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OB/GYN > Early Pregnancy Complications > Flashcards

Early Pregnancy Complications Flashcards

1
Q

incidence of ectopic pregnancy

A

1 in 100

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2
Q

why has the incidence of ectopic pregnancy increased over the past 10 years?

A

increase in assisted fertility, STDs and PID

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3
Q

RFs for ectopic pg’y

A 
hx of STs or PID
Previous ectopic pg'y
previous tubal surgery
prior pelvic or ab'l surgery (adhesions)
endometriosis
current use of exogenous hrms
IVF/assisted repro
DES-exposed pts w/congenital abnormalities
congenital abnormalities of fallopian tubes
use of an IUD
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4
Q

presenting sx’s of ectopic pg’y

A

unilateral pelvic or lower ab’l pain
vag bleeding
may be hypotensive or w/peritoneal signs

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5
Q

lab findings of ectopic pg’y

A

b-hCG levels low for GA, does not increase at expected rate (doesn’t double q48h)

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6
Q

how is ectopic pg’y definitively dx’d?

A

urine pg’y test is +
u/s shows extrauterine pg’y. If too early to show on u/s, then follow serial b-hCGs and see that it does not double q48h

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7
Q

at what b-hCG level should you be able to see an intrauterine pg’y

A

1500-2000

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8
Q

tx of ruptured ectopic pg’y

A

stabilize first w/IVF, blood, pressors PRN
ex lap after stabilization to remove pg’y
If they were stable to begin w/, then do ex laparoscopy

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9
Q

tx of unruptured ectopic pg’y

A

monitor for signs of rupture
MTX
ex laparoscopy

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10
Q

what kind of f/u is required if MTX is used to tx unruptured ectopic pg’y?

A

obtain baseline AST and ALT and Cr, then give IM MTX, then serially follow b-hCG levels. Will at first rise, then will drop by 10-15% by 4-7d. If not, give second MTX dose.

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11
Q

what is a SAB? Incidence?

A

pg’y that ends before 20 weeks. 15-25% of all pg’ies end in SAB.

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12
Q

abortus =

A

the fetus lost before 20 weeks, or weighing < 500g, or < 25cm long

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13
Q

complete abortion =

A

complete expulsion of all POC before 20 weeks

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14
Q

incomplete abortion =

A

partial expulsion of POC

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15
Q

inevitable abortion =

A

no expulsion of products, but bleeding & dilation of cervix, making a viable pg’y unlikely

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16
Q

threatened abortion =

A

any intrauterine bleeding before 20 weeks, w/o cervical dilatation or expulsion of POC

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17
Q

missed abortion =

A

death of fetus/embryo but with no expulsion of POC. Usually proceed to complete abortions in 1-3 weeks.

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18
Q

Most first-trimester SABs are due to what?

A

chromosomal abnormalities

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19
Q

DDx of first-tri bleeding:

A 
SAB
postcoital bleeding
ectopic pg'y
vaginal or cervical lesions or lacerations
extrusion of molar pg'y
nonpg'y bleeding
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20
Q

sx’s of first trimester abortion:

A

bleeding
cramping
ab’l pain
decreased sx’s of pg’y

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21
Q

how do you w/u a pt presenting w/vaginal bleeding & cramping in 1st tri?

A

Hx of sx’s
Physical - pelvic exam, vitals to r/o infection & shock
labs - b-hCG, CBC, blood type & screen
u/s to assess fetal viability & placentation

22
Q

tx of 1st-tri complete abortion

A

1) stabilize if hypotensive
2) follow for recurrent bleeding and signs of infection
3) send any expelled tissue to pathology

23
Q

tx of 1st-tri incomplete abortions

A

1) stabilize
2) either do expectant mgt or D&C or admin of misoprostol
3) send tissue to pathology

24
Q

mgt of inevitable abortion & missed abortion

A

1) stabilize if hypotensive
2) either do expectant mgt, or D&C
3) send tissue to pathology

25
Q

mgt of threatened abortion

A

1) monitor for bleeding
2) bedrest, nothing per vagina
3) give RhoGam if Rh-

26
Q

what are pts w/threatened abortion at increased risk for?

A

PTL

PPROM

27
Q

most common causes of 2nd-tri abortions

A

maternal systemic dis, infection, fetotoxic agents, trauma, uterine or cervical abnormalities. Chromosomes not a common cause.

28
Q

tx of 2nd-tri abortion

A

1) r/o ectopic pg’y, stabilize
2) follow for recurrent bleeding, signs of infection,
3) expectant mgt, or D&E or labor induction if retained POC

29
Q

D&C vs. D&E

A 
D&C = done during 1st tri
D&E = done during 2nd tri
30
Q

D&E vs. labor induction

A

D&E is faster, but aggressive dilation w/laminaria is necessary. Increased risk of uterine perforation & cervical laceration. Labor induction takes longer, uses high doses of oxytocin & PG’s. Lower risk of trauma 2/2 instrumentation.

31
Q

PTL vs. incompetent cervix

A

PTL = ctr’ns w/cervical dilation

incompetent cervix = painless cervical dilatation

32
Q

mgt of PTL

A

tocolytics

33
Q

mgt of incompetent cervix

A

emergent cerclage

34
Q

CP of incompetent cervix:

A

painless cervical dilation, expsoure of fetal membranes. short-tem cramping or ctr’ns. Maybe infection. Vaginal discharge.

35
Q

RFs for cervical insufficiency:

A

surgery/cervical trauma/previous cervical dilation
hx of cervical lacerations w/prior vag delivery
uterine anomalies
hx of DES exposure

36
Q

dx of cervical insufficiency:

A

dilated cervix seen on exam or u/s. Level of dilation is more than expected for level of ctr’ns.

37
Q

tx of cervical insufficiency

A 
if < 24 weeks, expectant mgt or elective termination.
If viable:
1) betamethasone
2) strict bed rest
3) tocolytics if ctr'ns are occurring
- or- immediate cerclage
38
Q

what is cerclage

A

suture placed around the cervix.
McDonald cerclage = suture placed at cervical-vaginal jct
Shirodkar cerclage = suture placed at internal os

39
Q

mgt of a subsequent pg’y in a pt w/hx of cervical insufficiency

A

elective cerclage offered at 12-14 weeks. Maintained till 36-38 weeks, then rmoved & pt is followed till labor occurs

40
Q

mgt of subsequent pg’y in a pt in whom previous vaginal cerclage has failed

A

transabdominal cerclage. Then they’ll need C-sections.

41
Q

cervical insufficiency carries increased risk of:

A

infection
PPROM
PTL

42
Q

what is a recurrent or habitual aborter

A

a pt who has had 3 or more consecutive SABs

43
Q

what is the risk of a SAB after one prior? Two prior? Three?

A

20-25%. 25-30%. 30-35%

44
Q

causes of recurrent pg’y loss:

A 
chromosomal abnormalities
maternal systemic dis
infection
maternal anatomic defects
antiphospholipid antibody syndrome
luteal phase defect (low progesterone)
45
Q

screening of habitual aborters:

A

1) karyotype both parents
2) karoytype of POC from previous SABs
3) hysterosalpingogram
4) if HSG is abnormal, then f/u w/hysteroscopy or laparoscopy
5) screen for hypothyroidism, DM, antiphlipid Ig’s, hypercoagulability, SLE
6) check serum progesterone level
7) cx’s of cervix, vagina, endometrium
8) endometrial bx during luteal phase

46
Q

labs to check for habitual aborters:

A 
TSH, free T3/T4
factor V Leiden mutation
prothrombin mutation
ANA
anticardiolipin antibody
Russell viper venom
antithrombin III levels
protein C and S levels
47
Q

tx of luteal phase defect:

A

supplemental progesterone

48
Q

tx of antiphospholipid antibody syndrome

A

low-dose aspirin

49
Q

tx of thrombophilia

A

SQH

50
Q

pts w/3 prior SABs will have a subsequent normal pg’y how often?

A

2/3 of the time

51
Q

cause of recurrent SABs is undiagnosed in how many cases?

A

1/3

OB/GYN (29 decks)

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