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Ectopic Pregnancy
Questions
261. Which of the following regarding Ectopic pregnancy is /are
true: (PGI 2004)
a. Occurs in about 10% of pregnancies
b. The risk is increased in those with a history of PID
c. Usually presents between 2 and 4 months of gestation
d. Patients usually have a negative pregnancy test
e. If patient is in shock, early laparotomy is essential
128
Ectopic Pregnancy 129
266. Commonest cause of ectopic gestation: (Kerala 96)
a. Previous salpingitis
b. Dysfunction of cilia
c. Uterine abnormalities
d. Delayed fertilization of ovum
e. Hydrosalphynx
267. Which one of the following drug is not used for medical managem-
ent of ectopic pregnancy? (AIIMS 2003)
a. Kcl
b. Methotrexate
c. Actinomycin D
d. Misoprostol
277. The hormone responsible for the decidual and Arias Stella
reaction of the ectopic pregnancy: (Kerala 2001)
a. HCG
b. Progesterone
c. Estrogen
d. HPL
281. Match List I (Type of Pill) with List II (Effect) and select the correct
answer using the codes given below the Lists:
List I List II
A. Triphasic 1. Prevention of ovarian tumors
B. DMPA 2. Good for women having hypomenorrhoea
C. Biphasic pill 3. Amenorrhoea is common
D. Progestin 4. Beneficial effect on HDLcontaining IUD
5. Chance of ectopic pregnancy
Codes:
a. A B C D
4 3 1 5
b. A B C D
4 1 3 5
c. A B C D
5 4 2 1
d. A B C D
5 3 4 2
282. A primipara with a cardiac lesion (MI) has come on the 40th day of
delivery asking for contraception. The contraceptive of choice is
a. Condom with spermicidal jelly
b. Oral contraceptive pill
c. Intrauterine contraceptive device
d. Laparoscopic sterilization
Ectopic Pregnancy
Answers
261. Ans. b and e
Ectopic pregnancy
Occur in about 1% of pregnancies
It usually presents at between 6 and 8 weeks gestation A sensitive
beta-HCG test is usually positive
Occurs in 1% of pregnancies
Mortality is less than 1%
Commonest site is in the tubal ampulla
Usually presents at 6-8 weeks amenorrhoea
Clinical presentation:
o Clinically patient has lower abdominal pain and slight vaginal
bleeding
o Cardiovascular collapse and shoulder tip pain suggest large
intraperitoneal bleed
o Examination will often shown abdominal and adnexal tenderness
Management:
o Patient invariably has positive urinary pregnancy test
o In cases of doubt sensitive serum beta-HCG is helpful
o Ultrasound shows empty uterus and may identify ectopic
o An intrauterine pregnancy on USG almost invariably excludes an
ectopic
o If no evidence of cardiovascular compromise laparoscopy is
investigation of choice
o If patient is shocked immediate laparotomy is essential
o Fetus can then be removed by salpingotomy or salpingectomy
Ectopic Pregnancy
Cervical
Extrauterine Uterine Angular
Cornual
Tubal Ovarian Abdominal
(Commonest 95%)
Ampulla Isthmus Infundibulum Interstitial Primary Secondary
(55%) (25%) (18%) (2%) (rare)
Intraperitoneal Extraperitoneal
(Broad ligament)
(Rare)
277. Ans. a, b
(Ref. Textbook of obstetrics D C Dutta 6th ed. 195)
Arias Stella reaction is characterized by a typical adenomatous
change of endometrial glands. Intraluminal budding together with
a typical cell changes (loss of polarity of cells, hyperchromatic nuclei,
vacuolated cytoplasm and occasional mitosis) are collectively
Ectopic Pregnancy 139
referred as Arias Stella reaction. This is strikingly due to progesterone
influence.
281. Ans: a
Biphasic pill Prevention of ovarian tumors
Triphasic Beneficial effect on HDL
DMPA Amenorrhoea is common
Progestin containing IUD Chance of ectopic pregnancy