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29 Cards in this Set
- Front
- Back
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If a woman comes in with vaginal spotting and lower abdominal pain, what should this be considered automatically?
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Ectopic until proven otherwise
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What would be a risk factor you'd look for in ectopic?
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HISTORY OF STD
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What is the DISCRIMINATORY ZONE?
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The b-hCG level at which a transvaginal ultrasound should show an IUP - 1500-2000 mIU/mL
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How much should the hCG level rise in 48 hrs before week 12 of pregnancy?
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66%
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What is hCG secreted by?
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The chorionic villi of the placenta
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Why do we assay for b-hCG?
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Because it prevents cross-reacting with LH
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What are 3 indications for doing a laparoscopy or laparotomy for ectopic pregnancy?
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1. Acute abdomen - severe abdominal or adnexal pain
2. Hypotension/volume depletion |
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What is often done when progesterone levels are <5ng/mL and the hCG is not rising normally and its still not known if its ectopic or IUP?
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D/C of the uterus to assess for miscarriage
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What D/C results would be indicative of an abortion?
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Finding of chorionic villi remnants within the curettage
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What women are candidates for methotrexate treatment of an ectopic?
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-Asymptomatic
-Smaller than 3.5cm -Ectopic |
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What are 3 ways that a nonviable intrauterine pregnancy can be managed?
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1. Expectantly
2. Surgical removal w/ D/C 3. Vaginal misoprostol |
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What is the reported efficacy rate of Misoprostol in evacuating the nonviable IUP?
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80%
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What should be done when the hCG is above the discrimin. zone and an IUP is seen on transvag US? (spotting/pain)
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Send home - its a THREATENED abortion; closely follow up
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What if the same case is seen but no IUP is seen on US?
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Highly suspect an ectopic; should probably do a laparoscopy and treat it.
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What should you NOT do for abdomin pain, spotting, hCG >2000, and no visible IUP?
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Don't give methotrexate; 15% of the time this is still an IUP just not visible yet.
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What is placenta accreta?
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Abnormal adherence of the placenta to the uterine wall bc villi attach to myometrium
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What is the abnormal adherence of placenta accreta due to?
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An abnormality of the DECIDUA BASALIS layer of the uterus
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What are 2 subtypes of worse placenta accreta?
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Increta - invasion INTO the myometrium
Percreta - complete PENETRATION across it to the serosa |
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What is required for the histologic diagnosis of placenta accreta?
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Abnormal decidua basalis layer
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What are the risk factors for placenta accreta?
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-Any uterine incision
-Placenta previa -Uterine curettage -DOWN SYNDROME |
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What is the usual management for true placenta accreta?
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HYSTERECTOMy
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Why is hysterectomy the treatment for placenta accreta?
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Because attempts to remove the placenta cause severe PPH and death
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What does TRACTION on the umb cord in placenta accreta increase the risk for?
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Uterine inversion
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What do clinicians usually do first when the placenta fails to deliver?
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Try to manually find a cleavage plane
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What happens?
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No cleavage plane exists
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What is the most common scenario for Placenta Accreta?
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-Placenta previa due to past C-section
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When does a woman have a 40-50% chance of having a Placenta Accreta?
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-PHx of 3/more c-sections
-Low-lying anterior placenta |
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What can often happen to a low-lying placenta or PPrevia if it's diagnosed in the 2nd trimester?
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It TRANSMIGRATES - the lower uterine segment grows more rapidly so PPrevia resolves
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Does a subSEROSAL incision without entry into the endometrium increase the risk for placenta accreta?
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nope
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