1St Trimester Bleeding

Front 1

What percentage of pregnant women experience spotting/bleeding in the 1st trimester?

Back 1

25%, half of those who bleed will miscarry

Front 2

What comprises the physical exam during 1st trimester bleeding?

Back 2

Documentation of the size and position of the uterus, fetal heart sounds by Doppler and bimanual exam for masses and tenderness

Front 3

What should you do if your patient with 1st trimester bleeding appears normal?

Back 3

Guarded reassurance and watchful waiting; as long as fetal heart sounds are detected, patient is stable and there are no adnexal mass/tenderness or signs of intraperitoneal bleeding

Front 4

What can an adnexal tenderness and presence of a mass indicate?

Back 4

Ectopic pregnancy

Front 5

What does the presence of chorionic villi when removed with forceps?

Back 5

Spontaneous abortion

Front 6

If the H&P does not reveal a diagnosis, what is the next step?

Back 6

Ultrasonography with/without b-hCG test

Front 7

What is an anembryonic pregnancy?

Back 7

Presence of a gestational sac without evidence of embryonic tissue

Front 8

What is an ectopic pregnancy?

Back 8

Pregnancy outside the uterine cavity; most commonly in the Fallopian tube

Front 9

What is embryonic demise?

Back 9

Embryo without cardiac activity

Front 10

What is gestational trophoblastic disease?

Back 10

Placental proliferation in the absence of a fetus

Front 11

What is a heterotopic pregnancy?

Back 11

Simultaneous intrauterine and ectopic pregnancy

Front 12

What is recurrent pregnancy loss?

Back 12

More than 2 consecutive pregnancy losses

Front 13

What is spontaneous abortion?

Back 13

Spontaneous loss of pregnancy before 20 weeks gestation

Front 14

What is inevitable abortion?

Back 14

Bleeding in the presence of a dilated cervix; conceptus is unavoidable

Front 15

What is subchorionic hemorrhage?

Back 15

Sonographic finding of blood between the chorion and the uterine wall

Front 16

What is a threatened abortion?

Back 16

Bleeding in the presence of an embryo with cardiac activity and a closed cervix

Front 17

What is the 1st measurable finding in pregnancy? What produces it? When does it show up?

Back 17

b-hCG, produced by the placenta as early as 8 days after conception

Front 18

How fast do b-hCG levels rise?

Back 18

They rise in the first 4-8 weeks by 80% every 48 hours

Front 19

What does a normal intrauterine pregnancy look like on ultrasonography?

Back 19

Central blastocyst surrounded by a double ring of echogenic chorionic villi and decidua

Front 20

What finding positively confirms intrauterine pregnancy?

Back 20

Visible yolk sac by 6 menstrual weeks

Front 21

What is the most accurate way to date pregnancy?

Back 21

Measurement of the embryonic crown-rump length

Front 22

What are risk factors for spontaneous abortion?

Back 22

Endocrine abnormalities, genetic aneuploidy, immunologic abnormalities, infection, chemical exposures, radiation exposures, uterine conditions

Front 23

What are risk factors for ectopic pregnancy?

Back 23

IUD, hx of ectopic pregnancy, exposure to DES, hx of genital infection, PID, hx of tubal surgery, IVF, infertility, smoking

Front 24

What is the discriminatory criteria? What is the significance of a lack of fulfilling the criteria?

Back 24

It is a list of findings that must accompany a normal pregnancy; absence of expected discriminatory finding is consistent with pregnancy failure

Front 25

What makes up the discriminatory criteria?

Back 25

A normal pregnancy should exhibit a gestational sac when
1) b-hCG levels reach 1500-2000
2) a yolk sac when the gestational sac is greater than 10mm in diameter
3) cardiac activity when the crown-rump length is greater than 5mm

Front 26

What are findings associated with ectopic pregnancy?

Back 26

b-hCG above the discriminatory cutoff, gestational sac not visible, embryo with cardiac actiity outside the uterus (definitive proof) and adnexal mass or free pelvic fluid

Front 27

What characterizes gestational trophoblastic disease?

Back 27

Snowstorm of amorphous material filling the uterus; risk of metastatic disease

Front 28

When does subchorionic hemorrhages occur?

Back 28

Common finding during the 1st trimester, may be an incidental finding in uncomplicated pregnancies and may be mistaken for a twin gestational sac

Front 29

What should one do when b-hCG levels are not rising as normally and ultrasound cannot confirm pregnancy location?

Back 29

D&C or manual vacuum aspiration

Front 30

What finding rules out an ectopic pregnancy?

Back 30

Presence of intrauterine embryo with cardiac activity

Front 31

How does one treat miscarriages?

Back 31

D&C historically treatment of choice, but misoprostol can be as effective and safer

Front 32

What is the significance of a negative urine b-hCG 4-6 weeks after a pregnancy loss?

Back 32

Excludes persistent gestational trophoblastic disease

Front 33

What is the current treatment options for ectopic pregnancy?

Back 33

Medical and laparoscopic management

Front 34

When do you use expectant management for ectopic pregnancy?

Back 34

When b-hCG fall less than 1000

Front 35

When do you use surgical management for ectopic pregnancy?

Back 35

patients with hemoperitoneum

Front 36

When do you use medical management for ectopic pregnancy?

Back 36

Patients who do not have a falling b-hCG < 1000 or signs of hemoperitoneum; use methotrexate

Front 37

What treatment should be given after pregnancy loss?

Back 37

Rh- women should receive anti D immune globulin