Keppler - 6 Flashcards
2 types of bleeding during pregnancy
pregnancy related
non-pregnancy related
pregnancy-related causes of first trimester bleeding
ectopic
spontaneous abortion
subchorionic bleeding
when should you be able to see viable fetus in uterus
6-7 weeks
what is the discriminatory zone
level of hcg that you expect to see viable fetus → 2000-3000
how do you localize/find location of fetus
US
next step if you don’t see fetus on US
order hcg → is it w.in discriminatory zone?
suspect __ on any pregnant pt. that comes in w. pain and bleeding in the first trimester
ectopic pregnancy
tx for ectopic pregnancy
methotrexate → inhibits folate
contraindication for methotrexate
hemodynamic instability
evaluation of spontaneous abortion
US findings
hcg for change/discriminatory zone
diagnostic criteria for spontaneous abortion
empty gestational sac 2.5 cm or unchanged
HCG above discriminatory zone w.o viable fetal pole
previous viable fetus w. no cardiac activity
fetal pole > 7 weeks by CRL w.o cardiac activity
management of spontaneous abortion (3)
expectant
medical (misoprostol)
surgical (d&c)
obstetric causes of second/third trimester bleeding
labor
abruption
placenta/vasa previa
2 major causes of 2nd/3rd trimester bleeding to know
placental abruption
placenta previa
rf for placental abruption
HTN
nicotine/tobacco, amphetamines, caffeine
trauma
rupture of membranes
prior hx
dx for for placental abruption
clinical → painful bleeding in 2nd/third trimester
management of placental abruption
acute blood loss protocol (type and screen)
fetal monitoring
+/- steroids
consider timing and mode of delivery
major rf to know for placenta previa
prior uterine surgery
painless vaginal bleeding in 3rd trimester is highly suggestive of
placenta previa
major differentiating sx between placental abruption and placenta previa
abruption: painful bleeding
previa: painless bleeding
exam to avoid for placenta previa
digital exam
t/f: speculum exam is ok in placenta previa
T!
just not digital
management of placenta previa
acute blood loss protocol (type and screen)
+/- steroids
inpt vs outpt (3 strikes rule)
consider timing of delivery
2 common causes of early pregnancy bleeding
ectopic pregnancy
spontaneous abortion
miscarriage management (3)
expectantly
medically
surgically
ectopic pregnancy management (2)
medical
surgical
2 major causes of 2nd/3rd trimester bleeding
placental abruption → painful
placenta previa → painless
2 major rf for postpartum bleeding
happened before
atony
what is atony
loss of tone of uterus
mc cause of postpartum hemorrhage
atony!
big warning sign for postpartum hemorrhage
bleeding gets heavier a week after delivery
initial management of PPH
uterotonics
