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Ectopic Pregnancy (Family Medicine Residency Program) PowerPoint Presentation

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Slide 1 - Ectopic Pregnancy
Slide 2 - ppt slide no 2 content not found
Slide 3 - Incidence 2% of all pregnancies 6% of maternal mortality 6 fold increase in ectopic 1970 to 1992 19.7 ectopics per 1000 pregancies, stable since 1992
Slide 4 - Risk Factors Prior PID especially chlamydia Prior ectopic pregnancy Prior tubal surgery History of infertility History of IUD usage In vitro fertilization
Slide 5 - Diagnostic Tools Clinical triad of delayed menes, pain, and abnormal bleeding Ultrasound Beta HCG Progesterone
Slide 6 - ppt slide no 6 content not found
Slide 7 - Surgery Laparotomy verses Laparoscopy Conservative verses radical surgery
Slide 8 - Methotrexate Single dose 50 mg/sq meter IM Multiple dose MTX 1 mg/kg on d 0,2,4,6 Leucovorin 0.1 mg/kg d 1,3,5,7
Slide 9 - Side Effects Associated with Methotrexate Treatment Nausea Vomiting Stomatitis Diarrhea Gastric distress Dizziness Severe neutropenia (rare) Reversible alopecia (rare) Pneumonitis
Slide 10 - Treatment effects Increase in abdominal pain (occurs in up to two thirds of patients) Increase in Beta HCG levels during first 1-3 days of treatment Vaginal bleeding or spotting
Slide 11 - Signs of treatment failure and tubal rupture Significantly worsening abdominal pain, regardless of change in hCG levels Hemodynamic instability Levels of hCG that do not decline by at least 15% between day 4 and day 7 post injection Increasing or plateauing hCG levels after the first week of treatment
Slide 12 - 3/2 NJ is a 29 y/o GoPo complaining of no period PI: one month of intermittant low abd cramps Spotting on and off Gyn Hx: sexually active no birth control PE: Abdomen soft nontender Pelvic exam: no vaginal bleeding, Cx if closed, uterus is nontender, no adnexal mass or tenderness
Slide 13 - Quant Beta HCG = 3633 Ultrasound: 1 cm gestational sac in Left Adenexa
Slide 14 - 3/3 Methotrexate 50 mg/sq m IM 3/6 (day 4) Quant = 6019 3/9 (day 7) Quant = 5817 (3.3% decrease)
Slide 15 - 3/10 Methotrexate 50 mg/ sq m IM 3/13 (day 4) Quant = 4100 3/16 (day 7) Quant = 2609 (54% decrease)
Slide 16 - 3/2 NJ is a 29 y/o GoPo complaining of no period PI: one month of intermittant low abd cramps Spotting on and off Gyn Hx: sexually active no birth control PE: Abdomen soft nontender Pelvic exam: no vaginal bleeding, Cx if closed, uterus is nontender, no adnexal mass or tenderness
Slide 17 - Quant = 1500 Ultrasound show gestational sac in the uterus
Slide 18 - 3/16 CC: cramping continues on and off but the bleed is more like a menstral period Pelvic exam shows menstral blood in the vagina but the cervix is slightly dilated, uterus and adenexa are tender but no masses felt Ultrasound shows thickened endometrium with no gestational sac as seen 2 weeks ago
Slide 19 - Quant = 4500
Slide 20 - Path report shows chorionic villi
 

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