Ectopic pregnancy -Answer- Implantation of a blastocyst in a location other than in the uterine cavity Classic triad of ectopic symptoms? -Answer- Pain Amenorrhea Spotting or bleeding Three categories of ectopic pregnancies? -Answer- Intrauterine, extrauterine, heterotopic Treatment options for ectopic? -Answer- Medical Surgical Expectant management Which is preferable, medical or surgical management of ectopic? -Answer- Medical management is preferable to even "conservative" surgical procedures whenever feasible, esp in asymptomatic women with early unruptured EP Location might an intrauterine ectopic occur? -Answer- Gestation in cervix or cornua Location might an extrauterine ectopic occur? -Answer- Fallopian tube, ovary, abdomen, broad ligament Location might an heterotopic pregnancy occur? -Answer- Implantation in both uterine cavity and in an ectopic site (usually tube) When are heterotopic pregnancies more likely? -Answer- With pregnancy resulting from IVF Which type of ectopic is most common? -Answer- Tubal (97%) How are tubal ectopics classified? -Answer- By location: ampullary, isthmic, fimbrial, cornual/insterstital What type of tubal ectopic is most common? -Answer- Ampullary Why is ampullary ectopic so common? -Answer- Because it is where fertilization usually occurs When will a woman with an isthmic ectopic become symptomatic? -Answer- Earlier rather than later (6-7w?) Why will a woman with an isthmic ectopic become symptomatic earlier? -AnswerBecause it that part of the tube is so narrow What is the most distal part of the fallopian tube? -Answer- Fimbriae What can happen to the products of conception in a fimbrial ectopic? -Answer- They can be expelled into the peritoneal cavity Why do interstitial ectopics generally rupture later rather than earlier? -Answer- Thicker portion of the tube partially surrounded by myometrium When would rupture generally occur with an interstitial ectopic? -Answer- 9-12w What is a possible etiology of ectopic related to implantation? -Answer- Mechanical interference with implantation: IUC, hormonal dysfunction, sterilization failure What are some factors considered high risk for ectopic? -Answer- Prior ectopic pregnancy Tubal pathology & surgery In utero DES exposure What is the chance of recurrence with prior ectopic pregnancy? -Answer- 33% What kind of infection can result in tubal pathology? -Answer- Chlamydia, GC, polymicrobial What is the relationship between IUDs and ectopic? -Answer- Doesn't cause EP but if a pregnancy occurs there's a greater risk that the pregnancy is EP What type of infertility is of greatest risk for ectopic? -Answer- Patients with primary infertility due to tubal factors that prohibit or delay ovum transport What are some surgical risk factors for ectopic? -Answer- History of pelvic or abdominal procedures What lifestyle factor is known to increase risk of ectopic? -Answer- Smoking (dose dependent), multiple partners, early age of 1st intercourse What percentage of women with ectopic will have NO identifiable risk factors or initial definitive physical findings? -Answer- 50% What kind of pain is associated with ectopic? -Answer- Abdominal usually monitor pelvic, shoulder What kind of pain suggests rupture? -Answer- Sharp, sudden, stabbing What might exacerbate abdominal pain due to ectopic? -Answer- Movement What does shoulder pain suggest in ectopic? -Answer- Phrenic nerve stimulation -> rupture Why does shoulder pain occur in some ectopic pregnancies? -Answer- Intra-peritoneal bleeding with blood collecting below the diaphragm How are vital signs affected by ectopic? -Answer- Usually normal On abdominal exam, how might a woman with ectopic present if she hasn't ruptured? - Answer- Unilateral tenderness in lower abdomen On abdominal exam, how might a woman with ectopic present if she has ruptured? - Answer- Acute abdomen -- rebound, guarding, rigidity