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Question 1

Under what circumstances is it appropriate to take on a ‘guarded reassurance and watchful waiting’ approach to a pt. with first trimester bleeding?

Answer 1

Only if fetal sounds can still be detected with dopple, if the pt is stable, AND if there is no adnexal mass, tenderness, or signs of abdominal bleeding

Question 2

What is an anembryonic pregnancy?

Answer 2

Presence of a gestational sac alrger than 18mm without evidenc of embryonic ttuse (yolk sac or embryo)

Question 3

What is embryonic demise?

Answer 3

An embryo larger tahn 5mm wihtout cadaic activity

Question 4

What is a heterotopic pregnancy?

Answer 4

simultaneous intrauterine and ectopic pregnancy

Question 5

What is an incomplete abortion?

Answer 5

Occurs wehn some, but not all, of the products of conception pass

Question 6

What is an inevitable abortion?

Answer 6

bleeding in the first trimester in the presence of a dialted cervix

Question 7

What is a threatened abortion?

Answer 7

Bleeding before 20 weeks gestation in the presence of an embryo with cardiac activity and a closed cervix

Question 8

T or F. Evidence should not support the routine use of ABX in all women with incomplete abortion

Answer 8

T. Only in the presence of a septic abortion

Question 9

When should a gestational sac be visible in the uterus for a normal IUP?

Answer 9

Only 100% reliable when hCG levels exceed 1500-200 mIU/ml

Question 10

When must a yolk sac appear for a normal viable IU pregnancy to occur?

Answer 10

once the gestational sac gets to 10mm in size

Question 11

When should cardiac activity be heard for a normal IUP?

Answer 11

Once the crown-rump lenth of the embryo exceeds 5mm in length

Question 12

Levels of hCG exceeding 1500-200 mIU/ml but with the lack of an endometrial gestational sac suggests what?

Answer 12

Ectopic pregnancy

Question 13

What are the risk factors for an ectopic pregnancy?

Answer 13

-current IUD-hx of ectopic, exposure to DES, PID caused by chlamydia or gonorrheae, tubal ligation or reanastomois-infertility or IVF-smoking

Question 14

What is an adnexal mass?

Answer 14

Anadnexalmass is a lump in tissue of theadnexaof uterus (structures closely related structurally and functionally to the uterus such as the ovaries, fallopian tubes, or any of the surrounding connective tissue).Adnexalmasses can be benign or cancerous, and they can be categorized as simple or complex.

Question 15

Hyperelevated hCG levels suggest what?

Answer 15

Molar pregnancy

Question 16

What is this?

Answer 16

A normal IUP with the presene of a subchorionic hemorrhage

Question 17

What is asubchorionic hemorrhage?

Answer 17

A common source of first trimester bleeding

Question 18

What should be done if a repeat 48 hr hCG is drawn and it has not doubled and there is still not a gestational sac in the uterus?

Answer 18

dilatation and curettage to look for POC- if they are there, its a SAB. If not, ectopic

Question 19

T or F. The presence of subchorionic hemorrhage increases the risk of SAB

Answer 19

T.

Question 20

Although D&C has been historically the treatment of choice for abortion, new trials confirm the expectant or medical management with misoprostol can be as effective and safe while offering the pt more control over her care

Question 21

Expectant vs medical management of SAB

Answer 21

When though both expectant and medical management are effective for incomplete abortion, expectant management is more likely to fail than medical in embryonic demise or anembronic pregnancy and these women have more outpt visits

Question 22

T or F. Women treated medically for abortion have more bleeding but less pain than those treated surgically

Answer 22

T. And surgeries are more assoicated with post-abortion infections

Question 23

What is misoprostol?

Answer 23

A medication that be used to induce abortion

Question 24

Misoprostol has fewer GI AEs when given what way?

Answer 24

vaginally compared to orally

Question 25

Note that there is evidence for the use of prophylactic ABX for induced abortions, but not for early pregnancy failure

Question 26

What is the preferred treatment for ectopic pregnancy?

Answer 26

Medical (methotrexate) or laparoscopic tx

Question 27

What must RH negative women do after any type of pregnancy loss?

Answer 27

receive 50 mcg of Rhogam