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Blue Prints > BP Chapter 2 > Flashcards

BP Chapter 2 Flashcards

1
Q

Ectopic pregnancy definition

A

implants outside the uterine cavity

ampula > isthmus > fimbriae

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2
Q

why increase in ectopic pregnancy?

A

increased assisted fertility, STIs, PID

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3
Q

Risk factors for ectopic

A
  • prior ectopic (10%)
  • assisted reproductive technology
  • IUD (if they actually get pregnant)
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4
Q

Presentation

A
  • u/l abd pain, VB
  • tender adnexal mass
  • uterus small for GA
  • bleeding from cervix
  • beta HCG low for GA, doesn’t inc as expected
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5
Q

Why doesn’t beta hcg double every 48hrs?

A

poorly implanted placenta with less blood supply than in the endometrium

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6
Q

What indicates IUP on US?

A

gestational sac with a yolk sac seen in the uterus

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7
Q

Heterotopic pregnancy

A

one IUP and one ectopic (IVF pregnancies)

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8
Q

Ectopic tx

A

ruptured, unstable - IV fluids, blood, vasopressor meds, and then to OR for exploratory laparotomy

ruptured, stable - exploratory lap (salpingostomy or salpingectomy)

enruptured, stable - methotrexate or surgery

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9
Q

When to use methotrexate?

A
  • small ectopics( <4cm, beta hcg <5000, no fetal heartbeat) and reliable f/u
  • monitor baseline transaminases, creatinine
  • beta hcg level will rise first few days post tx, but fall 10-15% b/t days 4 and 7 (if it doesn’t fall, need second dose)
  • continue to monitor for signs of rupture (and pain, VB, shock)
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10
Q

Risk Factors for ectopic (chart!)

A

hx of STI or PID
prior ectopic
previous tubal surgery
prior pelvic/abd surgery leaving adhesions
endometriosis
current use of exogenous hormones (including prog and estrogen)
IVF and other ART
DES exposure with congenital abnormalities
congenital abnormalities of the Fallopian tubes
IUD use
smoking

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11
Q

SAB def

A

pregnancy that ends before 20 weeks gestation

15-25% of all pregnancies

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12
Q

Abortus

A

fetus lost before 20 weeks or less than 500g

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13
Q

Complete abortion

A

complete expulsion of all POC before 20 weeks

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14
Q

Incomplete abortion

A

partial expulsion of some but not all PCO before 20 weeks

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15
Q

Inevitable abortion

A

no expulsion of products, but vaginal bleeding and cervical dilation such that viable pregnancy is unlikely

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16
Q

Threatened abortion

A

any VB before 20 weeks without dilation of cervix or expulsion of any POC

17
Q

Missed abortion

A

death of the embryo or fetus before 20 weeks with complete retention of POC

18
Q

Main cause of abortions

A

abnormal chromosomes

95% due to errors in maternal gametogenesis (trisomy 16)

other factors: infections, maternal anatomic defects, immunologic factors, environmental exposures, endocrine factors

19
Q

Dx of SAB

A

present with VB

cramping, abd pain, dec sx of pregnancy

labs: quantitative level of beta hcg, cbc, blood type, AB screen
- US for fetal viability and placentation

20
Q

Medical management of inevitable, missed, and incomplete SABs - T1

A

misoprostol with or without mifepristone to induce cervical dilation, uterine contractions, and expulsion of POC

21
Q

Tx of threatened abortion

A

followed for continued bleeding, placed on pelvic rest

if Rh -, give RhoGAM

22
Q

DDX of first trimester bleeding (chart!)

A 
SAB
postcoital bleeding
ectopic pregnancy
vaginal or cervical lesions or lacerations
extrusion of molar pregnancy
non pregnancy causes of bleeding
23
Q

Second trimester abortion etiology

A

infection, maternal or cervical anatomic defects, maternal systemic disease, exposure to fetotoxic agents, and trauma

24
Q

Tx of incomplete and missed abortions - T2

A
  • finish on their own
  • D&C or D&E (second)
  • 16-24 weeks –> D&E or labor induction with oxytocin or prostaglandins
    • DE is faster, but laminaria may perf uterus; labor takes longer, but allows genetic analysis
25
Q

PTL vs. Incompetent cervix

A

PTL - contractions leading to cervical change (tocolysis may help)
IC - painless dilation of the cervix (emergent cerclage can help)

26
Q

What bad things are associated with incomp cervix? RFS?

A

infection, vaginal discharge, rupture of membranes, cramping, contracting

RFs: surgery or other cervical trauma (d&c, LEEP, cervical conization), congenital abnormality (DES)

27
Q

Incompetent cervix tx

A

previable: expectant management or elective termination, emergent cerclage
viable: betamethasone, strict bed rest

28
Q

McDonald cerclage vs. Shirodka cerclage vs. Transabd cerclage

A

M - cervical-vaginal junction
S - internal os
T - failure of M or S; around cervix at level of internal os during a laparotomy (have to be delivered via c/s)

complications: rupture of membranes, PTL, infection

29
Q

Elective cerclage

A

placed at 12-14 weeks

removed at 36-36 weeks

30
Q

RFs for Cervical Incompetence

A

hx of cervical surgery (cone bx, d/c)
hx of cervical lacerations with vag delivery
uterine anomalies
hx of DES exposure

31
Q

Recurrent / habitual aborter

A

3 or more consecutive SABs

reasons: chromosomal abnormalities, maternal systemic disease, maternal anatomic defects, and infection, antiphospholipid antibody syndrome, luteal phase defect (not enough progesterone)

32
Q

W/u of habitual aborters

A
  1. karyotype of both parents and POC* from each SAB
  2. Maternal anatomy examination with hysterosalpinogram (if abnormal or nondx–> hysteroscopic or laparoscopic exploration)
  3. Screening tests for hypothyroidism, DM, APA syndrome, hyper coagulability, SLE
  4. serum progesterone level in luteal phase
  5. cultures of cervix, vagina, and endometrium to r/o infection

*array complete genome hybridization (CGH) can be used to id chromo abs on POC if you can’t get karyotype

33
Q

Tests to order in recurrent SAB w/u

A 
lupus anticoagulant
factor V Leiden deficiency
prothrombin G20210A mutation
ANA, anticardiolipin antibody
Russell viper venom
antithrombin III
protein S
protein C
34
Q

Tx of recurrent SAB

A
  • IVF with donated sperm/ova for trisomies
  • Preimplanation diagnosis
  • cerclage
  • progesterone
  • low dose ASA if APA syndrome
  • SQ heparin for thrombophilia
  • tx of maternal diseases

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