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Repro 2 > Early Pregnancy, Ectopic, RH - Moulton > Flashcards

Early Pregnancy, Ectopic, RH - Moulton Flashcards

1
Q

Define the 3 trimesters by weeks

A 
1 = 1 - 13.6
2 = 14 - 27.6
3 = 28 - 42
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2
Q 
Abortion = before week \_\_\_
Preterm = before week \_\_\_
Post-term = after week \_\_\_
A

20
37
42

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3
Q

***How does hCG rise in pregnancy?

A

Doubles every 2 days, peaks at 10 weeks at 100,000

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4
Q

***At what point will a gestational sac be visible on ultrasound?

What is this called?

A

hCG = 1500-2000

Discriminatory level

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5
Q

At what point is a spontaneous abortion unlikely?

A

8 weeks, appropriate size, cardiac activity seen

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6
Q

Most common cause of spontaneous abortions

Most common one?
Most common CLASS?

A

Chromosome abnormalities

Turner (45 XO)

Trisomies (16 esp.)

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7
Q

“Types” of abortion…

  • Vaginal bleeding, closed cervix
  • Vaginal bleeding, cervix partially dilated
  • Vaginal bleeding, cramping lower abdominal pain w/ dilated cervix
A

Threatened

Inevitable

Incomplete

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8
Q

“Types” of abortion…

  • Passage of all products w/ closed cervix, resolution of all symptoms
  • Fetus has expired, still in uterus,
A

Complete

Missed

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9
Q

“Types” of abortion…

  • Fever, cervical tenderness, purulent discharge, retained POC
  • Gestational sac, no embryo
A

Septic (endometritis)

Blighted ovum

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10
Q

Treatment of cervical incompetence

A

Cervical cerclage

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11
Q

Testing for APA syndrome (3)

Treatment?

A
  • Lupus anticoagulant
  • Anticardiolipin Ab
  • Anti-B2-glycoprotein 1 Abs

Prophylactic heparin and aspirin

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12
Q

Most common cause of maternal death in 1st trimester

A

Ectopic pregnancy

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13
Q

Ectopic pregnancy - classic triad

A
  • Missed menstrual cycle
  • Bleeding later
  • Lower abdominal pain
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14
Q

Ultrasound finding = thickened endometrial stripe (Arias-Stella reaction)

A

Ectopic pregnancy

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15
Q

Ultrasound finding = fluid in cul de sac…what is it?

A

BLOOD - ruptured ectopic pregnancy

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16
Q

Treatment of ectopic pregnancy

How to know if it’s working?

A

Methotrexate

hCG drops by 15% from day 4 to day 7

17
Q

5 types of surgery for ectopic pregnancy

A
  • Laparotomy (if unstable)
  • Laparoscopy (if stable)
  • Salpingectomy (remove tube)
  • Salpingostomy (leave open)
  • Salpingotomy (close incision)
18
Q

Describe RH sensitization in pregnancy

Treatment?

A

Rh- mom, Rh+ baby, anti-Rh IgG’s cross placenta and cause hemolysis in baby

Prophylactic RhoGAM

19
Q

What is required for RH sensitization to occur? How?

A
  1. 1 mL of fetal blood to get into the mother

- ANY cause of trauma, placental issue, etc.

20
Q

If genetic testing of parents shows that the baby has a risk of developing RH hemolysis from mom, do what?

A

Amniocentesis - fetal antigen testing, bilirubin levels (looking for signs of hemolysis)

21
Q

Signs of fetal hydrops on ultrasound (4)

A
  • Ascites
  • Pleural effusion
  • Pericardial effusion
  • Skin or scalp edema
22
Q

TODAY, how to best determine if fetal RH hemolysis is occurring in baby? Explain.

A

Fetal MCA peak systolic velocity

- If getting anemic from hemolysis, will pump faster to compensate, will be detected by doppler of MCA

23
Q

Treating baby with fetal hydrops

A

Transfusion of O- blood (umbilical vein or other)

24
Q

Nonstress testing

A

Monitor fetal heart rate accelerations and decelerations to fully assess the fetal sleep-wake cycle

25
Q

Girl comes in with minimal vaginal bleeding and cramping sensation. Pregnant, blood in uterus, cervix is closed. AB negative. Dx?

Plan? (3)

A

Threatened abortion

  • SAB precautions
  • Follow up in 1 week
  • RhoGAM (bleeding + pregnancy + Rh-)
26
Q

Woman w/ previous abortions, mild cramping. Positive pregnancy test. hCG 1000. Ultrasound shows nothing. Potential Dx? (2)

Plan? Why?

A

Normal IUP or SAB

Repeat testing in 2 days – hCG will be in discriminatory zone

27
Q

Contraindications of methotrexate for ectopic pregnancy (10)

A
  • Breastfeeding
  • Immunodeficiency
  • Alcoholism or liver disease
  • Blood disease
  • Sensitivity to MTX
  • Active pulmonary disease
  • Peptic ulcer disease
  • Large gestational sac
  • Embryonic cardiac activity
28
Q

MTX - MoA

A

Folic acid antagonist – inhibit DNA synthesis and cell replication

29
Q

If giving MTX and hCG is falling normally, do what?

If NOT falling normally, do what?

If symptomatic or bHCG starts rising?

A

Follow weekly until negative

Give another dose

Surgery

Repro 2 (28 decks)

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