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Obstetrics > Ectopic, Abortion, HTN, 3rd Trimester Bleeding - PANCE Pearls > Flashcards

Ectopic, Abortion, HTN, 3rd Trimester Bleeding - PANCE Pearls Flashcards

1
Q

Where is the most common implantation site in ectopic pregnancy?

A

Fallopian tube (amopulla)

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2
Q

What are high risk factors for ectopic pregnancy?

A 
previous abdominal or tubal surgery (adhesions)
PID
previous ectopic 
history of tubal ligations
endometriosis 
IUD use 
assisted reproduction
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3
Q

What are intermediate risk factors for ectopic pregnancy?

A

infertility
history of genital infections
multiple partners

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4
Q

Classic triad in the clinical presentation for ectopic pregnancy

A

unilateral pelvic/abdominal pain
vaginal bleeding
amenorrhea

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5
Q

What do you want to differate from ectopic pregnancy in a patient presenting with unilateral pain, vaginal bleeding, and amenorrhea?

A

threatened abortion

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6
Q

What are signs of shock in a ruptured ectopic pregnancy?

A

syncope, tachycardia, hypotension

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7
Q

What are the signs of ruptured ectopic pregnancy?

A

severe abdominal pain, dizziness, nausea, vomitting

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8
Q

What will you see on physical exam for ectopic pregnancy?

A

cervical motion tenderness, adnexal mass, +/- uterine enlargement

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9
Q

How does the B-hCG in ectopic pregnancy differ from normal?

A

should double q24-48 hours

doesn’t double in ectopic (rises < 66% expected)

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10
Q

What do you do if B-hCG initial value is < 1,500?

A

repeat q2-3 days

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11
Q

absence of gestational sac on transvaginal ultrasound with B-hCG levels > 5,000 could indicate

A

ectopic pregnancy or nonviable intrauterine pregnancy (IUP)

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12
Q

What procedure can be done to diagnose ectopic pregnancy?

A

laparoscopy

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13
Q

MOA of methotrexate

A

destroys trophoblastic tissue (disrupts cell multiplication)

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14
Q

What circumstances would you treat an ectopic pregnancy with?

A

hemodynamically stable, early gestation (< 4cm), B-hCG < 5,000, no fetal tones

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15
Q

When would methotrexate be contraindicated?

A

ruptured ectopic and h/o TB

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16
Q

what would indicate successful treatment with methotrexate?

A

B-hCG drops >15% between 2 successive draws

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17
Q

Treatment for stable ectopic pregnancy if the mother is Rh negative

A

RhoGAM

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18
Q

1st choice in treating unstable ectopic pregnancy

A

laparoscopic salpingostomy

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19
Q

Spontaneous abortion is the termination of pregnancy before

A

20 weeks

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20
Q

Which type of abortion is the only associated with possible fetal viability?

A

treatened

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21
Q

MC etiology for spontaneois abortion

A

fetal chromosomal abnormalities

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22
Q

MC cause of first trimester bleeding and pregnancy may be viable or abortion may follow

A

threatened abortion

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23
Q

Patient presents with bloody vaginal discharge, profuse spotting, uterine contractions and uterus size is compatible with gestational date

A

threatened abortion

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24
Q

Treatment for threatened abortion

A

supportive - rest at home and return to ER is symptoms persist or passage of POC
check B-hCG for doubling

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25
Q

What is inevitable abortion?

A

progressive cervix dilation (> 3cm)
no POC expelled
pregnancy is not salvageable

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26
Q

Patient presents with moderate bleeding > 7 days and moderate to severe uterine cramping

A

inevitable abortion

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27
Q

Management of inevitable abortion

A 
dilation and evacuation (2nd trimester)
suction curettage (1st trimester)
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28
Q

Cervical os dilates and some POC are expelled and some are retained - patient presents with heavy bleeding, moderate to severe cramping, boggy uterus on exam

A

incomplete abortion

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29
Q

Management of incomplete abortion

A

D&E (1st trimester)

pitocin

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30
Q

Patient expells all POC from the uterus and the cervical os is usually closed - pain, cramps, bleeding subsidie and uterus returns to prepregnancy size

A

complete abortion

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31
Q

Fetal demise but still remains in the uterus - loss of pregnancy symptoms and +/- brown discharge

A

missed abortion

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32
Q

Management for missed abortion

A

D&E (1st trimester)

Misotrostol

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33
Q

Retained POC becomes infected and spreads to uterus and other organs - cervical motion tenderness, foul brown discharge, fever, chills, spotting/heavy bleed

A

septic abortion

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34
Q

Management of septic abortion

A

D&E to remove POC

broad spectrum antibiotics

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35
Q

Medical method for elective abortion

A

Mifepristone → misoprostol 24-72 hours after (safe up to 9 weeks)
methotrexate → misoprostol 3-7 days later (safe up to 7 weeks)

36
Q

MOA of mifepristone

A

anti-progestin

37
Q

MOA of methotrexate

A

antimetabolite (folic antagonist)

38
Q

MOA of misoprostol

A

prostaglandin that cuases uterine contractions

39
Q

Surgery can be performed for elective abortion up to ____ from LMP

A

24 weeks

40
Q

Surgical procedure for elective abortion during 4-12 weeks gestation

A

dilation and curettage

41
Q

Surgical procedure for elective abortion if it is > 12 weeks gestation

A

dilation and evacuation

42
Q

HTN without proteinuria after 20 weeks gestation and resolves 12 weeks post partum

A

gestational HTN

43
Q

HTN + proteinuria +/- edema after 20 weeks gestation (may be earlier in multiple gestation or molar pregnancy)

A

Preeclampsia

44
Q

Preeclampsia + seizures or coma

A

eclampsia

45
Q

HTN before 20 weeks gestation or before pregnancy - persists > 6 weeks post partum

A

chronic/prexisting HTN

46
Q

HTN in gestational HTN is thought to be due to

A

arteriolar vasocontriction

47
Q

Management of gestational HTN

A

may withhold meds

+/- hydralazine or labetalol

48
Q

Clinical manifestation of preeclampsia

A

headache, vision symptoms, fetal growth restriction, edema

49
Q

Mild preeclampsia is what two criteria

A

> 140/90 on 2 separate occasions (less than 1 week apart)

proteinuria (>300mg/24hr)

50
Q

Severe preeclampsia is

A 
BP >160/110 
Proteinuria >5g/24hr 
oliguria 
thrombocytopenia +/- DIC
HELLP syndrome
51
Q

What is HEELP syndrome?

A

Hemolytic anemia, Elevated Liver enzymes, Low Platelets

52
Q

If a patient presents with mild preeclampsia after 37 weeks gestation, what is the best management?

A

delivery

53
Q

If patient presents with mild preeclampsia at <34 weeks, what is the best management?

A

conservative (daily weights, BP and dipstick weekly, bedrest)
if elective delivery → may need steroids to mature lungs

54
Q

If patient presents with severe preeclampsia what is the best management?

A

prompt delivery + magnesium sulfate

55
Q

What BP meds are approved in acute severe HTN?

A

hydralazine, labetalol, nifedipine

56
Q

Clinical presentation of eclampsia

A

abrupt tonic-clonic seizures 1-2 min → postical state

hyperreflexia

57
Q

First line treatment for seizures in eclampsia

A

magnesium sulfate

58
Q

Treatment for eclampsia once the monther is stabilized

A

deliver the fetus

59
Q

Mild HTN
Moderate HTN
Severe HTN

A

> 140/90
150/100
160/110

60
Q

How should you monitor a pregnant patient with mild chronic HTN?

A

q 2-4 weeks → weekly @ 34 - 36 weeks → deliver @ 37 weeks

61
Q

Treatment of choice for moderate/severe HTN in pregnant patients

A

Methyldopa (1st line) → labetalol (BB), hydralazine, nifedipine (CCB)

62
Q

What HTN meds should be avoided in pregnant patients?

A

ACE inhibitors and diuretics

63
Q

abnormal placena placement on or close to the cervical os

A

placenta previa

64
Q

placenta covers cervix ahead of fetal presenting part

A

partial placenta previa

65
Q

placenta totally covers the cervical os

A

complete placenta previa

66
Q

placenta is within 2-3 cm of cervical os

A

marginal placenta previa

67
Q

Patient presents in third trimester with sudden onset of painless bright red bleeding → no abdominal pain present and the uterus is soft and nontender

A

placenta previa

68
Q

What will the fetal HR be with placenta previa?

A

normal

69
Q

How do you diagnose placenta previa?

A

pelvic US to localize placenta

70
Q

Premature separation of placenta from the uterine wall after 20 weeks gestation → bloody vaginal discharge (ranked I, II, III)

A

abruptio placentae

71
Q

Patient presents with third trimester bleeding that is continuous and dark red → severe abdominal pain, rigid uterus

A

abruptio placentae

72
Q

In abruptio placentea, how will the fetus present?

A

bradycardia → fetal distress because it interferes with fetal oxigenation

73
Q

How do you diagnose abruptio placentae?

A

pelvic US

74
Q

Fetal vessels transverse the fetal membranes over the cervical os → membranes rupture → painless vaginal bleed results

A

vasa previa

75
Q

How will fetus present with vasa previa?

A

bradycardic → fetal distress

76
Q

Management for vasa previa

A

immediate C-section

77
Q

How can you stabilize a fetus in the instance of placenta previa?

A

tocolytics or amniocentesis

78
Q

MOA of magnesium sulfate in pregnancy

A

inhibits uterine contractions (preterm labor)

79
Q

In partial or marginal placenta previa, how should you deliver the baby?

A

vaginal

80
Q

In complete placenta previa how should you deliver the baby?

A

C-section

81
Q

How do you manage a patient with abruptio placentae?

A

hospitalize to hemodynamically stablize and deliver imediately

82
Q

what is a complication of abruptio placentae?

A

may lead to DIC (disseminated intravascular coagulation)

83
Q

Risk factors for placenta previa

A

multiparity, increasing age, smoking

84
Q

risk factors for abruptio placentae

A

MC is maternal HTN

smoking, EtOH, cocaine, folate deficiency, high parity, increased age, trauma, chorioamnionitis

85
Q

2 most common causes of third thrimester bleeding

A

abruptio placentae and placenta previa

86
Q

Abruptio →

Previa →

A

Abdominal pain

Painless

Obstetrics (17 decks)

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