Chapter 2 Early Pregnancy Complications Flashcards
ectopic pregnancy is one that implants outside the uterine cavity. implantation occurs in the fallopain tube in 95% to 99% of patients. The most common site of implantation in a tubal pregnancy is the __.
ampulla 70% followed by isthmus 12%, and fimbriae 11%.
Patients who present with ___and/or ___ should always be evaluated for
ectopic pregnancy
strongest risk factor for ectopic pregnancy…?
prior ectopic pregnancy. the risk of a subsequent ectopic pregnancy is 10% after one prior ectopic preg and increases to 25% after more than one prior ectopic pregnancy.
IUD decreases the overall rate of pregnancy, in case the contraceptive fails, there is an increased rate of ectopic pregnancy in those who become pregnant because IUD prevents normal intrauterine implantation. this risk is as high as
25% - 50%
patients often complain of ____, ____, and ____.
unilateral pelvic or lower abdominal pain and vaginal bleeding.
in patients with a normal IUP, the trophoblastic tissue secrets beta hcg in a predictable manner that should lead to ___ or __ every 48 hrs
doubling or at least an increase of 2/3 or more
an ectopic pregnancy has a poorly implanted placenta with less blood supply than in the endometrium, this levels of bhcg do not double every 48 hrs.
true
pts who cannot be definitvely diagnosed with an ectopic vs IUP are labled rule out etopic. if such pts are stable on examination they may be followed with serial bhcg levels every __ hrs
48
as a guideline, an iup should be seen on TVS with bhcg btwn
1500-2000.
fetal heart beat should be seen with bhcg > ___
5,000
pts who present with unruptured ectopic pregnancy can be treated either surgically or medically - ___
methotrexate. treats uncomplicated, nonthreatening, ectopic pregnancies.
it is appropriate to use methotrexate for pts who have small ectopic pregnancies
<5,000, without fetal heart beat
care of ectopic pregnancies with methotrexate need assessment of bloodwork including:
baseline trasminainases, creatinine.
single dose regimen uses a 50mg/m^2 , requires frewer clinic visits. but sucess rate is lower.
93% vs 88% respectively.
bhcg level will rise first few days after methotrexate therapy, but should fall by __ to __% btwn days __ and __.
fall by 10% to 15% btwn days 4 and 7. if bhcg does not fall to these levels, the pt requires a second dosage of methotrexate.
an incomplete abortion can be allowed to:
- finish on its own if the pt prefers expectant management, but can also be 2. taken to completion either surgially or medically.
second trimester abortions (12-20wks) have multiple etiologies. such as..?
infection, maternal uterine/cervical anatomic defects, maternal systemic disease, exposure to fetotoxic agents, and trauma are all associated with late abortions.
late second trimester abortions and periviable deliveries are also seen with ___.
PTL and incompetent cervix.
between 16-24 weeks gestation, either a
D&E may be performed, or labor may be induced with high doses of oxytocin / prostaglandins.
what’s the advantage of D&E over induction of labor?
procedure is self-limited and performed faster than an induction of labor. however, aggressive dilation is necessary prior to procedure with laminaria, and there is a significant risk of uterine perforation and cervical acerations.
define incompetent cervix:
painless dilation and effacement of the cervix, often in the second trimester of pregnancy.
diagnosis of incompetent cervis:
dilated cervix noted on routine examination, utrasound, or in setting of bleeding, vaginal discharge, or rupture of membranes. pts experience mild cramping of pressure in lower abdomen or vagina.
Recurrent pregnancy loss / habitual aborter definition
3 or more consecutive SAB.
Risk of an SAB after one prior SAB is..
20% to 25%;
after 2 consecutive SAB, 25-30%;
and after 3 consecutive SAB, 30-35%
etiologies of recurrent pregnancy loss:
- chromosomal abnormalities
2. maternal systemic disease, maternal anatomic defects, and infection.
15% of pts with recurrent pregnancy loss have
antiphospholipid syndrome. another group of pts are thought to have a luteal phase defect, and lack an adequate level of progesterone to maintain the pregnancy.
patients who are habitual aborters should be evaluated for the etiology. pts with 2 consequtive SABs are occasionally assessed as well, esp for AMA or whom continued fertility may be an issue. how are pts screened?
- karyotype of both parents obtained, as well as karyotypes of the POC from each of the SABs if possible. new tchnology, particularly array complete genome hybridization (CGH) can be used to identify chromosomal abnormalities as well with much more success.
- maternal anatomy should be examined. initially, hysterosalpingogram. a hysteroscopic / laparoscopic exploration may be performed.
- screening tests for hypothyroidism, diabetes mellitus, APA syndrome, hypercoagulability, and systemic lupus erythematosus. include lupus anticoagulant, factor V Leiden deficiency, prothrombin g20210a mutation, ANA, anticardiolipin antibody, Russell viper venom, antithrombin III, protein S, and protein C.
luteal phase defect is suspected, what may be given?
progesterone
if antiphospholipid syndrome, how can pt be treated?
low dose aspirin.
approximately how many pregnancies are ectopic?
1%
most common cause of fetal abnormality
chromosomal abnormality.
most second trimester abortions are secondary to
uterine or cervical abnormalities, trauma, systemic disease, or infection.
patients with hx of incompetent ervix should be offered an elctive, prophylactic cerclage at how many weeks?
12-14 wks.
most common diagnosed causes of recurrent pregnancy loss are
apa syndrome and luteal phase defects.
