10. Pregnancy-Related Complications Flashcards
1
Q
Describe history: Approach to the Patient with Bleeding in T1/T2 (8)
A
- risk factors for ectopic pregnancy
- previous spontaneous abortion
- recent trauma
- characteristics of the bleeding (including any tissue passed)
- characteristics of the pain (cramping pain suggests spontaneous abortion)
- history of coagulopathy
- gynecological/obstetric history
- fatigue, dizziness, syncopal episodes due to hypovolemia, fever (may be associated with septic abortion)
2
Q
Describe physical: Approach to the Patient with Bleeding in T1/T2 (5)
A
- vitals (including orthostatic changes)
- abdomen (symphysis fundal height, tenderness, presence of contractions)
- perineum (signs of trauma, genital lesions)
- speculum exam (cervical os open or closed, presence of active bleeding/clots/tissue)
- pelvic exam (uterine size, adnexal mass, uterine/adnexal tenderness, cervical motion tenderness)
3
Q
Describe investigations: Approach to the Patient with Bleeding in T1/T2 (4)
A
- β-hCG (may be lower than expected for GA in spontaneous abortion, can be used to diagnose viable pregnancy vs. ectopic pregnancy vs. abortion)
- U/S (confirm intrauterine pregnancy and fetal viability)
- CBC
- group and screen
4
Q
Describe treatment: Approach to the Patient with Bleeding in T1/T2 (2)
A
- IV resuscitation for hemorrhagic shock
- treat the underlying cause
5
Q
Define: First trimester bleeding (1)
A
vaginal bleeding within the first 12 wk
6
Q
Define: Second trimester bleeding (1)
A
12-20 wk
7
Q
Name DDX of: First and second trimester bleeding (6)
A
- Physiologic bleeding: spotting, due to implantation of placenta – reassure and check serial β-hCGs
- Abortion (threatened, inevitable, incomplete, complete)
- Abnormal pregnancy (ectopic, molar)
- Trauma (post-coital or after pelvic exam)
- Genital lesion (e.g. cervical polyp, neoplasms)
- Subchorionic hematoma
8
Q
Every woman of childbearing age presenting to ER with abdominal or pelvic pain should have ___ measured
A
β-hCG
9
Q
Name: Classification of Spontaneous Abortions (7)
A
- Threatened
- Inevitable
- Incomplete
- Complete
- Missed
- Recurrent
- Septic
10
Q
Describe: Threatened
- History
- Clinical
- Management (± Rhogam®)
A
- History: Vaginal bleeding ± cramping
- Clinical: Cervix closed and soft
- Management (± Rhogam®): Watch and wait <5% go on to abort
11
Q
Describe: Inevitable
- History
- Clinical
- Management (± Rhogam®)
A
- History: Increasing bleeding and cramps ± rupture of membranes
- Clinical: Cervix closed until products start to expel, then external os opens
- Management (± Rhogam®):
- a) Watch and wait
- b) Mifepristone 200 mg PO followed by Misoprostol 800 μg PV 24 h later
- c) D&C
12
Q
Describe: Incomplete
- History
- Clinical
- Management (± Rhogam®)
A
- History: Extremely heavy bleeding and cramps ± passage of tissue noticed
- Clinical: Cervix open
- Management (± Rhogam®):
- a) Watch and wait
- b) Mifepristone 200 mg PO followed by Misoprostol 800 μg PV 24 h later
- c) D&C
13
Q
Describe: Complete
- History
- Clinical
- Management (± Rhogam®)
A
- History: Bleeding and complete passage of sac and placenta
- Clinical: Cervix closed, bleeding stopped
- Management (± Rhogam®): No D&C – expectant management
14
Q
Describe: Missed
- History
- Clinical
- Management (± Rhogam®)
A
- History: No bleeding (fetal death in utero)
- Clinical: Cervix closed
- Management (± Rhogam®):
- a) Watch and wait
- b) Mifepristone 200 mg PO followed by Misoprostol 800 μg PV 24 h later
- c) D&C
15
Q
Describe: Recurrent
- History
- Clinical
- Management (± Rhogam®)
A
- History: ≥3 consecutive spontaneous abortions
- Clinical: -
- Management (± Rhogam®): Evaluate mechanical, genetic, environmental, and other risk factors
