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26 Cards in this Set
- Front
- Back
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How can you tell an intrauterine pregnancy from an ectopic with ultrasound and b-hCG levels
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IUP should be seen on transvaginal US w/b-hCG between 1500 and 2000; fetal heartbeat should be seen with b-hCG > 5000
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Rx for a hemodynamically unstable ectopic pregnancy
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Stabilize with IV fluids, blood, pressors
Then do exploratory laparotomy to remove ectopic |
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What is the major treatment tool used for a stable ectopic
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methotrexate or exploratory laparoscopy to remove hemoperitoneum, coagulate ongoing bleeding, resect ectopic --> salpingostomy, salpingectomy, cornual resection (interstitial ectopic)
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When is methotrexate indicated as treatment for an ectopic?
what should you monitor and when is a second dose indicated |
small ectopics (<4cm, w/o fetal heartbeat), patients who are stable and will be reliable w/followup
Monitor transaminases and creatinine, serially follow b-hCG if b-hCG does not fall by 10-15% between 4-7 days of treatment, give a second dose |
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What is a spontaneous abortion
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pregnancy that ends before 20 weeks
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Definition
abortus |
fetus lost before 20 weeks gestation, <500g, or <25cm
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What is the difference between a complete abortion and an incomplete abortion
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complete = complete expulsion of all products of conception before 20 wks
incomplete = partial epulsion |
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What is the difference between an inevitable abortion and a threatened abortion
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inevitable = no expulsion of products, but vaginal bleeding and dilation of the cervix so viable pregnancy is unlikely
threatened = vaginal bleeding before 20 wks, w/o dilation of cervix or expulsion of POC |
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What is a missed abortion
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death of the embryo/fetus before 20 weeks, complete retention of all POC
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Majority of first trimester abortions are due to what
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60-80% due to abnormal chromosomes
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6 things on the differential for first trimester bleeding
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-Spontaneous abortion
-Postcoital bleeding -Ectopic pregnancy -Vaginal/cervical lesions or lacerations -Extrusion of molar pregnancy -Nonpregnancy causes of bleeding |
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Rx for an incomplete abortions, inevitable and missed abortions
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1. Finish on its own
2. D&C 3, Misoprostol to induce cervical dilation and uterine contractions |
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Rx for threatened abortion
What 2 conditions are these patients at risk for |
Follow for bleeding, place on pelvic rest w/nothing per vagina
Increased risk for preterm labor, preterm premature rupture of membranes |
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5 common etiologies for second trimester abortions
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Infection
Maternal uterine/cervical anatomic defects Maternal systemic disease Fetotoxic agents Trauma |
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How do you treat Incomplete or missed abortions between 16-24 weeks
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Dilation and evacuation (must aggressively dilate with laminaria)
OR Induced labor with oxytocin or prostaglandins |
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What is the difference between Pre-term labor and incompetent cervix (as etiologies of incomplete or threatened abortions in 2nd trimester)? How do you treat them differently?
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PTL - contractions --> cervical change; manage with cerclage
Incompetent cervix - painless dilation of the cervix; manage with tocolysis |
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What happens when a patient as an incompetent cervix?
Findings? What does it normally cause problems |
15% of all second trimester losses
Painless dilation and effacement of the cervix --> fetal membranes exposed to vaginal flora --> increased risk of trauma, infection FIndings: infection, vaginal discharge, rupture of membranes, cramping, chorionic/amniotic sacs bulging through cervix |
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Risk factors for incompetent cervix (4)
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History of cervical surgery
History of cervical lacerations (in a vaginal delivery) Uterine anomalies History of DES exposure |
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What is the etiology of pain associated with an incompetent cervix as opposed to pre-term labor
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incompetent cervix - dilated cervix with exposed membranes
pre-term labor - contractions/cramping leading to cervical change |
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How do you treat previable (<24wks) cervical incompetence
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1. Possible expectant management
2. Elective termination |
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How do you treat patients with viable pregnancies with cervical incompetenece
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betamethasone (decrease risk of prematurity), bed rest
Tocolysis if preterm contractions |
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What is a cerclage?
When is it used? 2 types? |
suture placed around the cervix
cervical-vaginal jn (McDonald) or internal os (Shirodkar) Used in previable pregnancy w/incompetent cervix |
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What is the management procedure if a patient has a failed vaginal cerclage
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transabdominal cerclage - placed aroundt he cervix at the level of the internal os in a laparotomy
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What is a recurrent pregnancy loss
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woman with 3 or more consecuative spontaneous abortions
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What is antiphospholipid antibody syndrome?
Luteal phase defect? what do both of these predispose to? |
APA syndrome -
Luteal phase defect - lack adequate progesterone Recurrent pregnancy loss |
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What is the screening procedure for a woman with recurrent pregnancy loss
(5) |
1. karytype analysis of bothe parents, previous conceptuses if possible
2. examine female anatomy with a hysterosalpingogram 3. screen for hypothyroidism, DM, Anti-phospholipi Ab syndrome, hypercoag, SLE 4. Serum progesterone measured during luteal phase 5. culture cervix, vagina, endometrium |
