12- vag bleed Flashcards
who should get screened for chalymdia
All sexually active women age 24 and younger
Sexually active women age 25 and older who are at increased risk
risk factors for chlamydia
history of chlamydial or other sexually transmitted infection, new or multiple sexual partners, inconsistent condom use, and exchanging sex for money or drugs.
what is dosage of folic acid pre-conception
400-800 mcg
when is folic acid dosage increased
A. 1 mg in patients with diabetes or epilepsy
B. 4 mg in patients who bore a child with a previous neural tube defect
pre-conception screening for family hx
sickle cell anemia
thalassemia
Tay-Sachs disease
Carrier screening (family history):
cystic fibrosis
nonsyndromic hearing loss (connexin-26)
which diseases to screen for pre-conception
HIV
Syphilis
Hepatitis B immunization
Preconception immunizations (rubella, varicella)
Toxoplasmosis-avoid cat litter, garden soil, raw meat
CMV
Goodell’s sign and Hegars sign
Goodell’s sign: Softening of the cervix
Hegars signsoftening of the uterus
signs of pregnancy
Chadwick’s sign
bluish-purple hue in the cervix and vaginal walls
sign of pregnancy
whats the earliest an enlargement of uterus can be detected
8 weeks
when can the uterine fundus can be palpated above the symphysis pubis
Around 12 weeks,
when are Fetal heart tones are typically elicited by hand-held Doppler
10-12 weeks
Fetal movement or “quickening” is detected by the mother around
18-20 weeks
Naegele’s Rule
calculating due date
starting with first day of LMP:
add 1 year
subtract 3 months
add 1 week
Initial Pregnancy Laboratory Studies
B. Complete blood count C. Rubella antibodies D. Hepatitis B surface antigen E. Type & screen F. RPR G. HIV
thought 1 in 4 women have bleeding in 1st trimester, what percentage of those bleeds will be miscarriages?
25-50%
Ectropion
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.
Recommended Laboratory Studies to Investigate First Trimester Vaginal Bleeding
CBC- hgb, WBC for infection
PCR for gonorrhea and chlamydia
Wet mount preparation- trichomonas
Quantitative beta-human chorionic gonadotropin (quant. beta-hCG)
progesterone
how is progesterone helpful in deciphering 1st tri bleed?
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
hcg in normal pregnancy growth
beta-hCG approximately doubles every 48 hours for the first 6-7 weeks of gestation.
when is hcg lower or higher
higher-molar
lower- ectopic, miscarriages
intrauterine pregnancy may not be conclusively detected until the quantitative beta-hCG reaches
1500-1800
To detect an intrauterine pregnancy by transabdominal ultrasound, the beta-hCG will typically be
> 5000
3 most common reasons for bleeding 1st trimester
spontaneous abortion,
ectopic pregnancy,
idiopathic bleeding in a viable pregnancy.
what is measured in first trimester ultrasound to determine gestational age?
crown-rump length
when should ultrasound date be regarded more than naegele’s rule of counting LMP? and what about 2nd trimester? what about third?
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
how do you measure GA in 2nd tri via ultrasound
biparietal diameter
head circumference
abdominal circumference
femur length
Threatened abortion
bleeding before 20 weeks gestation.
Inevitable abortion
dilated cervical os.
Incomplete abortion
some but not all of the intrauterine contents (or products of conception) have been expelled.
Missed abortion -
fetal demise without cervical dilitation and/or uterine activity (often found incidentally on ultrasound without a presentation of bleeding).
Septic abortion -
with intrauterine infection (abdominal tenderness and fever usually present).
Complete abortion -
the products of conception have been completely expelled from the uterus.
expectant management option of miscarriage
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
Surgical options for miscarriage
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.
medical management of miscarriage
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)
