Ch 2 Early Pregnancy Complications

Question 1

most common site of implantation in tubal pregnancy is in

Answer 1

ampulla (79%)

Question 2

currently more than 1:100 of all pregnancies are ectopic secondary to increase in assisted fertility, std, and pid.

Answer 2

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Question 3

patients who present with vaginal bleeding, and/or abdominal pain should always be evaluated for ectopic pregnancy because a ruptured ectopic pregnancy is a true emergency

Answer 3

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Question 4

ruptured ectopic can result in rapid hemorrhage, leading to shock and eventually death

Answer 4

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Question 5

risk factors for ectopic pregnancy

Answer 5

1. Hx std, pid
2, prior ectopic pregnancy
3. previous tubal surgery
4. prior pelvic/abdominal surgery resulting in adhesions
5. endometriosis
6. current use of exogenous hormones including progetserone / estrogen
7. ivf or other assisted reproduction
8. des
9. use of IUD for birth control 
10. smoking

Question 6

classic finding in lab is beta hcg level is low for GA and does not increase at the expected rate. in patients with normal IUP, trophoblastic tissue secretes b hcg in a predictable manner leading to doubling apprx every 48 hrs. hematocrit may be low or drop in patients with ruptured ectopic pregnancy.

Answer 6

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Question 7

a hemorrhaging , ruptured ectopic pregnancy, may reveal intraabdominal fluid throughout pelvis and abdomen

Answer 7

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Question 8

patients who cannot be definitively diagnosed with ectopic versus IUP are labeled as

Answer 8

pregnancy of unknown location

Question 9

an IUP should be seen on tvs US with beta hcg between

Answer 9

1500-2000

Question 10

a fetal heartbeat should be seen with bhcg level greater than 5,000

Answer 10

a fetal heartbeat should be seen with bhcg level greater than 5,000

Question 11

appropriate to use methotrexate in order to treat uncomplicated, nonthreatening, ectopic pregnancies. it is appropriate to use methotrexate for patients who have small ectopic pregnancies
rule for MTX
<5cm, serum bhcg level <5,000, and without a fetal heartbeat

Answer 11

rule for MTX

<5cm, serum bhcg level <5,000, and without a fetal heartbeat

Question 12

assessment prior to MTX:

baseline transaminases and creatinine, intramuscular mtx, and serially following bhcg levels

Answer 12

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Question 13

bhcg level will rise first few days after MTX , but should fall by 10-15% between days 4 and 7. if doesn’t fall, pt needs a second dose of MTX.
these women should be monitored for ss of rupture - increased abdominal pain, bleeding, or signs of shock, and advised to come to ER immediately in case of such symptoms

Answer 13

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Question 14

60-80% of all SABs in 1st trimester are associated with abnormal chromosomes, with 95% are due to errors in maternal gametogenesis.

Answer 14

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Question 15

incomplete abortion can be allowed to finish on its own if patient prefers expectant management, but can also be taken to completion either surgically or medically.

Answer 15

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Question 16

recurrent pregnancy loss etiologies:

Answer 16

chromosomal abnormalities
maternal systemic disease,
maternal anatomic defects
infection

Question 17

15% of patients with recurrent pregnancy loss have antiphospholipid antibody (APA) syndrome. another group of patients are thought to have luteal phase defect and an adequate level of progesterone to maintain the pregnancy

Answer 17

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Question 18

diagnosis for recurrent pregnancy loss:
1st, karyotype of both parents obtained, as well as karyotypes of POC from each of SAB if possible.
2. maternal anatomy should be examined, initially with hysterosalpingogram (HSG). if hsg is abnormal/ nondiagnostic, a hysteroscope or laparoscope exploration may be performed.
3. screening tests for hypothyroidism, diabetes mellitus, apa syndrome, hypercoagulability, and systemic lupus erythematosus. should include lupus anticoagulant, factor V leiden deficiency, prothrombin G20210A mutation, ANA, anticardiolipin antibody, Russel viper venom, anithrombin III, protein S and protein C.

Answer 18

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Question 19

treatment: for patients with chromosomal abnrmalities such as balanced translocations, IVF can be performed using donor sperm/ova.

Answer 19

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Question 20

prior to methotrexate, draw labs:

type and screen, cbc, complete metabolic painel

Answer 20

hemoglobin is normal and liver enzymes also normal.

once dx of ectopic pregnancy is made, patient should no longer be managed expectantly. mifepristone and misoprostol reserved for treatment of IUP

Question 21

in an IUP, bhcg level can be expected to increase by 60% or more every 48 hours. an ectopic pregnancy would be expected to have a slower rate of increase in bhcg level because of decreased blood supply due to abnormla placentation

Answer 21

in an IUP, bhcg level can be expected to increase by 60% or more every 48 hours. an ectopic pregnancy would be expected to have a slower rate of increase in bhcg level because of decreased blood supply due to abnormla placentation