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Ectopic Pregnancy Ch 25

Ectopic Pregnancy Ch 25. 2009-2010 Academic Year MSIII Ob/Gyn Clerkship Self-Directed Study. Case Presentation.

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Ectopic Pregnancy Ch 25

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  1. Ectopic PregnancyCh 25 2009-2010 Academic Year MSIII Ob/Gyn Clerkship Self-Directed Study

  2. Case Presentation A 37 o G5P3013 with LMP 8 weeks ago presents to the ED with RLQ pain, nausea and vomiting, and vaginal spotting. The ED provider was concerned that the patient may have appendicitis because of her history, as well as her past surgical history significant for a tubal ligation. Initial lab work revealed a positive hCG. USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  3. GYN SAB Ruptured corpeus luteum cyst PID Adnexal torsion Degenerating fibroid NON-GYN Appendicitis Pyelonephritis Pancreatitis Peritonitis from other cause Differential Diagnosis USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  4. Risk Factors for Ectopic • Hx of tubal surgery • Hx of STD’s (such as chlamydia) • Hx of ART (assisted reproductive technology - IVF, clomid, etc) • Hx of ectopic (esp if conservatively managed without surgery) • Smoking • IUD in place at time of conception USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  5. Adapted from Hacker, et al. 4th ed. Figure 25-1 Possible locations of ectopic pregnancy with spontaneous conception versus pregnancies that result from assisted reproductive technologies (ART) such as in vitro fertilization (IVF). Modified from Pisarska MD et al: Clin Obstet Gynecol 42:3, 1999. Downloaded from: StudentConsult (on 16 June 2009 03:48 AM) USUHS MSIII Ob/Gyn Clerkship Self Directed Studies © 2005 Elsevier

  6. Incidence and Location • 1 in 80 spontaneous pregnancies • Tubal • 80% Ampullary • 12% Isthmic • 6% Fimbrial • 2% Interstitial • Cervical, intraperitoneal, ovarian USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  7. Locations of Etopics Adapted from www.ectopicpregnancyfoundation.org USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  8. Diagnosis • If HCG is above discriminatory value (1500-2000 depending on hospital), then US • US evaluation (Intra-uterine vs. extra) • HCQ - 66% of pregnancies double in 48h • Clinical Sx’s (bleeding, pain, hx of amenorrhea) USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

  9. Adapted from Hacker, et al. 4th ed. Distribution curve of hCG in normal pregnancies with an ex of a Discriminatory zone (DZ) in the shaded area. J Obstet Gynecol 152:299, 1985. Downloaded from: StudentConsult (on 16 June 2009 03:48 AM) USUHS MSIII Ob/Gyn Clerkship Self Directed Studies © 2005 Elsevier

  10. Adapted from Hacker, et al. 4th ed. Algorithm for diagnosis and treatment of ectopic in non-acute, stable patient. Downloaded from: StudentConsult (on 16 June 2009 03:48 AM) USUHS MSIII Ob/Gyn Clerkship Self Directed Studies © 2005 Elsevier

  11. Treatment Options • Medical Management • Methotrexate (See Table 25-1, pg 333) • Surgical Management • Salpingostomy (incision in tube) • Salpingectomy (removal of tube) • Open abdominal incision or laparoscopy (depending on stability of patient) USUHS MSIII Ob/Gyn Clerkship Self Directed Studies

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