OnlineMedEd: Gynecology - "Vaginal Bleeding 2"

Question 1

Talk about (1) passage of blood, (2) passage of parts, (3) cervical dilation, and (4) ultrasound imaging for each of the following: 
•Normal pregnancy
• Threatened abortion
• Inevitable abortion
• Incomplete abortion
• Complete abortion

Answer 1

• Normal pregnancy: no bleeding; no passage of parts; closed cervix; live baby
• Threatened abortion: some bleeding; no passage of parts; closed cervix; live baby
• Inevitable abortion: bleeding; no passage of parts; open cervix; dead baby
• Incomplete abortion: bleeding; passage of parts; open cervix; baby parts
• Complete abortion: bleeding; passage of entire baby; open cervix; no baby parts

Question 2

What is a missed abortion?

Answer 2

The baby has died but the cervix is closed.

Question 3

What is the treatment for molar pregnancy?

Answer 3

• Suction curettage
• OCPs (to prevent future pregnancy which would confound b-hCG levels)
• Monitor b-hCG

Question 4

Discuss the three treatment options for ectopic pregnancy.

Answer 4

• If it has ruptured the fallopian tube, then salpingectomy is indicated.
• If the fallopian tube has not ruptured, the b-hCG is less than 8,000, and the fetus is less than 3.5 cm without heart tones, then methotrexate can medically treat it.
• If the fallopian tube has not ruptured but the b-hCG is greater than 8,000 or the fetus is greater than 3.5 cm or has heart tones, then salpingostomy is indicated.

Question 5

What is used to help diagnose ectopic pregnancy?

Answer 5

Transvaginal ultrasound and b-hCG

Question 6

If the b-hCG is greater than ____________, then you should be able to see an intrauterine pregnancy on TVU.

Answer 6

1,500 - 2,000

Question 7

If the b-hCG is less than 1,500 but you still suspect an ectopic pregnancy, then you can do what test?

Answer 7

Wait 48 hours and test it again. If it doubles, then it is a normal pregnancy. If it fails to double by a large margin, then it is likely an ectopic.