Ectopic & Antepartum Hemorrhage

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Ectopic & Antepartum Hemorrhage
2011-10-12 21:01:27

Ectopic pregnancy
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  1. Ectopic Pregnancy
    Embryo outside of endometrial cavity
  2. Frequency
    1% of pregnancies
  3. Most common cause
    50% due to damage of fallopian tube cilia from PID
  4. Other causes
    abnormal fertilized ovum, late conception in cycle
  5. RF's for ectopic
    previous ectopic, African origin, smoking, endometriosis, IUD (if pregnant), Hx PID, infertility, climiphene citrate use with induction, prior tubal procedures
  6. More RF's
    abd surgery, uterine leiomyomas, adhesions, abN uterus shape
  7. Management of suspected ectopic
    ABCs/Vitals/stabilize, confirm B-hCG, exam and investigations to assess, Rhogram is Rh-
  8. Investigations
    serial B-hCGs, US (TVUS if >1500, abd if >6500), blood type
  9. 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
  10. Dosage of medical treatment
    50mg/m2 of MTX IM dose x 1 then follow B-hCG weekly until non-detectable
  11. Success rate of Medical Tx of Ectopic
    67% success rate, 25% may require 2nd dose MTX, 80% tubal potency after
  12. Surgical Treatment of Ectopic
    linear salpingostomy if tube salvageable, or salpingectomy if damaged
  13. What condition do we worry about after Ectopic?
    persistent trophoblast/GTD in 15% - need to follow B-hCG weekly
  14. What is the definition of antepartum hemorrhage
    vaginal bleeding after 20weeks to term
  15. 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
  16. Categories of placental invasion (placenta accrete)
    At myometrium = pl. Accreta, Into myo = pl. Increta, Passes myometrium = pl. Percreta