OB/GYN Emergencies - Exam 3 Flashcards
What does abnormal uterine bleeding cover? How is it divided?
Encompasses all causes of abnormal bleeding in nonpregnant women
structural vs nonstructural causes and ovulatory or anovulatory
What are common causes of premenarcheal vaginal bleeding? ( in that order)
Genital Trauma and/or sexual abuse
Vaginitis
Tumors (vaginal, uterine)
Foreign bodies
Menarche
Precocious puberty
Hematuria
Coagulopathy
What are 2 super important question you need to ask yourself when working a pt up for vaginal bleeding?
how old is the pt!!!! very much changes your ddx
and is there a chance they are pregnant?
What are common causes of vaginal bleeding in a women of reproductive age? these are in order
Coagulopathy
Anovulatory cycles
Pregnancy (including ectopic, abortion)
Endocrine abnormality
Uterine leiomyomas
Cervical and endometrial polyps
Pelvic infections (salpingitis, cervicitis)
Trauma
What are some common causes of vaginal bleeding a postmenopausal women?
Exogenous hormones
Atrophic vaginitis
Endometrial lesions (including cervical or uterine cancer/tumors)
Cervical/endometrial polyps
Trauma
What are important history questions to ask a women when working them up for vaginal bleeding?
how many pads/tampons do you use in 24 hours?
how long as this bleeding been occurring?
any hx of previous STIs?
are there any other signs of bleeding?
What is the management of an unstable pt with vaginal bleeding?
Uterine compression
D&C/laparoscopy/laparotomy
IV estrogen
ADMIT
What is the management for a stable pt with vaginal bleeding?
oral short-term hormonal therapy (ordered by GYN) vs TXA
Discharge and follow up gynecologist
NSAIDs
need to give VERY SPECIFIC return precautions
What are the risk factors for an ectopic pregnancy?
Prior ectopic pregnancy
Prior fallopian tube, pelvic, or abdominal surgery
Sexually transmitted infections
Pelvic Inflammatory Disease
Endometriosis
also mentioned smoking, IUD, and IVF in class
Where is an ectopic pregnancy most likely to implant?
in the fallopian tubes
What is the classic triad of ectopic pregnancy? Will the pain be sudden or gradual? Describe the pain
abdominal pain, vaginal bleeding, amenorrhea
can be EITHER sudden or gradual
Ectopic pregnancy pain can manifest either suddenly or gradually, and may be persistent or come and go; it’s often described as a sharp, stabbing pain on one side of the lower abdomen (but can be both)
If the pt complains of shoulder pain without obvious trauma to the shoulder, what should you be thinking?
pain from the diaphragm can radiate to the shoulder, ectopic pregnancy can irritate the diaphragm
What lab studies should you order when working a pt up for ectopic pregnancy? What imaging? What are you looking for?
HCG (needs to be quantitative), CBC, progesterone, type & screen, comprehensive metabolic panel
transabdominal US first then transvaginal if it is nondiagnostic
visualization of unequivocal IUP without abnormalities excludes ectopic pregnancy
aka it is an assumed ectopic pregnancy until proven otherwise
In a normal healthy intrauterine pregnancy, how often should hCG levels increase? What level of hCG should you be able to visualize the baby in the uterus?
hCG should double every 48 hours
hCG over 1500 should be able to see something in the uterus
What is the definitive tx for an ectopic pregnancy?
sx or medication but both at the discretion of OB/GYN
______ is sometimes given in pregnant vaginal bleeding pts but OBs have differing opinions on the subject so up to their judgement
Rh negative: anti-Rho (D) immunoglobulin
How will gestational trophoblastic dz present? Why?
usually with super severe vomiting because the hCG levels are super super super high
What are the top 3 ddx for a pt who presents late in pregnancy with vaginal bleeding?
placental abruption
placenta previa
preterm labor
What is the difference between placental abruption and placental previa? What is considered preterm labor?
Placental Abruption: premature separation of the placenta from the uterine wall
Placenta Previa: the implantation of the placenta over the cervical os
preterm labor: before 37 weeks
Need to listen for ____ in vaginal bleeding in late pregnancy. What are 3 super important hx questions to ask?
fetal heart tones!!!
associated timing: sudden or gradual and do you have pain?
describe the “blood”: thin, watery fluid with a blood tinge could be amniotic fluid
Describe the onset and pain of placental abruption vs previa? What is the tx?
abruption will be sudden onset with pain -> may need emergency c-section
previa will be PAINLESS!! -> may need emergency c-section
consult OB for both!!
When US a preg pt with vaginal bleeding, what are you looking for?
fetal heart beat
where is the placenta?
amniotic fluid levels
How does PROM present? What do you use to exam?
rush of fluid or continuous leakage of fluid from vagina
STERILE speculum exam with STI testing, consult OB!!!
What is a threatened abortion? **What are the 2 important features?
vaginal bleeding in the first 20 weeks of pregnancy with a CLOSED cervical os, benign examination, and no passage of tissue
in the first 20 weeks
CLOSED cervical os