Ectopic Pregnancy Medical Treatments PDF

Ectopic Pregnancy Symptoms 50% of patients will have all three Abdominal Pain Vaginal Bleeding Amenorhea Other potential Signs Unfortunately, only about 50% of patients present with all 3 symptoms. Patients may present with other symptoms common to early pregnancy (eg, nausea, breast...

Ectopic Pregnancy Symptoms 50% of patients will have all three Abdominal Pain Vaginal Bleeding Amenorhea Other potential Signs Unfortunately, only about 50% of patients present with all 3 symptoms. Patients may present with other symptoms common to early pregnancy (eg, nausea, breast fullness). The following symptoms have also been reported: Painful fetal movements (in the case of advanced abdominal pregnancy) Dizziness or weakness Fever Flulike symptoms Vomiting Syncope Cardiac arrest The presence of the following signs suggests a surgical emergency: Abdominal rigidity Involuntary guarding Severe tenderness Evidence of hypovolemic shock (eg, orthostatic blood pressure changes, tachycardia) Fertilized Egg outside of the Uterus Diganosis Ultrasound & HCG Serial serum quantitative beta-hCG If initial hCG level is 3,000 mIU/mL, expected rate of increase is 33% in 48 hours Ultrasound Ultrasound imaging is necessary to visually determine location of pregnancy Although a gestational sac may be visible as early as 5 weeks, ultrasound evidence of an intrauterine pregnancy must include visualization of gestational sac with yolk sac or embryo An hCG discriminatory level at which the landmarks of an intrauterine pregnancy would be visualized is 3,500 mIU/mL Treatment Medical management with intramuscular methotrexate is an option for a confirmed or high suspicion of ectopic pregnancy in women who are hemodynamically stable, without rupture and no contraindications. This is not an FDA-approved use for methotrexate, but it has been endorsed by ACOG Medical management is more cost effective and avoids the risk of surgery and anesthesia hCG values should be less than 1,500 mIU/mL Medications During Pregnancy HTN: LABETALOL, NIFEDIPINE, METHYDOPA Mood Disorders: ZOLOFT DIABETES: INSULIN https://www.cdc.gov/ pregnancy/meds/ treatingfortwo/treatment- guidelines.html Hypertension in Pregnancy Gestational hypertension - BP > 150/90 after 20 weeks into the pregnancy that resolves 12 weeks postpartum clinically asymptomatic elevated BP and NO PROTEIN May withhold medications, hydralazine or labetalol are considered safe if treatment is warranted Chronic hypertension - BP > 140/90 prior to 20 weeks of gestation that persist for > 6 weeks postpartum symptoms of HTN include headache and visual symptoms if severe Mild BP > 140/90, Severe >180/110 with NO PROTEINURIA Monitor every 2-4 weeks, then weekly at 34-36 weeks gestational age and deliver at 39-40 weeks Severe - Meds if BP > 150/100 - labetalol or intermediate-acting or extended-release nifedipine. Oral hydralazine may be added if needed to achieve and maintain target blood pressure. Methyldopa is also a safe alternative but is hard to reach BP goals and is limited by sedative effects. Avoid ACEI and diuretics Gestational Diabetes TX: Patients with gestational diabetes must check their blood glucose levels daily after fasting overnight and after each meal. At each office visit, the patient’s home glucose levels should be reviewed, and if necessary, a fasting or a 2-hour postprandial blood glucose measurement should be done during the office visit. Patients who have fasting blood glucose measurements of greater than 105 mg/ dL or 2-hour postprandial blood sugar measurements of greater than 120 mg/ dL may require insulin. Insulin is the treatment of choice - the goal is fasting glucose < 95 NPH/Regular 2/3 in AM and 1/3 in PM Glyburide (only oral hypoglycemic that doesn't cross placenta but higher risk of eclampsia) initially or insulin if needed, higher risk of eclampsia Early delivery by c-section at 38 weeks if the child is macrosomic. Good glucose control is described as a 2-hour glucose tolerance test