Lecture Flashcards
Define bleeding in early pregnancy
Bleeding per vagina before 24 weeks (before viability(
Causes of early
E ectopic
A abortion
Rly gingga gtd
Finally, one size fits all: local causes (lesions in cervix or vagina(
Threatened abortion
Symptoms? Size of uterus? Cervix? Fetal heart sounds? U/s? Management?
Bleeding
Uterus same as gest age
Cervix closed
Fhs positive
Us shows viable fetus
Management is bed rest and avoid sexual intercourse until bleeding subsides
Cause of pain in abortion?
Cervical dilation causes pain
Why hysteroscopy is painful
Bc we pass through cervix, stretching it causing pain
Inevitable abortion
Bleeding, pain bc cervical os open
Abortion will happen si o si
Management: evacuation or d & c
Mnem for incomplete and inevitable (management)
In cancels in
Ev= evacuation
C= curretage ( d &c or e&c)
Incomplete abortion
Bleeding, passage of tissue, clots and pain bc os is open
Uterus is tender
Cervical os open
Uterus size is smaller than GA bc already passed some of fetus
U/s shows remaining products of conception
Since shes losing tissue and clots= a lot of blood loss= may be hemodynamically unstable
Give iv fluids, blood transfusion
Then after stabilixing, evacuation/ d and c under general anesthesia preferablly ultrasound guided
Complication of d and c
Uterine perforation
Anti- d given to whom and why
Given to ANNI NEGATIVE (anti-d) anni nt
Rhogam intramuscular injection
To protect future pregnancies (isoimmunization)
Tender uterus might indicate?
Infection - septic abortion
How does incomplete abortion turn to septic abortion
If ignored, poorly managed
Remeber that os is open, which means theres no barrier between cervix (uterus) and vagina
So microbes in vagina will ascend causing infection in products of conception as blood is a good medium for microbial growth
To identify organism do a vaginal swab, most likely due to e.coli or strep faecelias min wara
Most imp lab to order in septic abortion
Cbc for anemia and leukocytosis
Foul smelling discharge usually equals
Infection
How to check for hypovolemia
Volume means we are talking about fluids
The two most important fluids we care about are blood and urine
Check blood volume by blood pressure and if v bad condition also do cvp central venous pressure
Check urine by measuring urine output put a foleys and a bag to check
If hypovolemia low bp and low urine which is oliguria
Single best way to monitor fluid status is OLIGURIA
