OB Flashcards
define spontaneous abortion
b4 20 weeks
fetal RF for spont abortion
chromosomal abornamlities MC is trisomy
materal RN for spont abortion
-smoking**** STIs trauma BMI under or over celiac dz
which type of spont aortion is viable
threatened
bloody vaginal discharge
cervical os closed
POC intact
thereatened abortion
tx for threatened abortion
supportive—observation at home, bedrest, close follow up
serial BHCG to if
POC intact
cervical os dilated without passage of tissue
inevitable abortion
some POC expelled
os is dilated
incomplete
all POC expelled from uterus
os is usually closed
complete
POC intact
cervical os closed
missed
***fetus died before 20 weeks and POC remain intrauterine
medical abortion
mifepristone (antiprogestin) 1st
misoprostol (prostaglandin) 2nd
mifepristone
progesterone recp antagonist
-leads to dilation and softening of cervix and placental detachement
misopristol
prostaglandin E1 analog (caues uterine contractions)
-
three times we give RHOGAM
- at 28 weeks
- within 72 hours of birth
- after any mixing of blood– ectopic, abortion, amniocentesis etc
define PP hemorrhage
vaginal = >500 CS= >1000
etiologies for PP hem
and whih is MC
FOUR T’s
- TONE–uterine atony– MC– uterus cannot contract
- TISSUE–retained placental tisssue
- TRAUMA–to cervix, perineum or vagina, uterine rupture, lacerations
- THROMBIN—coag abnorm (hem A/B, von willie, ITP or DIC)
RF for uterine atony
prolonged labo overdistended uterus CS anesthesia retained placenta
soft flaccid boggy uterus with dilated cervix
uterine atony
tx for PP Hem
- uterine massage and compression
- IV oxytocin
- Metagen (methylergonovine) if not HTN
- IM Hemobate (Carboprost tromethamine) if no asthma
- TXA
- Cytotec or misoprostol
define ectopic pregnnacy
implantation outside uterine cavity
locations for ectopic
-mc
98% FT—– ampulla
abdomen (`1.4%)
ovary and cervix (.3%)
strongest RF for ectopic
-others
previous ectopic **
others: PID causing salpingitis IUD previous tubual suregyre endometriosis IVF
abd pain, left shoulder pain, vag bleeding
Ectopic
***shoulder pain= Kehr sign