Early Pregnancy Flashcards
Criteria diagnostic of failed pregnancy
CRL 7 mm w/ no heartbeat
Mean sac diameter 25 mm w/ no embryo
Absence of embryo w/ heart beat 14 days after US showed a gestational sac and no yolk sac
Absence of embryo w/ heart beat 11 days after US showed a gestational sac WITH a yolk sac.
When does Bhcg palateu?
100,000 at 10 wks
Absolute contraindications to MTX?
Unstable pt/ruptured ectopic
Intrauterine pregnancy
Breastfeeding
Blood dyscrasia
Clinically important liver/renal impairment
Active pulmonary/GI disease
Patient unable to follow-up
Relative contraindications to MTX?
Cardiac activity
Hcg > 5,000
Size > 4 cm by TVUS
Refusal to accept blood products
**associated with failure of MTX therapy
Dosing of MTX?
50 mg/m2 IM
Risks of ectopic pregnancy?
50% of patient’s w/ ectopic don’t have risk factors
Age > 35
Smoking
Hx of PID
IVF
Prior ectopic
Tubal surgery/ligation
Describe Hcg Trending
Repeat every 48 hours
99% of normal IUPs will have >/= 35% rise over 2 days OR should double every 3 days
What is the discriminatory zone?
Bhcg 3,500 mIU/ml
Preferred MTX regimen?
Single dose Regimen
50 mg/m2 BSA single dose
Obtain Hcg on D#4 and D#7 and assess for 15% decrease
If less than 15% decrease administer second dose
*Prior to second dose, should consider uterine aspiration to rule out SAB
Trend Bhcg to 0
Needs effective BC
Avoid folate containing vitamins and NSAIDs
Side effects of MTX?
Stomatitis
Leukopenia/Thrombocytopenia
Elevation of LFTs
Nausea/vomiting/GI upset
Photosensitivity
Patient has pregnancy of unknown location
Your perform suction D&C
Pathology returns as no villi
What do you do next?
Repeat Bhcg at 12-24 hours post procedure
If decreased by 50% or greater then this is consistent with failed IUP
If decreased by less than 50% further evaluation is needed
MOA of Methotrexate?
Folate antagonist
