Early to Mid-trimester Complications Flashcards
If an hCG is at 3500 you should see what on US? If you don’t see this, what is the indication?
- See gestational sac
-don’t see it then its likely the pregnancy is lost
Spontaneous abortion occurs what percent of clinically recognized pregnancies and why?
10-15%, usually chromosomal abnormalities
50% of pregnancies are lost in the first ____ days?
14
This type of abortion presents with spotting or profuse bleeding, a dull ache, with no fetal expulsion?
Threatened abortion
What is the treatment for threatened abortion?
Bed rest and monitoring
What is the definition of spontaneous abortion?
expulsion of all or some of conceptive material before 20 weeks
25-50% of this type of abortions end in pregnancy loss?
threatened
This abortion presents as cramping for 1 week, & partial cervical dilation?
Inevitable abortion
This abortion presents as expulsion of ALL products of conception, closed cervix, bleeding and contractions have stopped, and hCG is negative?
Complete abortion
This abortion presents with heavy bleeding, moderate cramping, boggy uterus, dilated cervix, and expulsion of SOME of conception remnants (can look like liver)?
Incomplete abortion
What is the treatment for incomplete abortion?
Misoprostol or surgery with D&C in 1st trimester or D&E in 2nd trimester
This abortion presents with a closed cervix, brown discharge, and means the fetus is dead inside the uterus; lasts about 6 weeks?
Missed abortion
What is the treatment for missed abortion
D&C in 1st
D&E in 2nd
Misoprostol which softens cervix to expel pregnancy
What is the diagnostic criteria for recurrent abortions?
2 or more abortions with US or pathology documentation; or 3+ spontaneous abortions
This type of abortion presents with a foul brown discharge, fever, chills, bleeding, CMT, and a closed cervix?
Septic
Treatment for septic abortion?
D&E with ABX
Hysterectomy if severe
How is a possible threatened abortion evaluated?
Ultrasound
What imaging test needs to be done to evaluate recurrent spontaneous abortions?
Hysteroscopy to evaluate the uterine cavity
What is the treatment for cervical insufficiency?
Cerclage or cervical suture at 12-14 weeks
When do you remove a cerclage?
36-38 weeks
This is an implantation of a fertilized egg outside the uterus, & 80% are in fallopian tube ampulla due to tube occlusion?
Ectopic pregnancy
These are risks for what condition: PID; Abdominal or tubal surgery; IUD; endometriosis; & assisted reproduction?
Ectopic pregnancy
What is the triad for recognizing ectopic pregnancy?
Unilateral pelvic pain
Vaginal bleeding
Pregnancy
Presentation: Shoulder pain, peritonitis, hypotension, tachycardia, bleeding, abdominal pain & syncope?
Ruptured ectopic pregnancy
How can you diagnose an ectopic pregnancy via hCG?
It won’t increase like in a normal pregnancy
If an hCG is >200 but there’s no gestational sac, what does this indicate?
The pregnancy is ectopic
What test and image study are required for diagnosis of ectopic pregnancy?
hCG & Trans vaginal ultrasound
What is the treatment for non-ruptured ectopic pregnancy?
Methotrexate because it destroys tissue and stops cells from growing
Whats the treatment for a ruptured ectopic pregnancy?
1st line: laparoscopic salpingostomy to remove fertilized egg
What should we always test for and consider giving if a patient experiences a spontaneous abortion or ectopic pregnancy?
Test Rh status
Administer RhoGAM
What is the spontaneous premature dilation or shortening of the cervix in the2nd or early 3rd trimester?
Cervical insufficiency (also called cervical incompetence)
Presentation: Painless dilation of >2cm and cervical effacement, bleeding, discharge and contractions?
Cervical insufficiency
How do you dx cervical insufficiency?
TVU
