Ectopic Pregnancy MCQs

Ans, A. 14 days Menstrual regulation (lnduction/Aspiration) Aspiration of endometrial cavity within l4 days of missed period in a woman with previous normal cycle. Done as an OPD procedure. Helps to detect failed abortion, molar pregnancy or ectopic Pregnancy. Contraindicated in advanced pregnancy & in presence of local pelvic inflammation.

Laparoscopy is considered the "gold standard". While it is the most reliable aid to support the clinical diagnosis, it may not be feasible to do in all cases. It is reserved only in those cases in which differential diagnosis includes salpingitis, appendicitis or ectopic pregnancy. Nonresponding pelvic mass needs laparoscopic clarification. Hysteroscopy may also provide confirmatory evidence for salpingitis. "Fallopian tube culture can be obtained laparoscopically and recently the hysteroscopic approach has been introduced. The specimen is obtained during hysteroscopy with a cytobrush." Reference : Shaw 15th/ed pg 451; William's Gynae 1st/ed pg 74; Gynecology by Ostrzenski (Lippincott Williams 2001/ 282); Dutta Gynae 6th/ed pg 130

M.C site of ectopic pregnancy – Fallopian tubes . In Fallopian Tubes – M/C sites in descending order are:Ampulla > isthmus > infundibulum > interstitium Rarest overall site of ectopic pregnancy is cervix or cesarean section scan Average period of survival of ectopic pregnancy is 8 weeks. Ectopic pregnancy survives for the longest time in its annual pregnancy. Reference: Dutta Obs. 7/e, p 179; CODGT 10/e, p 267

The lady in the question is presenting with unruptured ectopic pregnancy with b-hCG levels - 2000 IU/L. So there is no doubt we can manage the patient medically (i.e. option d - ruled out) Expectant management as explained earlier is not better than medical management as it carries a risk of rupture of ectopic pregnancy (i.e., option C ruled out) and also it is done when b-hCG levels are Single dose therapy is more commonly used because of simplicity. It is less expensive, requires less invasive post therapy monitoring and does not require leucovorin supplementation. Reference: Williams Gynae 1/e, p 166, 167

Abdominal pain. It is seen in 95-100% cases. Most common and the most consistent symptom of ectopic pregnancy (undisturbed) is Pain is located in the lower abdomen/pelvic region. It can be unilateral or bilateral. In case of ruptured ectopic pregnancy: pain is due to hemoperitoneum and when internal hemorrhage floods the peritoneal cavity and irritates the undersurface of diaphragm and phrenic nerve, the patient also complains of shoulder tip and epigastric pain. In case of unruptured ectopic pain is due to stretching of the Fallopian tube Reference: Dutta Obs. 7/e, p 179; CODGT 10/e, p 267

Diagnostic Aids in Ectopic Pregnancy In hemodynamically stable patient presenting with a triad of amenorrhea, abdominal pain and vaginal bleeding 1st Test: UPT (+ve in 90% cases of ectopic) Reference: Shaw 14/e, p 244 Reference: Dutta Obs. 7/e, p 182, 183; Leon Speroff 7/e, p 1280-1285; Novak

Minipill can be used during lactation (i.e. option "c" is incorrect). It is not used in combination with other pills therefore option "b" is incorrect. Minipill "Ectopic pregnancy is not prevented as effectively as intrauterine pregnancy. Although the overall incidence of ectopic pregnancy is not increased, When pregnancy occurs (with mini pill use) the clinician must suspect that it is more likely to be ectopic. A previous ectopic pregnancy should not be regarded as a contraindication to the mini pill." —Leon Speroff 7 th /ed p 922 So option "d" is incorrect Main side effect of Minipill /progesterone only pill: Irregular bleeding and amenorrhea (i.e. option "a" is correct). Pearl index-3% Reference : Leon Speroff 7 th /ed p 922

A young woman presenting with 6 weeks of amenorrhea and USG showing empty uterus could either mean it is an ectopic pregnancy or abortion. In abortion – patient will give history of bleeding, pain but mass in abdomen does not favour it. Reference: Dutta Obs. 7/e, p 182; Williams Obs. 22/e, p 258, 259, 23/e, p 242, 243.