ECTOPIC PREGNANCY: QUESTIONS AND ANSWERS
LATEST UPDATE (GRADED A+)
what is the MC location of ectopic preg?
98% in fallopian tube, 80% in ampulla
ectopic pregnancies make up what %age of all pregnancies?
1.5%
what are the 3 outcomes from tubal ectopic pregnancy?
1. tubal abortion
2. tubal rupture
3 spontaneous resolution
what is a tubal abortion?
expulsion of products of conception through fimbriated end, tissue can regess or reimplant in abd cavity
what is the biggest consequence of tubal rupture?
associated with significant hemorrhage, needs surgery
risk factors for ectopic pregnancy
tubal inflammation causing scarring: salpingitis, saplingitis isthmica nodosa, chlamydia (acute or chronic
infection), pregnancy after sterilization, hx of infertility, ovulation induction, prior ectopic, smoking, DES
exposure, advanced age
symptoms of ectopic pregnancy
- amenorrhea
- vaginal bleeding
- abd pain
- normal preg sxs: breast tenderness, nausea
- shoulder pain- phrenic nerve irritation from blood in abd
- vasomotor sxs: vertigo, syncope from hypovolemia
what histologic findings confirm an ectopic pregnancy
no chorionic villi in the tissue passed
sxs of tubal rupture on physical exam
- pain on abd palpation
- pain on pelvic exam
- pain worse with cervical manipulation
- possibly a pelvic mass felt
, - decreased bowel sounds maybe
- abd distention possibly
should you perform a pelvic exam on suspected ectopic?
you should avoid it if possible so as to avoid iatrogenic rupture of ectopic, diagnosis can be based on
history, lab findings, and US findings
DDx of ectopic pregnancy
1. threatened, incomplete, missed abortion
2. placental polyp
3. hemorrhagic corpus luteum cyst
4. appendicitis
5. renal calculi
diagnostic procedures for ectopic
1. pregnancy test
2. TVUS
3. serial hCG measurements
how do hCG levels change in normal pregnancy?
they rise in a log-linear fashion until 60-80 days after last menses, then plateua around 100,000 IU/L;
you should expect hCG levels to double every 48 hours
how early can you see a gestational sac on TVUS?
4.5 to 5 weeks after LMP
how early can you see a yolk sac on TVUS?
5 to 6 weeks from LMP
when can you detect a fetal pole and heart beat on TVUS?
5.5 to 6 weeks from LMP
at what hCG level can an intrauterine pregnancy be seen on TVUS?
1,000 to 2,000 IU/L
at what hCG level can an intrauterine pregnancy be detected on transabdominal US?
5,000 to 6,000 IU/L
what is a pseudogestational sac?
a collection of fluid in the uterine cavity caused by sloughing of the decidua
what progesterone level signals a viable pregnancy?
serum progesterone level of >20 ng/mL
LATEST UPDATE (GRADED A+)
what is the MC location of ectopic preg?
98% in fallopian tube, 80% in ampulla
ectopic pregnancies make up what %age of all pregnancies?
1.5%
what are the 3 outcomes from tubal ectopic pregnancy?
1. tubal abortion
2. tubal rupture
3 spontaneous resolution
what is a tubal abortion?
expulsion of products of conception through fimbriated end, tissue can regess or reimplant in abd cavity
what is the biggest consequence of tubal rupture?
associated with significant hemorrhage, needs surgery
risk factors for ectopic pregnancy
tubal inflammation causing scarring: salpingitis, saplingitis isthmica nodosa, chlamydia (acute or chronic
infection), pregnancy after sterilization, hx of infertility, ovulation induction, prior ectopic, smoking, DES
exposure, advanced age
symptoms of ectopic pregnancy
- amenorrhea
- vaginal bleeding
- abd pain
- normal preg sxs: breast tenderness, nausea
- shoulder pain- phrenic nerve irritation from blood in abd
- vasomotor sxs: vertigo, syncope from hypovolemia
what histologic findings confirm an ectopic pregnancy
no chorionic villi in the tissue passed
sxs of tubal rupture on physical exam
- pain on abd palpation
- pain on pelvic exam
- pain worse with cervical manipulation
- possibly a pelvic mass felt
, - decreased bowel sounds maybe
- abd distention possibly
should you perform a pelvic exam on suspected ectopic?
you should avoid it if possible so as to avoid iatrogenic rupture of ectopic, diagnosis can be based on
history, lab findings, and US findings
DDx of ectopic pregnancy
1. threatened, incomplete, missed abortion
2. placental polyp
3. hemorrhagic corpus luteum cyst
4. appendicitis
5. renal calculi
diagnostic procedures for ectopic
1. pregnancy test
2. TVUS
3. serial hCG measurements
how do hCG levels change in normal pregnancy?
they rise in a log-linear fashion until 60-80 days after last menses, then plateua around 100,000 IU/L;
you should expect hCG levels to double every 48 hours
how early can you see a gestational sac on TVUS?
4.5 to 5 weeks after LMP
how early can you see a yolk sac on TVUS?
5 to 6 weeks from LMP
when can you detect a fetal pole and heart beat on TVUS?
5.5 to 6 weeks from LMP
at what hCG level can an intrauterine pregnancy be seen on TVUS?
1,000 to 2,000 IU/L
at what hCG level can an intrauterine pregnancy be detected on transabdominal US?
5,000 to 6,000 IU/L
what is a pseudogestational sac?
a collection of fluid in the uterine cavity caused by sloughing of the decidua
what progesterone level signals a viable pregnancy?
serum progesterone level of >20 ng/mL
