ectopic pregnancy special populations

from most to least common what are the implantatoin sites of an ectopic pregnancy

fallopian tube

ampulla

isthmus

infundibulum and fimbrae

interstitial

where are less common implantation sites for ectopic pregnancy

ovary

uterine cervix

peritoneal cavity

what is the epidemiology of ectopic pregnancy 

4-6% of maternal deaths in the US

most common cause of maternal mortality in first trimester

what is the etiology of ectopic pregnancy

pervious tube infection 

tubal litigation

fertility treatments

prior history of tubal pregnancy 

smoking 

use of IUD 

what are symptoms of ectopic pregnancy

missed menses

irregular vaginal bleeding

lower unilateral ab and pelvic pain

is a ruptured ectopic pregnancy a medical emergency

yes

what are the s/s of ectopic pregnancy 

dizziness

hemorrhage 

ipsilateral shoulder pain

tachycardia

hypotension 

when should we “think ectopic'“

unilateral ab pain

vaginal bleeding

positive pregnancy test

what will an ultrasound show for an ectopic pregnancy

gestational sac with fetal heart in fallopian tube

what is needed to diagnose an ectopic preganancy 

ultrasound

drop in hCG levels 

laproscopy/lapratomy 

what is a culdocentesis

extract blood from cul de sac of douglas if rupture has occured

what can cullens sign indicate 

ruptured ectopic pregnancy 

what is cullens sign

blue-black bruising of the area around umbilicus

what complications are associated with ectopic pregnancy

rupture with internal bleeding that leads to shock

how often does infertility occur in women who have had an ectopic pregnancy 

10-15% 

who is a laparotomy done for

hemodynamically unstable pt

who is a laproscopy done for

hemodynamically stable pt

what is a salpingotomy 

incision on tube then closing incision 

what is a salpingostomy

making an incision resolving the pregnancy and leaving it open

what is a salpingectomy

removing the tube 

what is a segmental resection

cutting out affected portion of the tube

when can we use medical management with methotrecate

if hCG below a certain level

no risk of rupture

injection of methotrexate (stop rapidly growing cells from multiplying)

following an ectopic pregnancy what do the chances of futrue pregnancy depend on 

status of adnexa left behind 

what is the chance of recurreng ectopic pregnancy

10-25%