Chapter 2 Early Pregnancy Complications

Question 1

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 __.

Answer 1

ampulla 70% followed by isthmus 12%, and fimbriae 11%.

Question 2

Patients who present with ___and/or ___ should always be evaluated for

Answer 2

ectopic pregnancy

Question 3

strongest risk factor for ectopic pregnancy…?

Answer 3

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.

Question 4

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

Answer 4

25% - 50%

Question 5

patients often complain of ____, ____, and ____.

Answer 5

unilateral pelvic or lower abdominal pain and vaginal bleeding.

Question 6

in patients with a normal IUP, the trophoblastic tissue secrets beta hcg in a predictable manner that should lead to ___ or __ every 48 hrs

Answer 6

doubling or at least an increase of 2/3 or more

Question 7

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.

Answer 7

true

Question 8

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

Answer 8

48

Question 9

as a guideline, an iup should be seen on TVS with bhcg btwn

Answer 9

1500-2000.

Question 10

fetal heart beat should be seen with bhcg > ___

Answer 10

5,000

Question 11

pts who present with unruptured ectopic pregnancy can be treated either surgically or medically - ___

Answer 11

methotrexate. treats uncomplicated, nonthreatening, ectopic pregnancies.

Question 12

it is appropriate to use methotrexate for pts who have small ectopic pregnancies

Answer 12

<5,000, without fetal heart beat

Question 13

care of ectopic pregnancies with methotrexate need assessment of bloodwork including:

Answer 13

baseline trasminainases, creatinine.

Question 14

single dose regimen uses a 50mg/m^2 , requires frewer clinic visits. but sucess rate is lower.

Answer 14

93% vs 88% respectively.

Question 15

bhcg level will rise first few days after methotrexate therapy, but should fall by __ to __% btwn days __ and __.

Answer 15

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.

Question 16

an incomplete abortion can be allowed to:

Answer 16

1. finish on its own if the pt prefers expectant management, but can also be 2. taken to completion either surgially or medically.

Question 17

second trimester abortions (12-20wks) have multiple etiologies. such as..?

Answer 17

infection, maternal uterine/cervical anatomic defects, maternal systemic disease, exposure to fetotoxic agents, and trauma are all associated with late abortions.

Question 18

late second trimester abortions and periviable deliveries are also seen with ___.

Answer 18

PTL and incompetent cervix.

Question 19

between 16-24 weeks gestation, either a

Answer 19

D&E may be performed, or labor may be induced with high doses of oxytocin / prostaglandins.

Question 20

what’s the advantage of D&E over induction of labor?

Answer 20

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.

Question 21

define incompetent cervix:

Answer 21

painless dilation and effacement of the cervix, often in the second trimester of pregnancy.

Question 22

diagnosis of incompetent cervis:

Answer 22

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.

Question 23

Recurrent pregnancy loss / habitual aborter definition

Answer 23

3 or more consecutive SAB.

Question 24

Risk of an SAB after one prior SAB is..

Answer 24

20% to 25%;
after 2 consecutive SAB, 25-30%;
and after 3 consecutive SAB, 30-35%

Question 25

etiologies of recurrent pregnancy loss:

Answer 25

1. chromosomal abnormalities

2. maternal systemic disease, maternal anatomic defects, and infection.

Question 26

15% of pts with recurrent pregnancy loss have

Answer 26

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.

Question 27

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?

Answer 27

1. 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.
2. maternal anatomy should be examined. initially, hysterosalpingogram. a hysteroscopic / laparoscopic exploration may be performed.
3. 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.

Question 28

luteal phase defect is suspected, what may be given?

Answer 28

progesterone

Question 29

if antiphospholipid syndrome, how can pt be treated?

Answer 29

low dose aspirin.

Question 30

approximately how many pregnancies are ectopic?

Answer 30

1%

Question 31

most common cause of fetal abnormality

Answer 31

chromosomal abnormality.

Question 32

most second trimester abortions are secondary to

Answer 32

uterine or cervical abnormalities, trauma, systemic disease, or infection.

Question 33

patients with hx of incompetent ervix should be offered an elctive, prophylactic cerclage at how many weeks?

Answer 33

12-14 wks.

Question 34

most common diagnosed causes of recurrent pregnancy loss are

Answer 34

apa syndrome and luteal phase defects.