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Ectopic Pregnancy
Embryo outside of endometrial cavity
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Frequency
1% of pregnancies
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Most common cause
50% due to damage of fallopian tube cilia from PID
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Other causes
abnormal fertilized ovum, late conception in cycle
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RF's for ectopic
previous ectopic, African origin, smoking, endometriosis, IUD (if pregnant), Hx PID, infertility, climiphene citrate use with induction, prior tubal procedures
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More RF's
abd surgery, uterine leiomyomas, adhesions, abN uterus shape
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Management of suspected ectopic
ABCs/Vitals/stabilize, confirm B-hCG, exam and investigations to assess, Rhogram is Rh-
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Investigations
serial B-hCGs, US (TVUS if >1500, abd if >6500), blood type
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When to use Medical Treatment of Ectopic
Only if all criteria met: <3.5cm unruptured, no FHR, B-hCG<5000, no liver/kidney/blood diseases, compliant/reliable, close follow-up
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Dosage of medical treatment
50mg/m2 of MTX IM dose x 1 then follow B-hCG weekly until non-detectable
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Success rate of Medical Tx of Ectopic
67% success rate, 25% may require 2nd dose MTX, 80% tubal potency after
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Surgical Treatment of Ectopic
linear salpingostomy if tube salvageable, or salpingectomy if damaged
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What condition do we worry about after Ectopic?
persistent trophoblast/GTD in 15% - need to follow B-hCG weekly
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What is the definition of antepartum hemorrhage
vaginal bleeding after 20weeks to term
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DDx of antepartum hemorrhage
bloody show, placenta prevue, vasa previa, abruptio placentae, marginal sinus bleeding, cervical lesion, uterine rupture, coagulopathy, urinary/bowel bleeding, vaginal laceration
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Categories of placental invasion (placenta accrete)
At myometrium = pl. Accreta, Into myo = pl. Increta, Passes myometrium = pl. Percreta
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