12- vag bleed

Question 1

who should get screened for chalymdia

Answer 1

All sexually active women age 24 and younger

Sexually active women age 25 and older who are at increased risk

Question 2

risk factors for chlamydia

Answer 2

history of chlamydial or other sexually transmitted infection, new or multiple sexual partners, inconsistent condom use, and exchanging sex for money or drugs.

Question 3

what is dosage of folic acid pre-conception

Answer 3

400-800 mcg

Question 4

when is folic acid dosage increased

Answer 4

A. 1 mg in patients with diabetes or epilepsy

B. 4 mg in patients who bore a child with a previous neural tube defect

Question 5

pre-conception screening for family hx

Answer 5

sickle cell anemia
thalassemia
Tay-Sachs disease

Carrier screening (family history):
cystic fibrosis
nonsyndromic hearing loss (connexin-26)

Question 6

which diseases to screen for pre-conception

Answer 6

HIV
Syphilis
Hepatitis B immunization
Preconception immunizations (rubella, varicella)
Toxoplasmosis-avoid cat litter, garden soil, raw meat
CMV

Question 7

Goodell’s sign and Hegars sign

Answer 7

Goodell’s sign: Softening of the cervix

Hegars signsoftening of the uterus

signs of pregnancy

Question 8

Chadwick’s sign

Answer 8

bluish-purple hue in the cervix and vaginal walls

sign of pregnancy

Question 9

whats the earliest an enlargement of uterus can be detected

Answer 9

8 weeks

Question 10

when can the uterine fundus can be palpated above the symphysis pubis

Answer 10

Around 12 weeks,

Question 11

when are Fetal heart tones are typically elicited by hand-held Doppler

Answer 11

10-12 weeks

Question 12

Fetal movement or “quickening” is detected by the mother around

Answer 12

18-20 weeks

Question 13

Naegele’s Rule

Answer 13

calculating due date

starting with first day of LMP:
add 1 year
subtract 3 months
add 1 week

Question 14

Initial Pregnancy Laboratory Studies

Answer 14

B. Complete blood count
C. Rubella antibodies
D. Hepatitis B surface antigen
E. Type & screen
F. RPR
G. HIV

Question 15

thought 1 in 4 women have bleeding in 1st trimester, what percentage of those bleeds will be miscarriages?

Answer 15

25-50%

Question 16

Ectropion

Answer 16

When the central part of the cervix appears red from the mucous-producing endocervical epithelium protruding through the cervical os, onto the face of the cervix. It has no clinical significance and is common in women who are taking oral contraceptive pills.

Question 17

Recommended Laboratory Studies to Investigate First Trimester Vaginal Bleeding

Answer 17

CBC- hgb, WBC for infection

PCR for gonorrhea and chlamydia
Wet mount preparation- trichomonas

Quantitative beta-human chorionic gonadotropin (quant. beta-hCG)

progesterone

Question 18

how is progesterone helpful in deciphering 1st tri bleed?

Answer 18

If the result is >25, it is highly associated with a sustainable intrauterine pregnancy.

If the result is <5, it is highly associated with an evolving miscarriage or ectopic pregnancy.

Levels between 5 and 25 have minimal diagnostic value

Question 19

hcg in normal pregnancy growth

Answer 19

beta-hCG approximately doubles every 48 hours for the first 6-7 weeks of gestation.

Question 20

when is hcg lower or higher

Answer 20

higher-molar

lower- ectopic, miscarriages

Question 21

intrauterine pregnancy may not be conclusively detected until the quantitative beta-hCG reaches

Answer 21

1500-1800

Question 22

To detect an intrauterine pregnancy by transabdominal ultrasound, the beta-hCG will typically be

Answer 22

> 5000

Question 23

3 most common reasons for bleeding 1st trimester

Answer 23

spontaneous abortion,
ectopic pregnancy,
idiopathic bleeding in a viable pregnancy.

Question 24

what is measured in first trimester ultrasound to determine gestational age?

Answer 24

crown-rump length

Question 25

when should ultrasound date be regarded more than naegele’s rule of counting LMP? and what about 2nd trimester? what about third?

Answer 25

If the ultrasound measurements suggest an EGA & EDD that is greater than seven days from the EGA & EDD calculated from the LNMP

two weeks for second trimester

never regard third trimester ultrasound for age

Question 26

how do you measure GA in 2nd tri via ultrasound

Answer 26

biparietal diameter
head circumference
abdominal circumference
femur length

Question 27

Threatened abortion

Answer 27

bleeding before 20 weeks gestation.

Question 28

Inevitable abortion

Answer 28

dilated cervical os.

Question 29

Incomplete abortion

Answer 29

some but not all of the intrauterine contents (or products of conception) have been expelled.

Question 30

Missed abortion -

Answer 30

fetal demise without cervical dilitation and/or uterine activity (often found incidentally on ultrasound without a presentation of bleeding).

Question 31

Septic abortion -

Answer 31

with intrauterine infection (abdominal tenderness and fever usually present).

Question 32

Complete abortion -

Answer 32

the products of conception have been completely expelled from the uterus.

Question 33

expectant management option of miscarriage

Answer 33

means watchful waiting with precautions regarding unusual amounts of bleeding or pain, or fever, and is effective in over 75% of cases in this setting.

takes up to a month

Question 34

Surgical options for miscarriage

Answer 34

D&C with or without vacuum aspiration, or manual or electric vacuum aspiration.

main indication : unusually heavy bleeding and patient preference.

contraindication: is active pelvic infection and patient refusal.

Question 35

medical management of miscarriage

Answer 35

vaginal administration of 800 mcg of misoprostol (Cytotec), possibly repeated on day three.

time to completion is generally 3-4 days (but may take up to 2 weeks)