Early Pregnancy, Ectopic, RH - Moulton Flashcards
Define the 3 trimesters by weeks
1 = 1 - 13.6 2 = 14 - 27.6 3 = 28 - 42
Abortion = before week \_\_\_ Preterm = before week \_\_\_ Post-term = after week \_\_\_
20
37
42
***How does hCG rise in pregnancy?
Doubles every 2 days, peaks at 10 weeks at 100,000
***At what point will a gestational sac be visible on ultrasound?
What is this called?
hCG = 1500-2000
Discriminatory level
At what point is a spontaneous abortion unlikely?
8 weeks, appropriate size, cardiac activity seen
Most common cause of spontaneous abortions
Most common one?
Most common CLASS?
Chromosome abnormalities
Turner (45 XO)
Trisomies (16 esp.)
“Types” of abortion…
- Vaginal bleeding, closed cervix
- Vaginal bleeding, cervix partially dilated
- Vaginal bleeding, cramping lower abdominal pain w/ dilated cervix
Threatened
Inevitable
Incomplete
“Types” of abortion…
- Passage of all products w/ closed cervix, resolution of all symptoms
- Fetus has expired, still in uterus,
Complete
Missed
“Types” of abortion…
- Fever, cervical tenderness, purulent discharge, retained POC
- Gestational sac, no embryo
Septic (endometritis)
Blighted ovum
Treatment of cervical incompetence
Cervical cerclage
Testing for APA syndrome (3)
Treatment?
- Lupus anticoagulant
- Anticardiolipin Ab
- Anti-B2-glycoprotein 1 Abs
Prophylactic heparin and aspirin
Most common cause of maternal death in 1st trimester
Ectopic pregnancy
Ectopic pregnancy - classic triad
- Missed menstrual cycle
- Bleeding later
- Lower abdominal pain
Ultrasound finding = thickened endometrial stripe (Arias-Stella reaction)
Ectopic pregnancy
Ultrasound finding = fluid in cul de sac…what is it?
BLOOD - ruptured ectopic pregnancy
Treatment of ectopic pregnancy
How to know if it’s working?
Methotrexate
hCG drops by 15% from day 4 to day 7
5 types of surgery for ectopic pregnancy
- Laparotomy (if unstable)
- Laparoscopy (if stable)
- Salpingectomy (remove tube)
- Salpingostomy (leave open)
- Salpingotomy (close incision)
Describe RH sensitization in pregnancy
Treatment?
Rh- mom, Rh+ baby, anti-Rh IgG’s cross placenta and cause hemolysis in baby
Prophylactic RhoGAM
What is required for RH sensitization to occur? How?
- 1 mL of fetal blood to get into the mother
- ANY cause of trauma, placental issue, etc.
If genetic testing of parents shows that the baby has a risk of developing RH hemolysis from mom, do what?
Amniocentesis - fetal antigen testing, bilirubin levels (looking for signs of hemolysis)
Signs of fetal hydrops on ultrasound (4)
- Ascites
- Pleural effusion
- Pericardial effusion
- Skin or scalp edema
TODAY, how to best determine if fetal RH hemolysis is occurring in baby? Explain.
Fetal MCA peak systolic velocity
- If getting anemic from hemolysis, will pump faster to compensate, will be detected by doppler of MCA
Treating baby with fetal hydrops
Transfusion of O- blood (umbilical vein or other)
Nonstress testing
Monitor fetal heart rate accelerations and decelerations to fully assess the fetal sleep-wake cycle
Girl comes in with minimal vaginal bleeding and cramping sensation. Pregnant, blood in uterus, cervix is closed. AB negative. Dx?
Plan? (3)
Threatened abortion
- SAB precautions
- Follow up in 1 week
- RhoGAM (bleeding + pregnancy + Rh-)
Woman w/ previous abortions, mild cramping. Positive pregnancy test. hCG 1000. Ultrasound shows nothing. Potential Dx? (2)
Plan? Why?
Normal IUP or SAB
Repeat testing in 2 days – hCG will be in discriminatory zone
Contraindications of methotrexate for ectopic pregnancy (10)
- Breastfeeding
- Immunodeficiency
- Alcoholism or liver disease
- Blood disease
- Sensitivity to MTX
- Active pulmonary disease
- Peptic ulcer disease
- Large gestational sac
- Embryonic cardiac activity
MTX - MoA
Folic acid antagonist – inhibit DNA synthesis and cell replication
If giving MTX and hCG is falling normally, do what?
If NOT falling normally, do what?
If symptomatic or bHCG starts rising?
Follow weekly until negative
Give another dose
Surgery
