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37 Cards in this Set
- Front
- Back
What percentage of pregnant women experience spotting/bleeding in the 1st trimester?
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25%, half of those who bleed will miscarry
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What comprises the physical exam during 1st trimester bleeding?
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Documentation of the size and position of the uterus, fetal heart sounds by Doppler and bimanual exam for masses and tenderness
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What should you do if your patient with 1st trimester bleeding appears normal?
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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
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What can an adnexal tenderness and presence of a mass indicate?
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Ectopic pregnancy
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What does the presence of chorionic villi when removed with forceps?
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Spontaneous abortion
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If the H&P does not reveal a diagnosis, what is the next step?
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Ultrasonography with/without b-hCG test
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What is an anembryonic pregnancy?
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Presence of a gestational sac without evidence of embryonic tissue
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What is an ectopic pregnancy?
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Pregnancy outside the uterine cavity; most commonly in the Fallopian tube
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What is embryonic demise?
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Embryo without cardiac activity
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What is gestational trophoblastic disease?
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Placental proliferation in the absence of a fetus
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What is a heterotopic pregnancy?
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Simultaneous intrauterine and ectopic pregnancy
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What is recurrent pregnancy loss?
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More than 2 consecutive pregnancy losses
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What is spontaneous abortion?
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Spontaneous loss of pregnancy before 20 weeks gestation
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What is inevitable abortion?
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Bleeding in the presence of a dilated cervix; conceptus is unavoidable
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What is subchorionic hemorrhage?
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Sonographic finding of blood between the chorion and the uterine wall
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What is a threatened abortion?
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Bleeding in the presence of an embryo with cardiac activity and a closed cervix
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What is the 1st measurable finding in pregnancy? What produces it? When does it show up?
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b-hCG, produced by the placenta as early as 8 days after conception
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How fast do b-hCG levels rise?
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They rise in the first 4-8 weeks by 80% every 48 hours
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What does a normal intrauterine pregnancy look like on ultrasonography?
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Central blastocyst surrounded by a double ring of echogenic chorionic villi and decidua
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What finding positively confirms intrauterine pregnancy?
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Visible yolk sac by 6 menstrual weeks
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What is the most accurate way to date pregnancy?
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Measurement of the embryonic crown-rump length
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What are risk factors for spontaneous abortion?
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Endocrine abnormalities, genetic aneuploidy, immunologic abnormalities, infection, chemical exposures, radiation exposures, uterine conditions
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What are risk factors for ectopic pregnancy?
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IUD, hx of ectopic pregnancy, exposure to DES, hx of genital infection, PID, hx of tubal surgery, IVF, infertility, smoking
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What is the discriminatory criteria? What is the significance of a lack of fulfilling the criteria?
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It is a list of findings that must accompany a normal pregnancy; absence of expected discriminatory finding is consistent with pregnancy failure
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What makes up the discriminatory criteria?
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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 |
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What are findings associated with ectopic pregnancy?
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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
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What characterizes gestational trophoblastic disease?
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Snowstorm of amorphous material filling the uterus; risk of metastatic disease
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When does subchorionic hemorrhages occur?
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Common finding during the 1st trimester, may be an incidental finding in uncomplicated pregnancies and may be mistaken for a twin gestational sac
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What should one do when b-hCG levels are not rising as normally and ultrasound cannot confirm pregnancy location?
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D&C or manual vacuum aspiration
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What finding rules out an ectopic pregnancy?
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Presence of intrauterine embryo with cardiac activity
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How does one treat miscarriages?
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D&C historically treatment of choice, but misoprostol can be as effective and safer
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What is the significance of a negative urine b-hCG 4-6 weeks after a pregnancy loss?
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Excludes persistent gestational trophoblastic disease
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What is the current treatment options for ectopic pregnancy?
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Medical and laparoscopic management
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When do you use expectant management for ectopic pregnancy?
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When b-hCG fall less than 1000
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When do you use surgical management for ectopic pregnancy?
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patients with hemoperitoneum
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When do you use medical management for ectopic pregnancy?
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Patients who do not have a falling b-hCG < 1000 or signs of hemoperitoneum; use methotrexate
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What treatment should be given after pregnancy loss?
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Rh- women should receive anti D immune globulin
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