Blueprints 2

Question 1

What is the most common site for ectopic pregnancies?

3 reasons they think they are on the rise?

Answer 1

Fallopian tubes, ampulla

Assisted fertility, STIs, and PID

Question 2

What is the strongest risk factor for ectopic pregnancy?

Two others that were mentioned?

Answer 2

Previous ectopic

ART and IUD

Question 3

Patient presentation of ectopic pregnancy?
Classic lab finding?
What is normal rate of increase for BHCG for IUP?

Answer 3

Younger lady with unilateral pelvic or low abdominal pain with vaginal bleeding.
BHCG that is low for GA and is not increasing at normal rate
Doubles every 48 hours

Question 4

What is a heterotropic pregnancy?

Answer 4

Multiple gestations with at least 1 IUP and 1 ectopic pregnancy

Question 5

How do we treat an unstable ruptured ectopic pregnancy?

Treat stable ruptured?

Answer 5

First give fluids, blood products and pressers to stabilize the patient.
Then go to OR to do exploratory lap

Exploratory lap. Salpingectomy or salpingostomy

Question 6

What is the general rule for using methotrexate to treat ectopic?
5 things

Answer 6

Non ruptured and life threatening, less than 4cm, BCHG less than 5k, no heart beat, and patient will follow up.

Question 7

How do we determine between single or multiple dose of methotrexate?

Answer 7

We first give 50 mg/m^2. Initially the bHCG will rise, but should drop 10-15% between days 4-7. If not, give a second dose.

Question 8

How do we define the following abortion terms.
Abortion?
Threatened abortion?
Inevitable abortion?
Incomplete abortion?
Complete abortion?
Missed abortion?

Answer 8

Loss of baby before 20 weeks or 500 g
Vaginal bleeding before 20 weeks, no dilation or cervix or expulsion of products
Blood and dilation of cervix, but no expulsion
Some products out
Complete expulsion
Death of baby before 20 weeks with everything retained.

Question 9

What is the most common cause of spontaneous abortions in first trimester?

Answer 9

Abnormal chromosomes due to mom making her gametes.

Most common abnormal chromosomes is autosomal trisomy

Question 10

3 things you can do to diagnose abortion?

Answer 10

Pelvic exam, labs, and US

Question 11

How to best treat complete abortion?
Treat incomplete, inevitable, and missed?
Threatened?

Answer 11

Follow her for recurrent bleeding and infection
Surgery with D and C, or medically with misoprostol
Pelvic rest and nothing in vagina

Any bleeding should have RhoGAM shot for RHnegative moms

Question 12

Most common causes of abortions in second trimester abortions?
5.

Answer 12

Infections, toxins, trauma, preterm labor and incompetent cervix

Question 13

3 options to treat second trimester abortions?

Answer 13

D and C
Let them naturally pass the baby
Induce labor with oxytocin

Question 14

During second trimester, what do we need to rule out if there is inevitable or threatened abortions and how do we treat?

Answer 14

Pre term labor and incompetent cervix

Tocolysis and cerclage

Question 15

What 3 common findings are found in incompetent cervix?

Answer 15

Infection, vaginal discharge and ruptured membranes

Question 16

What is the most common cause of cervical incompetence?

What is an additional cause they mentioned?

Answer 16

Surgery or trauma

DES exposure

Question 17

What is a cerclage?

Answer 17

Suture placed vaginally around the cervix to close it up

Question 18

How do we define recurrent pregnancy loss?

Answer 18

3 or more consecutive SABs

Question 19

Besides the normal causes of abortion, what are two additional and common causes they book mentioned of recurrent pregnancy loss?
What are those normal?

Answer 19

Antiphospholipid antibody syndrome and luteal phase defect, not having adequate progesterone to maintain pregnancy

Chromosomal abnormalities, infection, mom systemic dx

Question 20

4 things we can do to diagnose the cause of recurrent pregnancy loss?

Answer 20

Karyotype
Check moms anatomy
Screen for diabetes, hypothyroid, APA, lupus
Check level of progesterone during luteal phase

Question 21

How do we treat recurrent pregnancy loss in the following causes.
Chromosomal abnormalities?
Incompetent cervix?
APA?
Luteal phase defect?
Hypothyroid?

Answer 21

IVF or preimplantation with good cells
Cerclage
Low dose Aspirin, maybe with heparin 
Progesterone
Thyroid hormone

Question 22

Normal INR in healthy people?

Normal INR with warfarin?

Answer 22

Below 1.1

2-3