OB: EARLY PREGNANCY ECTOPIC PREGNANCY/Spont&Induced Abortions

Question 1

Most common location of an ectopic pregnancy?

Answer 1

Tubal (95-99%), within the tube, the ampulla (70%)

Nearly all ectopic pregnancies (~95%) implant in some segment of the uterine tube—70% in the ampulla, 12% in the isthmus, and 11% in the fimbriae

Question 2

What increases the risk for an ectopic?

Answer 2

Thus, anything that causes inflammation—previous ectopic, tubal surgeries, surgical sterilization, pelvic inflammatory disease—will increase the risk of future ectopic pregnancy. Intrauterine devices do NOT increase the risk of ectopic pregnancy. Assitive reporductive technologies, cigarretes, and advanced maternal age also increase risk.

Question 3

When can methotrexate be used for an ectopic?

Answer 3

Methotrexate works best when the ectopic pregnancy is small (< 3.5 cm), there is no ultrasound evidence of fetal cardiac activity, and the initial β-hCG level is low (< 5,000 mIU/mL).

Question 4

Technical definition of an abortion

Answer 4

technical definition of abortion is the loss of a pregnancy before 20 weeks’ gestation.

When a viable fetus is evacuated from the uterus via myometrial contractions, that evacuation is termed labor. When a nonviable fetus is evacuated from the uterus via myometrial contractions, it is termed abortion. The myometrial contractions may be spontaneous or medically induced—the same medications that induce labor can be used to induce abortion; they are both myometrial-contraction-induced evacuation of the uterus. When the uterus is evacuated via surgical techniques, it is termed a surgical abortion.

Question 5

Term pregnancy

Answer 5

36 to 40

Question 6

Viable pregnancy

Answer 6

24-36

Question 7

previable pregnancy

Answer 7

20-24

Question 8

nonviable pregnancy

Answer 8

0-20

Question 9

complete abortion

Answer 9

complete abortion (the evacuation is over, and the os closed),

Question 10

incomplete abortion

Answer 10

(the evacuation is underway, and the os is open)

Question 11

missed abortion

Answer 11

(the fetus is dead, but the os is closed and evacuation is not underway).

Question 12

Rupture of membranes before viability. DO NOT give tocolysis or keep the fetus in longer.

Answer 12

Inevitable abortion

Question 13

Vaginal bleeding while pregnant, may be followed by abortion or not. DO NOT prescribe bed rest.

Answer 13

Threatened abortion

Question 14

What is the difference between abortion and fetal demise

Answer 14

Question 15

When is expectant management appropriate?

Answer 15

Expectant management is not appropriate for a missed abortion, though may be appropriate for a woman with an incomplete abortion.