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ObGyn Lecture > Lecture 14- 1st trimester loss > Flashcards

Lecture 14- 1st trimester loss Flashcards

1
Q

When do the majority of spontaneous abortions occur?

A

<12 weeks GA

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2
Q

Termination of a pregnancy before ____ weeks is considered what trimester loss.

A

20; First

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3
Q

What are the three most common abnormal uteri?

A

Septate
Asherman’s syndrome
Bicornalte uterus

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4
Q

What are key things you want to know with a suspected miscarriage?

A

If the cervix is closed vs/ open
Presence of POC, discharge, blood
Uterine size

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5
Q

With a threatened AB what will they present like.

A

Bleeding
closed cervix
uterine size consistent with GA

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6
Q

What will an inevitable AB look like?

A

Cervix dilated
ROM
bleeding and UCs
expel POC (products of conception)

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7
Q

What will a missed AB present like.

A

POC reatained
Uterus < GA
Dark brown discharge
No pain & IUP symptoms cease

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8
Q

What is considered a recurrent loss?

A

loss on > 2 consecutive pregnancies

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9
Q

What are reasons for 2nd trimester loss?

A

Cervical insufficiency (painless effacement and dilation)

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10
Q

What do you do for cervical insufficiency?

A

Cervical cerclage

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11
Q

how do you induce labor surgically?

A

Vacuum aspiration

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12
Q

What are some complications with surgically induced labor?

A

uterine perf, cervical laceration

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13
Q

What is cervical priming?

A

use seaweed like plant to prime the cervix.

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14
Q

After induction what do you want to monitor?

A

temp, pain , bleeding

hemorrhage, incomplete evacuation, infection

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15
Q

Under how many days since LMP can you do a medical induced labor?

A

<49 days

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16
Q

Where do the majority of ectopic pregnancies occur?

A

Fallopian tube

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17
Q

What does an ectopic pregnancy look like on US?

A

cyst w/ wide echogenic vascular outer ring

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18
Q

What is the “classic” signs and symptoms of ectopic?

A

amenorrhea followed by bleeding and abdominal pain on affected side

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19
Q

What are the ominous signs of ectopic pregnancy?

A

Shoulder pain worsened w/ inspiration

syncope, vertigo

20
Q

You must r/o ectopic w/out confirmation of what in utero?

A

chorionic villi

21
Q

About what level with serum beta quant. level stay at with ectopic pregnancy?

A

600-800

22
Q

Can serum progesterone distinguish IUP from ectopic?

A

No

23
Q

Serum progesterone level < what is negative for pregnancy.

A

5

24
Q

Serum progesterone level greater than what is consistent with pregnancy.

A

20

25
Q

What is procedure that removes an ectopic pregnancy?

A

laparoscopic linear salpingostomy

26
Q

What is where the chorionic villi continue to grow and become swollen.

A

hydatidiform mole (aka molar pregnancy)

27
Q

Is molar pregnancy benign?

A

Usually

28
Q

What is the name for non-malignant, non-metastatic gestational trophoblastic neoplasia.

A

Hydatidiform mole

29
Q

What is the karyotype with complete hydatidiform mole?

A

Complete - 45XX or 45XY

30
Q

What is the karyotype with a partial molar pregnancy?

A

Triploid (Partial - 69XXX or 69XXY)

31
Q

In a molar pregnancy what is abnormal with the uterine size?

A

Uterine size >GA

32
Q

WHat is the treatment for a molar pregnancy?

A

Hospitalization
D&C
contraception for 1 year
Watch for uterine atony or pulmonary embolism
Monitor B-hCG for rise/decline/plateau to r/o persistant GTN

33
Q

for a localized persistent GTN what do they do?

A

Single agent chemotherapy

34
Q

What is a malignant transformation of GTN?

A

Choriocarcinoma

35
Q

What are reasons for 1st trimester recurrent loss?

A

parent karyotypes, Asherman’s syndrome, antiphospholipid antibodies

36
Q

What is post-abortal syndrome?

A

bleeding, dilated cervix, cramping, large, boggy uterus with hematometra

Mimics incomplete abortion

37
Q

What should you do for septic abortion?

A

IV fluid, IV antibiotics, evacuate uterus

38
Q

What are 3 outcomes of ectopic pregnancy without interventions?

A 
Tubal abortion (POC expelled out of fimbriated end)
Tubal rupture (intra-abdominal hemorrhage)
Spontaneous resolution
39
Q

What are risk factors for ectopic pregnancy?

A

tubal scarring 2ndary PID/salpingitis
Prior ectopic or tubal surgery
History of infertility

40
Q

What are PE of ectopic pregnancy post rupture?

A

Marked pelvis and abdominal tenderness, CMT, pelvic fullness or mass

41
Q

What are contraindications for Medical treatment (Methotrexate) for ectopic pregnancy?

A

Absolute: breastfeeding, liver disease, alcoholism, blood dyscrasias, active pulmonary disease, PUD, immunodeficiency, methotrexate sensitivity
Relative: >3.5cm, cardiac motion/fetus

42
Q

What is the ideal candidate for methotrexate for ectopic pregnancy treatment?

A

<5000mlU/L and no fetal heart activity

43
Q

What are neoplasms from spectrum of abnormal placental proliferation?

A

gestational trophoblastic neoplasia

44
Q

What is the PE for a hydatidiform mole?

A

Uterine size> GA, absent FHT, vaginal bleeding, HTN

45
Q

What will a complete hydatidiform mole look like on US?

A

no embryo/fetus, no amniotic fluid, thick and cystic placenta filled uterus; snowstorm appearance

46
Q

What will a partial hydatidiform mole look like on US?

A

growth-restricted fetus, low amniotic fluid, thick cystic placenta

ObGyn Lecture (21 decks)

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