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Questions and Answers
What is the recurrence rate of ectopic pregnancy after experiencing a first ectopic pregnancy?
What is the recurrence rate of ectopic pregnancy after experiencing a first ectopic pregnancy?
Which factor is NOT listed as an etiology of ectopic pregnancy?
Which factor is NOT listed as an etiology of ectopic pregnancy?
What is the fate of a tubal pregnancy that evolves into a tubal mole?
What is the fate of a tubal pregnancy that evolves into a tubal mole?
In which part of the fallopian tube does tubal abortion most commonly occur?
In which part of the fallopian tube does tubal abortion most commonly occur?
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What typically occurs when there is a rupture of the fallopian tube?
What typically occurs when there is a rupture of the fallopian tube?
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At what mean time after the last normal menstrual period does ectopic pregnancy typically present?
At what mean time after the last normal menstrual period does ectopic pregnancy typically present?
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What percentage of pregnancies can be attributed to ART (Assisted Reproductive Technology) contributing to ectopic pregnancies?
What percentage of pregnancies can be attributed to ART (Assisted Reproductive Technology) contributing to ectopic pregnancies?
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Which anatomical structure is found in the diagram of the fallopian tubes?
Which anatomical structure is found in the diagram of the fallopian tubes?
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What is defined as any vaginal bleeding before 20 weeks of gestation?
What is defined as any vaginal bleeding before 20 weeks of gestation?
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Which of the following is NOT a type of abortion?
Which of the following is NOT a type of abortion?
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What distinguishes induced abortion from spontaneous abortion?
What distinguishes induced abortion from spontaneous abortion?
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Which condition is most likely associated with cervical lesions leading to bleeding in early pregnancy?
Which condition is most likely associated with cervical lesions leading to bleeding in early pregnancy?
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What is a potential consequence of hemorrhage into the decidua basalis during early pregnancy?
What is a potential consequence of hemorrhage into the decidua basalis during early pregnancy?
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Which condition represents a non-pregnant state but shares similar symptoms with early pregnancy bleeding?
Which condition represents a non-pregnant state but shares similar symptoms with early pregnancy bleeding?
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Which factor is NOT considered an etiology for abortion?
Which factor is NOT considered an etiology for abortion?
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What type of abortion occurs when the fetus is expelled but the placenta remains in the uterus?
What type of abortion occurs when the fetus is expelled but the placenta remains in the uterus?
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Which condition is characterized by uterine bleeding following amenorrhoea without cramping pain?
Which condition is characterized by uterine bleeding following amenorrhoea without cramping pain?
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What is a common drug used for salphingocentesis in medical management?
What is a common drug used for salphingocentesis in medical management?
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What characterizes a threatened miscarriage?
What characterizes a threatened miscarriage?
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Which of the following is an initial characteristic of a low-risk condition in Gestational Trophoblastic Disease?
Which of the following is an initial characteristic of a low-risk condition in Gestational Trophoblastic Disease?
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In the case of an inevitable abortion, what symptom would NOT typically be present?
In the case of an inevitable abortion, what symptom would NOT typically be present?
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What is a complete abortion characterized by?
What is a complete abortion characterized by?
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Which procedure is NOT part of conservative surgery for ectopic pregnancy?
Which procedure is NOT part of conservative surgery for ectopic pregnancy?
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What histological classification is NOT included in Gestational Trophoblastic Disease?
What histological classification is NOT included in Gestational Trophoblastic Disease?
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Which of the following is a feature of missed abortion?
Which of the following is a feature of missed abortion?
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Which of these would indicate a high-risk prognosis in Gestational Trophoblastic Disease?
Which of these would indicate a high-risk prognosis in Gestational Trophoblastic Disease?
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What management is typically recommended for a threatened miscarriage?
What management is typically recommended for a threatened miscarriage?
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What is a significant complication of ectopic pregnancy?
What is a significant complication of ectopic pregnancy?
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During which time frame is the expulsion of the fetus followed by the placenta most commonly observed?
During which time frame is the expulsion of the fetus followed by the placenta most commonly observed?
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In cervical pregnancy, what finding is essential for diagnosis?
In cervical pregnancy, what finding is essential for diagnosis?
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In cases of incomplete abortion, what is typically observed on ultrasound?
In cases of incomplete abortion, what is typically observed on ultrasound?
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What could be a potential consequence of heavy bleeding accompanied by clots during an inevitable abortion?
What could be a potential consequence of heavy bleeding accompanied by clots during an inevitable abortion?
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What is the most common karyotype seen in complete hydatidiform moles?
What is the most common karyotype seen in complete hydatidiform moles?
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Which clinical feature is most commonly associated with partial hydatidiform moles?
Which clinical feature is most commonly associated with partial hydatidiform moles?
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What percentage of complete hydatidiform moles typically presents with theca lutein cysts?
What percentage of complete hydatidiform moles typically presents with theca lutein cysts?
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Which condition is most commonly diagnosed through ultrasonography in the case of hydatidiform moles?
Which condition is most commonly diagnosed through ultrasonography in the case of hydatidiform moles?
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Which of the following correctly states the malignant potential of complete hydatidiform moles?
Which of the following correctly states the malignant potential of complete hydatidiform moles?
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In terms of gestational age, at what range is partial hydatidiform moles typically diagnosed?
In terms of gestational age, at what range is partial hydatidiform moles typically diagnosed?
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Which of the following is a common characteristic of the gross findings in a complete hydatidiform mole?
Which of the following is a common characteristic of the gross findings in a complete hydatidiform mole?
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What is the typical uterine size for a partial hydatidiform mole?
What is the typical uterine size for a partial hydatidiform mole?
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What are the three main symptoms of the clinical triad suggestive of ectopic pregnancy?
What are the three main symptoms of the clinical triad suggestive of ectopic pregnancy?
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Which sign is typically observed in a patient with a chronic or old ectopic pregnancy?
Which sign is typically observed in a patient with a chronic or old ectopic pregnancy?
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What type of surgery is preferred in the emergency treatment of ectopic pregnancy?
What type of surgery is preferred in the emergency treatment of ectopic pregnancy?
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What does the presence of Cullen's sign indicate in a patient suspected of an ectopic pregnancy?
What does the presence of Cullen's sign indicate in a patient suspected of an ectopic pregnancy?
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During the examination of an unruptured tubal pregnancy, which symptom may present as a continuous or colicky pain?
During the examination of an unruptured tubal pregnancy, which symptom may present as a continuous or colicky pain?
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What is the purpose of performing culdocentesis in the context of an ectopic pregnancy diagnosis?
What is the purpose of performing culdocentesis in the context of an ectopic pregnancy diagnosis?
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What finding from a pelvic examination is commonly associated with unruptured tubal ectopic pregnancy?
What finding from a pelvic examination is commonly associated with unruptured tubal ectopic pregnancy?
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In the management plan for an ectopic pregnancy, what supportive treatment is often recommended?
In the management plan for an ectopic pregnancy, what supportive treatment is often recommended?
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Study Notes
Early Pregnancy Bleeding
- Vaginal bleeding before 20 weeks of gestation is defined as early pregnancy bleeding.
- Abortion is the termination of a pregnancy before the fetus is capable of extra-uterine survival (20 weeks or 500g birth weight)
- Types of spontaneous abortion: threatened, inevitable, incomplete, missed, septic
Causes of Bleeding in Early Pregnancy
-
Related to pregnant state:
- Abortion (various types)
- Ectopic pregnancy (implantation outside the uterus)
- Molar pregnancy (abnormal placental growth)
- Implantation bleeding
-
Associated with the pregnant state:
- Cervical lesions (like erosion, polyps)
- Ruptured varicose veins
-
Other causes:
- Genetic factors
- Endocrine and metabolic abnormalities
- Infections
- Immunological disorders
- Anatomical abnormalities
- Environmental factors
- Unexplained causes
- Blood group and incompatibility
- PROM (premature rupture of membranes)
Pathology of Miscarriage
- Hemorrhage into the decidua basalis
- Necrotic changes in adjacent tissue
- Conceptus detachment
- Uterine contractions resulting in expulsion
Mechanism of Miscarriage
- Before 8 weeks: ovum, villi, and decidual coverings expelled intact. External os may not dilate, leading to cervical miscarriage.
- Beyond 14 weeks: expulsion similar to mini-labor; fetus expelled first, followed by placenta after a variable interval
Blighted Ovum
- A pregnancy where the embryo fails to develop, leading to an empty gestational sac.
Threatened Miscarriage
- Clinical entity where miscarriage process has begun but not progressed to a point of no recovery.
- Clinical features: brief amenorrhea, mild spotting or bleeding, mild pain, closed cervical os, positive pregnancy test, viable intrauterine fetus on ultrasound, elevated serum progesterone
- Management: reassurance, rest, Diazepam 5mg BD, repeated ultrasound
Inevitable Miscarriage
- Miscarriage is inevitable, and the embryo cannot be saved.
- Clinical features: amenorrhea, heavy bleeding with clots, severe lower abdominal pain, open cervical os, positive pregnancy test, non-viable fetus and blood in uterus on ultrasound
- Management: fluids, methergin 0.2mg, evacuation (medical or surgical).
Complete Miscarriage
- All products of conception expelled.
- Clinical features: cessation of bleeding, resolved abdominal pain, closed cervix, empty uterus on ultrasound
- Management: U/S, Anti-D gamma globulin injection.
Incomplete Miscarriage
- Not all products of conception expelled.
- Ultrasound shows retained products.
Missed Miscarriage
- Embryo dies but is not expelled.
- Clinical features: gradual loss of pregnancy symptoms like breast tenderness, cessation of morning sickness, negative pregnancy test, fetal heart not detected on ultrasound.
- Treatment: wait to see if body expels, otherwise D&C to remove the fetus.
Septic Miscarriage
- Miscarriage complicated by infection.
- Symptoms: abdominal pain, fever, foul-smelling vaginal discharge.
- Signs: sick appearance, fever, tender uterus, offensive vaginal discharge or bleeding, soft dilated cervix
- Clinical Grading: Grade 1 (localized to uterus), Grade 2 (spread to parametrium), Grade 3 (generalized peritonitis/endotoxic shock, jaundice, renal failure)
- Management: resuscitation, IV fluids, insert catheter, monitoring input/output, blood tests, antibiotics (cephalosporins), anti-tetanus serum, evacuation (by the uterine contents removal)
Recurrent Miscarriage
- Three or more consecutive pregnancy losses. Etiology: genetic factors, endocrine issues, anatomical causes, infections, immunological problems
Ectopic Pregnancy
- Fertilized ovum implants and develops outside the normal uterine cavity.
- Incidence: increased by pelvic inflammatory disease, intrauterine devices (IUDs), tubal surgeries, Assisted Reproductive Techniques (ART)
- Average rate: 1 in 100 pregnancies
- ART increased risk: 5%
- Types of ectopic implantation sites: interstitial, isthmic, ampullary, infundibular, ovarian tubal, abdominal, intramural.
- Fates of tubal pregnancy:
- Tubal mole (sac surrounded by blood clot)
- Tubal abortion (sac expulsion)
- Tubal rupture (bleeding into peritoneal cavity)
- Clinical features: acute, unruptured, subacute (chronic)
Clinical features of ectopic pregnancy:
- Early symptoms: either absent or subtle
- Mean time of presentation: 7.2 weeks after last normal menstrual period
- Range: 5 to 8 weeks
- Common presenting symptoms:
- Amenorrhea
- Lower abdominal pain
- Abnormal vaginal bleeding
- Signs
- Patient looks quiet, conscious, but perspires and looks blanched (pale)
- Pallor (paleness)
- Features of shock
- Tensing, tender, and distended abdomen.
- Pelvic examination reveals white vaginal mucosa, somewhat enlarged uterus, cervix tenderness
- Tenderness in uterine fornix area on palpation or movement of the cervix
- Uterus floats/feels “watery” during examination
- Unruptured tubal pregnancy symptoms: delayed period, spotting, unilateral flank pain (or colicky nature)
- Chronic or old ectopic presentation: amenorrhea, lower abdominal pain, vaginal bleeding - Patient appears ill - Pallor, persistent high pulse even at rest, shock features, possibly slightly elevated temperature - Abdomen: tenderness, muscle guarding (tensing), lower abdomen especially on affected side; possible mass in lower abdomen and tender (irregular) - Cullen's sign (dark bluish discoloration) might indicate intraperitoneal hemorrhage
Diagnosis of Ectopic Pregnancy
- Positive pregnancy tests (82.5% are positive)
- Hematocrit
- White blood cell count
Management of Ectopic Pregnancy
- Emergency treatment (immediate surgical intervention, anti-shock measures, warm fluids, oxygen)
- Surgical treatment (laparoscopic techniques)
- Medical treatment (medications, like methotrexate)
- Supportive treatment (antibiotics, iron therapy, high-protein diet)
- Unruptured tubal pregnancy: expectant management (observation, monitoring serum hCG levels, gestational sac size, for spontaneous resolution)
Cervical Pregnancy
- Clinically diagnosed by:
- Soft, enlarged cervix at least as large as the uterine fundus
- Uterine bleeding during previously amenorrheic phase
- Products of conception confined to the endocervix, firmly attached to same
- Closed internal cervical os; partially opened external cervical os
- Confirmed by histological presence of villi within cervical stroma (on pathology sample)
Gestational Trophoblastic Disease (GTD)
- Category of inter-related diseases originating from the placental trophoblast.
- Classification:
- Hydatidiform mole (complete or partial)
- Invasive mole
- Choriocarcinoma
- Placental site trophoblastic tumor
- WHO classification:
- Hydatidiform mole: complete, partial
- Invasive mole
- Placental site trophoblastic tumor
- Choriocarcinoma: non-metastatic disease/ metastatic disease
Risk Factors for GTD
- Disease duration (<4 months for low risk, >4 months for high risk)
- Initial hCG level (<40,000 for low risk, >40,000 for high risk )
- Metastasis (limits to lungs/vagina for low risk)
- History of chemotherapy
- Prior term delivery
Complications of GTD
- Maternal death (1 in 1000 ectopic pregnancies)
- Untreated/mistreated ruptured ectopic pregnancies (8-12% of all maternal deaths)
Complications of Septic Abortions
- Immediate: hemorrhage, peritonitis, pelvic abscess, endometritis, septicemia, septic/hemorrhagic shock
- Late: Pelvic inflammatory disease (PID), pelvic adhesions, secondary infertility
Hydatidiform Mole
- Abnormal condition of the placenta characterized by partly degenerative and partly proliferative changes in the chorionic villi.
- Types: complete, incomplete
- Complete: absence of fetus, 46 xx or xy karyotype, complete molar degeneration and hydropic villi swelling
- Incomplete: presence of a fetus, 69 XXX or XXY karyotype, focal molar degeneration and variable, focal-diffuse villi swelling
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Description
Test your knowledge on ectopic pregnancy, its recurrence, and related complications. This quiz covers important factors such as etiology, presentation timing, and clinical implications of tubal pregnancies. Ideal for students and professionals in the field of obstetrics and gynecology.
