First trimester complications

Question 1

a gestational sac or intrauterine fluid collection compatible with pregnancy is visible at

Answer 1

4.5 to 5 weeks of gestation.

Question 2

DX of pregnancy is based on the following

Answer 2

Detection of HCG in blood or urine.
Identification of pregnancy by ultrasound examination.
Identification of fetal cardiac activity by Doppler Ultrasound (you can hear heartbeat around 10-12 weeks)

Question 3

Hydatidiform mole

Answer 3

an aberrant placenta composed of multiple grape like vesicles . It is not malignant and does not invade the uterine wall.

Question 4

clinical features of hydatidiform mole

Answer 4

• uterine bleeding

- uterine size that exceeds expected from gestational age

Question 5

uterus remains a pelvic organ until ( ) weeks

Answer 5

12, so abdominal trauma should not harm the fetus before this

Question 6

fetal heart activity by doppler is seen at

Answer 6

10-12 weeks

Question 7

Chadwicks signs:

Hegar’s sign:

Answer 7

cervical and vaginal cyanosis
lengthening and softening of the
cervix.
Seen in early pregnancy, normal signs bc of hypertrophy

Question 8

what to do if pt is nauseous in first trimester?

Answer 8

Best tx is to tel pt this is normal and goes away by 11/12 week

Question 9

severe hyperemesis is associated with….

Answer 9

high levels of BHCG, seen in multiple pregnancies and hydatidiform moles

Question 10

hyperemesis gravidum

Answer 10

Nausea and vomiting of pregnancy that are associated with systemic effects of dehydration; weight loss (>5% of pre-pregnancy weight); electrolyte abnormalities; ketosis , all appearing before the 10-12th week of gestation

Question 11

main tx for hyperemesis gravidum

Answer 11

Normal saline; ringers lactate; D5NS (when u/o 100ml/hr)
thiamine, folic acid
zofran

Question 12

you should be concerned if your pt is vomiting beyond ( ) weeks

Answer 12

12

Question 13

what should you always check when a pregnant lady comes in?

Answer 13

urine, could have an asymptomatic UTI

Question 14

how to treat acute HTN?

Answer 14

hydralazine

Question 15

TORCH

Answer 15

Toxoplasmosis-protozoa found in cat stool, triad of chorioretinitis/hydrocephalus/intracranial calcifications
Other (syphillis, Varicella Zoster, parovirus)
Rubella
Cytomegalovirus-MCC of deafness
Herpes Simplex Virus (HSV)-acquired during the birthing process via contact, skin/eye/encephalitis

Question 16

What happens to blood volume during pregnancy?

Answer 16

Normal blood volume is about 5 liters, in pregnancy can be about 7.5 liters
Hematocrit can be low in a normal pregnancy bc of dilutional anemia

Question 17

What happens to BP/CO during pregnancy?

Answer 17

increases, may have resting tachycardia

Question 18

What happens to the pregnant lady’s ABG?

Answer 18

Pregnant women have higher respiratory rate, blow off more CO2 making CO2 lower (normal 35-45, pregnant may be around 30)

Question 19

What can happen to aneurysms during pregnancy?

Answer 19

Aneurysm can rupture in pregnancy bc of fibro elastic-lytic enzymes that effects elastic tissue

Question 20

1st trimester bleeding can be from…?

Answer 20

• ectopic
• spontaneous abortion
• cervical, vaginal patho
• implantation bleed

Question 21

Abortion

Answer 21

All pregnancies that terminate before the period of fetal viability, i.e. terminate before fetal weight is 500 gram (or less than 20 weeks gestation; or miscarriage spontaneous/induced/TOP)

Question 22

classic 1st trimester triad of bleeding

Answer 22

Amenorrhea
Vaginal bleeding
Abdominal Pain

Question 23

MC complication of early pregnancy?

Answer 23

spontaneous abortion

Question 24

Threatened abortion

Answer 24

A state in which bleeding of intrauterine origin occurs before the twentieth completed week of gestation, with or without uterine contractions, without expulsion of the products of conception and without dilatation of the cervix.

Question 25

inevitable abortion

Answer 25

: the state in which bleeding of intrauterine origin occurs with continuous and progressive dilatation of the cervix, but without expulsion of the products of conception, before the twentieth week of gestation.

Question 26

Missed abortion

Answer 26

an abortion in which the embryo or fetus dies in utero before the 20th completed week of gestation, but the products of conception are retained in utero.
-Woman says she was pregnant and then sickness/nausea stopped suddenly

Question 27

MCC of first trimester mortality

Answer 27

ectopic

Question 28

Intramural/interstital ectopic

Answer 28

rupture causes massive bleeds bc it is right near the uterus

Question 29

isthmus ectopic

Answer 29

very narrow so pain is very early on, less bleeding

Question 30

ampulla ectopic

Answer 30

pain develops later bc it is larger, more bleeding

Question 31

infundibulum ectopic

Answer 31

very late pain, large ectopic pregnancy

Question 32

How to dx an ectopic?

Answer 32

Absence of IUP w/ HCG>2k indicates ectopic pregnancy**

Question 33

Heterotopic Pregnancy:

Answer 33

combined intrauterine and extrauterine pregnancy: mostly in women conceiving through IVF

Question 34

classic ectopic symptoms

Answer 34

Amenorrhea
Abdominal pain
Vaginal bleeding

Question 35

How to treat ectopic?

Answer 35

• mainly surgical

- methotrexate is concentrated and used more by cells that are actively dividing

Question 36

candidates for methtrexate are….

Answer 36

Hemodynamically stable
Have hCG level less than 5,000miu/ml
No fetal cardiac activity
Ectopic mass size less than 3-4 cm
Willing and able to comply with post treatment follow-up.