number of ectopic pregnancies rising?
Due to the increasing number of cases of PID and increasing number IVF users.
What is the current incidence of ectopic pregnancies in the UK?
1 ectopic for every hundred term deliveries
What are the risk factors for ectopic pregnancy?
Tubal surgery eg sterilisation or reversal of sterilisation, previous ectopic surgery
Peritonitis or pelvic surgery eg appendicitis
IUCD in situ (coil)
Progesterone only pill - if patient does conceive while on the mini pill then they are more at risk of ectopic.
What are the symptoms of ectopic pregnancy?
Bleeding - if ruptured
Shoulder tip pain
Pain when going to the loo
Nausea and diarrhoea
Positive pregnancy test
What investigations should be done for someone with acute abdominal pain and bleeding in whom you suspect an ectopic pregnancy?
Ultrasound - to demonstrate an empty uterus
Laparoscopy - once haemodynamically stable
How might serum hCG help with the differential diagnosis of vaginal bleeding in a pregnant woman?
Two serum hCG tests should be performed 48 hours apart
A viable pregnancy will show a rise in hCG
A miscarriage will show a fall in hCG
An ectopic will show a plateau in the levels of hCG
How do we manage patients with ectopic pregnancy?
Surgically - either salpingectomy (removal of the affected fallopian tube and ovary) or salpingotomy (removal of the ectopic pregnancy from the fallopian tube.
Medical treatment - cytotoxics such as methotrexate are increasingly being used (they are often delivered by injection straight into the site during laparoscopy). Used also in cases where ectopic pregnancy is located in cervix or intramurally.
What conditions must be met for medical (rather than surgical) treatment of ectopic pregnancy to be considered?
Small pregnancy - less than 3 cm measured on USS
No cardiac activity
hCG less than 3000 iu/L
How do we follow up patients who have been treated for ectopic pregnancy?
Serum hCG must be checked at various points over the following days to make sure there is a downward trend.
What are the complications of treatment for ovarian ectopic pregnancy?
Recurrence if management was conservative (ie not salpingectomy)
Lower chance of conception with salpingectomy)
What are the complications of untreated ectopic pregnancy?
Fallopian rupture and massive haemorrhage
What is a heterotopic pregnancy?
The extremely rare combination of intra- and extrauterine pregnancy. It is actually becoming more common because of IVF treatment. It is treated surgically through laparoscopy, avoiding instrumentation of the uterus.
What is gestational trophoblastic disease?
Gestational trophoblastic disease (GTD) is a group of conditions in which tumors grow inside a woman's uterus (womb). The abnormal cells start in the tissue that would normally become the placenta.
What are the three main types of gestational trophoblastic disease?
Complete hydatidiform mole
Partial hydatidiform mole
What is complete hydatidiform mole, one of the gestational trophoblastic diseases?
Benign tumour of trophoblastic material. Occurs when an empty egg is fertilized by a single sperm that then duplicates its own DNA, hence the all 46 chromosomes are of paternal origin.
What are the features of complete hydatidiform molar pregnancy?
Bleeding in first or early second trimester
Exaggerated symptoms of pregnancy e.g. hyperemesis
Uterus large for weeks of gestation
Very high serum levels of human chorionic gonadotropin (hCG)
Features of hyperthyroidism
Why are features of hyperthyroidism seen in complete hydatidiform molar pregnancy?
hCG can mimic thyroid-stimulating hormone (TSH) at the very high levels seen in complete hydatidiform molar pregnancy.
What investigations would be performed in someone with suspected complete hydatidiform molar pregnancy?
What would be seen on ultrasound of someone with complete hydatidiform molar pregnancy?
Molar pregnancy has a characteristic 'bunches of grapes' appearance on ultrasound.
How do we treat women with complete hydatidiform molar pregnancy?
Urgent referral to specialist centre
Evacuation of the uterus is performed
Effective contraception is recommended to avoid pregnancy in the next 12 months
What is partial hydatidiform molar pregnancy?
This is when a normal haploid egg may be fertilized by two sperms, or by one sperm with duplication of the paternal chromosomes. Therefore the DNA is both maternal and paternal in origin. Usually triploid - e.g. 69 XXX or 69 XXY.
What are the complications of hydatidiform molar pregnancy?
Molar pregnancy that continues or comes back
What percentage of complete hydatidiform molar pregnancies go on to develop choriocarcinoma?