1st trimester gestations and bleeding Flashcards
What are risk factors for 1st trimester bleeding?
AMA, drugs, caffeine > 200mg, multiple gest., chronic dz, infxns, antidepressants, incompetent cervix
When should you see a yolk sac and fetal pole on US?
yolk sac 5wks, fetal pole 6wks
At what size does an embryo have a heart beat?
> 5mm
If there is no yolk sac on US but there is + HCG and bleeding what do you suspect?
ectopic Pg (if bright endometrial stripe, then SAB)
What do you do if a pt is stable, has bleeding, and has < 1800 HCG?
monitor HCG and make sure it doubles q 48hrs. Confirm intrauterine Pg when > 1800
Define threatened abortion
bleeding before 20wks w/embryo, heartbeat, and closed cervix
Define spontaneous abortion
abortion < 20wks gestation. can be threatened, complete, incomplete, septic, inevitable, missed
What are signs of a missed abortion?
amenorrhea, no heartbeat on US. NO other sx’s
What is the most common cause of SAB?
chromosomal abnormalities, esp trisomies and 45, x
When should an Rh - woman having a SAB /bleeding receive Rhogam?
w/in 72hrs of miscarriage or ectopic Pg
How do you treat a SAB?
Complete = NO tx! 1. Expectant management 2. Misoprostol (Cytotec) 800mcg vaginally or 600mcg PO, repeat in 3d prn 3. a suction D & C; D & E in 2nd trimester
What are s/sx’s of hydatidiform mole?
painless bleeding, severe hyperemesis, passing vesicles, lg uterus, high HCG, “snowstorm” on US, hyperthyroid sx’s, high HCG
What is tx for hydatidiform mole?
urgent D & C, monitor for 6 - 12 mos, put on birth control!, r/o choriocarcinoma
What are the risk factors for ectopic Pg?
PID, current IUD, smoking, infertility, IVF, hx tubal ligation or ectopics
What are signs of ectopic Pg?
possible bleeding, abd pain, CMT, palpable adnexal mass, syncope, hypotension, no yolk sac on TVUS, HCG > 1500
