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obstetric - gynecol STEP 2 > abortion, ectopic, choriocarcinoma, mole, hyperemesis > Flashcards

abortion, ectopic, choriocarcinoma, mole, hyperemesis Flashcards

1
Q

parts of fallopian tube?? (from ovarie to uterus)

which is the MC site of ectopic pregnancy?

A
  • Fimbria - Infundibulum - Ampulla - Isthmus

- AMPULLA (70-80%)

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2
Q

ectopic pregnancy - risk factors (which is the strongest?)

A
  1. pelvic inflammatory disease
  2. intrauterine devices
  3. Previous ectopic pregnancies (strongest)
  4. smoking
  5. prior tubal surgery
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3
Q

ectopic pregnancy - presentation

A
  1. unilateral lower abdominal or pelvic pain
  2. vaginal bleeding
  3. if ruptured –> hypotensive with peritoneal irritation
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4
Q

ectopic pregnancy - diagnostic test

A
  • β-HCG: to comfirm the presence of a pregnancy
  • US: to locate the site of implantation (transvaginal)
  • Laparoscopy: invasive test + treatment to visualize the ectopic pregnancy
    (HCG and TRANSVAGINAL U/S)
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5
Q

ectopic pregnancy - treatment (generally)

A
  1. IF not ruptured: medical or surgical treatment

2. IF ruptured: surgery if stable, IV fluids, blood products, dopamine if unstable and then surgery

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6
Q

ectopic pregnancy - medical exam should begin with baseline exams such as

A
  1. CBC to monitor anemia
  2. Blood type/screen
  3. Transaminases to detect changes indicating hepatotoxicity from medications
  4. β-HCG to assess for success of treatment via decrease it
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7
Q

ectopic pregnancy - medical treatment after baseline exams

A

methotrexate
- β-HCG is followed to see if there is 15% decrease in 4-7 days
IF decreased: continue to observe for side effects, no other treatment necessary
IF not decreased: 2nd dose and evaluate again. IF drop observe for side effects without other treatment. IF not surgery

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8
Q

exclusion criteria for methotrexate

A
  1. immunodeficiency (is immunosuppressive drugs)
  2. noncompliant patient
  3. liver disease
  4. Ectopic is 3.5 cm or larger
  5. fetal heartbeat auscultated
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9
Q

ectopic pregancy - surgery

A

surgery is done to try + preserve the fallopian tube BY CUTTING A HOLE IN IT (SALPINGOSTOMY). However, REMOVAL OF THE WHOLE FALLOPIAN TUBE (SALPINGECTOMY) may be necessary

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10
Q

beside medical or surgical treatment for ectopic pregnancy - what else?

A

mothers who are Rh (-) should receive anti-D Rh immunoglobulin (RhoGAM)

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11
Q

suspected ectopic pregnancy but transvaginal is nondiagnostic - next step

A

serum HCG levels
if less than 1500: repeat it in 2 days
more: repeat it and also repeat transvaginal U/S

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12
Q

abortion - definition

A

pregnancy that ends 20 wks gestation or fetus less than 500g. Almost 80% f spontaneous abortion occur prior to 12 weeks gestation

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13
Q

etiological factor for abortion (MC?)

A
  1. chromosomal abnormalities (60-80%)
  2. anatomic abnormalities
  3. STDs
  4. immunological factors (antiphospholipid syndrome)
  5. endocrinological factors (uncontrolled hyperthyroidism or diabetes)
  6. Malnutrition
  7. Traume
  8. Rh isoimmunization
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14
Q

abortion - presentation

A
  1. cramping abd pain
  2. vaginal bleeding
  3. may be stable or unstable, depending on the amount of blood loss
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15
Q

abortion - diagnostic tests

A
  1. CBC: to evaluate blood loss / need of transfusion
  2. Blood type Rh screen: should blood need to be transfused, evaluation for anti-D Rh globulin
  3. US: to distinguish between types of abortion
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16
Q

value of US on abortion diagnosis

A

you cannot answer the “most likely diagnosis” question about abortion without US

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17
Q

spontaneous abortion - treatment

A

hemod stable: expectant or medical induction

unstable –> suction curretage if infection oR unstable

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18
Q

types of abortion

A
  1. complete 2. incomplete 3. inevitable

4. threatened 5. missed 6. septic

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19
Q

complete abortion - US findings / treatment

A

US: no products of conception found
treatment: follow up in office

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20
Q

Incomplete abortion - US findings / treatment

A

US: some products of conception found
treatment: Dilation and curettage (D&C) / medical

21
Q

inevitable abortion - US findings / treatment

A

US: products of conception intact, but intrauterine bleeding present and dilation of cervix
treatment: D&C/medical

22
Q

threatened abortion - US findings / treatment

A

US: products of conception intact, intrauterine bleeding present, NO dilation of cervix
treatment: bed rest, pelvic rest

23
Q

missed abortion - US findings / treatment

A

death of fetus, but all products of conception present in the uterus
treatment: D&C/medical

24
Q

septic abortion - US findings / treatment

A

infection of the uterus and the surrounding areas

treatment: D&C and antibiotics (such as levofloxacin and metronidazole)

25
Q

spetic abortion - RF

A

retained product of conception from

  1. elective abortion with nonsterile techinge
  2. missed or incomplete abortion
26
Q

spetic abortion - clinical presentation

A
  • fever, chills, abdominal pain
    sanguinopurulent vaginal discharge
    boggy tender uterus, dilated cervix
    pelvic U/S retained product of abortion, thick endometrial stripe
27
Q

spetic abortion management

A

IV fluids
broad spectrum antibiotics
suction curettage

28
Q

medical treatment of abortion

A
  • can occur via giving medications that induce labor such as misoprostol (prostagladin E1 analog) –> help open the cervix + expulse the fetus
  • also anti-D is needed in Rh (-) mothers)
29
Q

how to confirm the diagnosis of choriocarcinoma

A

elevated HCG

30
Q

choriocarcinoma - RF / treatment

A

advanced maternal age
prior complete hydatidiform mole
treatment: chemo

31
Q

management of hydatidiform mole management

A

suction currettage –> weekly β-HCG until undetectable:
- increasing/plateauing –> diagnosis of gestational trophoblsastic neoplasia
- decreasing –> monthly β-HCG levels for 6 months –> if detectable it is gestational troph neoplasia. If undetectable then surveillance complete and can attempt pregnancy
contraception during the surveillance period (so can estimate the HCG)

32
Q

Hydatidiform mole - presentation

A
  1. vaginal bleeding
  2. uterine enlargement more than expected
  3. pelvic pressure/pain
  4. hCG-mediated sequelae (a. early preeeclampsia (before 20wk), b. theca-lutein cysts) c. hyperthyroidism, d. hyperemesis gravidarum)
  5. Sometimes vaginal passage of grape-like cysts
33
Q

Hydatidiform mole - hCG-mediated sequelae

A

a. early preeeclampsia (before 20wk)
b. theca-lutein cysts
c. hyperthyroidism
d. hyperemesis gravidarum

34
Q

Hydatidiform mole - management

A
  1. dilation and curettage and methotrexate

2. Monitor β-hCG

35
Q

Hydatidiform mole - types and definition of each type

A
  1. complete mole –> no embryo or normal placental tissue

2. partial mole –> there’s an abnormal embryo and possibly some normal placental tissue

36
Q

Hydatidiform mole - complete vs partial according to mechanism

A

complete –> Most commonly enucleated egg + single sperm (subsequently duplicates paternal DNA) or 2 sperm + 1 egg (enucleated)
partial –> 2 sperm + 1 egg (nucleated)`

37
Q

Hydatidiform mole - complete vs partial according to karyotype

A

complete –> 46, XX, 46, XY

partial –> 69 XXX, 69 XXY, 69 XYY

38
Q

Hydatidiform mole - complete vs partial according to fetal parts

A

complete –> no

partial –> yes

39
Q

Hydatidiform mole - complete vs partial according to uterine size

A

complete –> increased

partial –> normal

40
Q

Hydatidiform mole - complete vs partial according to imaging

A

complete –> “Honeycombed uterus or clustes of grapes, snowstorm on US
partial –> fetal parts

41
Q

Hydatidiform mole - complete vs partial according to risk of malignancy (gestational trophoblastic neoplasia)

A

complete –> 15-20%

partial –> less than 5%

42
Q

Hydatidiform mole - complete vs partial according to risk of choriocarcinoma

A

complete –> 2%

partial –> rare

43
Q

Hydatidiform mole - classically present … (when)

A

in the 2nd trimester as passage of grape like masses through the vaginal canal

44
Q

hyperemesis gravidarum - RF

A
  1. hydatidiform mole
  2. multifetal gestation
  3. history of hyperemesis gravidarum
45
Q

Hyperemesis gravidarum - cliical features

A
  1. severe persistent vomiting
  2. loss of more than 5% of prepragnancy weight
  3. dehydration
  4. ortostatic hypotension
46
Q

Hyperemesis gravidarum - labs

A
  1. KETONURIA
  2. hypochloeremic metabolic alkalosis
  3. hypokalemia
  4. hemoconcentration
47
Q

hyperemesis gravidorum - treatmnet

A

admission
antiemetics
IV fluids

48
Q

pregnant with hyperemesis and nystagmus - think …

A 
thiamine def
(treat with IV thiamine followed by glucose

obstetric - gynecol STEP 2 (22 decks)

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