Ectopic Pregnancy Overview
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Questions and Answers

What is the primary location of implantation in an ectopic pregnancy?

  • In the fallopian tubes
  • Within the uterus
  • In the ovaries
  • Outside of the uterus (correct)

    • Which of the following symptoms is commonly associated with ectopic pregnancy?

  • Shoulder pain (correct)
  • Severe headaches
  • High fever
  • Leg swelling

    • What is a notable factor contributing to the high mortality associated with ectopic pregnancy?

  • Advanced maternal age
  • Increased prevalence of chlamydia infections (correct)
  • Obesity
  • Inadequate prenatal care

    • What sign may indicate a ruptured ectopic pregnancy during physical examination?

    <p>Bulging cul-de-sac (B)</p> Signup and view all the answers

    At what gestational age do symptoms of ectopic pregnancy typically appear?

    <p>6 to 12 weeks (A)</p> Signup and view all the answers

    What does a serum progesterone level of less than 5 indicate?

    <p>A nonviable pregnancy (C)</p> Signup and view all the answers

    Which of the following is NOT a differential diagnosis for abdominal pain and bleeding in a woman of childbearing age?

    <p>Acute pancreatitis (D)</p> Signup and view all the answers

    What is the main treatment option for ruptured ectopic pregnancy?

    <p>Surgical laparoscopy (C)</p> Signup and view all the answers

    Which complication can result from misdiagnosis of ectopic pregnancy?

    <p>Hemorrhage and infection (B)</p> Signup and view all the answers

    Which of the following is a contraindication for women receiving methotrexate therapy?

    <p>Sexual activity (B), Consumption of folic acid vitamins (C)</p> Signup and view all the answers

    What is the recommendation for women regarding subsequent fertility after an ectopic pregnancy?

    <p>Increased risk of recurrent ectopic pregnancy (A)</p> Signup and view all the answers

    Why is vaginal bleeding and abdominal pain significant in women of childbearing age?

    <p>It raises suspicion for ectopic pregnancy (A)</p> Signup and view all the answers

    What might an increase in abdominal pain 5 to 10 days after methotrexate therapy indicate?

    <p>Possible tubal rupture (B)</p> Signup and view all the answers

    What is a common initial warning sign of ectopic pregnancy?

    <p>Light vaginal bleeding (B)</p> Signup and view all the answers

    Which of the following symptoms may indicate a ruptured ectopic pregnancy?

    <p>Severe shoulder pain (C)</p> Signup and view all the answers

    When do symptoms of ectopic pregnancy typically begin to manifest?

    <p>6 to 12 weeks of gestation (D)</p> Signup and view all the answers

    What diagnostic method may indicate hemoperitoneum as a result of a ruptured ectopic pregnancy?

    <p>Speculum examination (D)</p> Signup and view all the answers

    Which factor is associated with the increased prevalence of ectopic pregnancy?

    <p>Higher rates of chlamydia infections (C)</p> Signup and view all the answers

    Which clinical condition must always be considered in a woman of childbearing age presenting with abdominal pain and bleeding?

    <p>Ectopic pregnancy (C)</p> Signup and view all the answers

    What serum progesterone level indicates a failing pregnancy?

    <p>&lt; 16 (D)</p> Signup and view all the answers

    What is the primary concern following a misdiagnosis of ectopic pregnancy?

    <p>Sudden death due to hemorrhage and infection (A)</p> Signup and view all the answers

    Which of the following treatments is indicated for a ruptured ectopic pregnancy?

    <p>Surgical laparoscopy or laparotomy (B)</p> Signup and view all the answers

    What side effect is NOT associated with methotrexate therapy for ectopic pregnancy?

    <p>Excessive weight gain (D)</p> Signup and view all the answers

    Which intervention is recommended for women receiving methotrexate therapy for ectopic pregnancy?

    <p>Refrain from sexual activity and alcohol (C)</p> Signup and view all the answers

    What should be monitored closely in patients after methotrexate therapy for ectopic pregnancy?

    <p>Increasing abdominal pain (C)</p> Signup and view all the answers

    What is a common long-term consequence of salpingectomy performed due to ectopic pregnancy?

    <p>Reduced fertility (A)</p> Signup and view all the answers

    Flashcards

    Ectopic Pregnancy Definition

    Fertilized egg implants outside the uterus.

    Ectopic Pregnancy Symptoms

    May include light vaginal bleeding, pelvic pain, shoulder pain, or bowel urge.

    Ectopic Pregnancy Cause

    Possible link to Chlamydia infections.

    Ectopic Pregnancy Timing

    Symptoms often appear 6-12 weeks after conception.

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    Ectopic Pregnancy Diagnosis

    Physical exam, hCG blood test, and ultrasound may be used.

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    Ectopic Pregnancy

    Pregnancy outside the uterus, usually in a fallopian tube.

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    Serum hCG

    Hormone in blood that indicates pregnancy.

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    Ruptured Ectopic Pregnancy

    Ectopic pregnancy where the fallopian tube breaks.

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    Methotrexate

    Medication to treat ectopic pregnancies (non-surgical).

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    Transvaginal US

    Ultrasound of the vagina to visualize structures.

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    Viable Pregnancy

    Pregnancy where the fetus can survive long-term.

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    Salpingectomy

    Surgical removal of a fallopian tube.

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    Reduced Fertility

    Lower chance of getting pregnant.

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    Ectopic Pregnancy Location

    A fertilized egg implants outside the uterus, most commonly in the fallopian tube.

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    Ectopic Pregnancy Signs

    Early symptoms may include light vaginal bleeding, pelvic pain, and sometimes shoulder pain or an urge to have a bowel movement.

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    Ectopic Pregnancy Risk

    Ectopic pregnancy is a leading cause of maternal death in the first trimester.

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    Serum hCG (hCG)

    A hormone produced during pregnancy, detected in blood tests. High levels indicate pregnancy, but specific levels can indicate potential risks.

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    Uterine Immobilization

    A method to reduce the risk of rupture in an ectopic pregnancy, often involving bed rest and avoiding strenuous activity.

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    Study Notes

    Ectopic Pregnancy

    • Definition: A fertilized ovum implants outside the uterus.
    • Common initial symptoms: Light vaginal bleeding and pelvic pain.
    • Other symptoms: Shoulder pain, urge to have a bowel movement.
    • Possible cause: Increased prevalence of chlamydia infections.
    • High mortality rate: Second leading cause of maternal mortality in the first trimester.

    Clinical Presentation

    • Symptoms are often vague and subtle.
    • Common symptoms: Abdominal pain (with or without vaginal bleeding/spotting), dizziness, and shoulder pain.
    • Symptoms typically appear between 6 and 12 weeks of gestation.
    • Early pregnancy signs (nausea, fatigue, breast tenderness) may be present.
    • Pain may be generalized or localized to one side (unilateral) of the pelvis or abdomen.
    • Shoulder pain can be a sign of a ruptured ectopic pregnancy.

    Physical Exam and Diagnostics

    • Obtain a complete medical history and physical exam.
    • Monitor vital signs.
    • Pelvic exam may reveal a bulging cul-de-sac (rupture possibility).
    • Uterine enlargement may be present, but sometimes smaller than expected for gestational age.
    • Check for abdominal tenderness.
    • Assess for adnexal masses, involuntary guarding, and peritoneal signs.
    • Diagnostics:
      • Rising hCG levels are a useful indicator of early ectopic pregnancy.
      • hCG levels below a certain threshold may suggest ectopic pregnancy.
      • Blood tests (e.g., CBC for anemia, blood type, Rh factor determination, serum progesterone) are important.
      • Transvaginal ultrasound (TVUS) is often used to visualize the location of a pregnancy when hCG is high enough (e.g. >1800 mIU/mL).

    Differential Diagnoses

    • Conditions to rule out include:
      • Appendicitis
      • Salpingitis
      • Cholecystitis
      • Pelvic Inflammatory Disease (PID)
      • Intrauterine pregnancy with inaccurate dates
      • Corpus luteum cyst
      • Gestational trophoblastic neoplasm
      • Incomplete or missed abortion
      • Endometriosis
      • Pelvic mass
      • Ureteral calculi
      • Adnexal torsion
      • Twisted cystic teratoma
      • Ruptured malignant ovarian tumor

    Management

    • Emergent referral to an Emergency Department (ED) is necessary for: positive hCG test, abdominal pain, and vaginal bleeding/rupture.
    • Potential treatment options:
      • Pharmacotherapy (with guided ultrasound): Methotrexate or Potassium Chloride.
      • Folic acid antagonist.
      • Uterine immobilization.
      • Laparoscopic or laparotomy surgery (for ruptured ectopic pregnancy).

    Complications

    • Acute, massive bleeding is life-threatening.
    • Misdiagnosis (occurring in 12% of cases) can lead to hemorrhage and death.
    • Salpingectomy (removal of the fallopian tube) can affect future fertility, especially in patients with advanced age.
    • Methotrexate can have adverse side effects including: mucositis, abdominal cramping, malaise, anaphylaxis, alopecia, depression, hepatotoxicity, pulmonary fibrosis, photosensitivity, and bone marrow depression (high doses).

    Patient and Family Education

    • Women need to be aware of the increased risk of reduced fertility and recurrent ectopic pregnancies.
    • Condom use can help prevent infection and pelvic inflammatory disease (PID).
    • During methotrexate therapy, women should temporarily refrain from sexual activity and avoid alcohol/folic-acid containing vitamins for at least 3 months.
    • Increased abdominal pain 5-10 days after methotrexate warrants clinical evaluation due to possible tubal rupture.
    • Methotrexate usage tends to have a high success rate for women with ectopic pregnancies; as 50% conceived within a year.

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    Related Documents

    Women's Health Chapter 144 Ectopic Pregnancy PDF

    Description

    This quiz covers the definition, symptoms, and clinical presentation of ectopic pregnancy. Learn about its possible causes, early signs, and the importance of timely diagnosis and treatment. Test your knowledge on this critical aspect of maternal health.

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