SAB, Rh - Moulton Flashcards
Painless dilation and delivery usually seen w/2nd trimester loss is what?
Cervical incompetence
What anembryonic gestation or a gestational sac too large to not have embryo (> 25mm)?
Blighted ovum
Empty gestational sac aka no embryo
Classic triad for ectopic pregnancy?
Missed menses
Vaginal bleeding
Lower abdominal pain
What ethnicity has highest incidence of Rh D (-)?
Caucasians - 15%
Sickle cellers - 8%
How long is the 2nd trimester?
14-27 weeks + 6 days
What fetal MCA peak systolic velocity is predictive of mod-severe fetal anemia?
Need to do what next?
> 1.5
Percutaneous umbilical blood sampling
Maybe intrauterine transfusion
What surgery method is preferred for ectopic pts who are hemodynamically unstable?
Stable pts?
Laparotomy
Laparoscopy
What should every pregnant woman get at her 1st prenatal appointment?
ABO
Rh D
Antibody screen
What is the most common single chromosomal abnormality of spontaneous abortion?
Most common class?
45 XO
Trisomy 16
Any women presents with vaginal bleeding, what is the 1st step?
Pregnancy test
What is preterm delivery?
Full term?
20-36 weeks + 6 days
37-42 weeks
Rh-Ab Titers less than 1:8 indicate what?
> 1:16?
Fetus ok, recheck q4wk
Need doppler of MCA
Where does ART increase ectopic pregnancy?
Ampulla - 93%
Cornual - 7.3%
Ovarian/abdominal - 4.6%
80% of what ectopics will not rupture and resolve spontaneously?
hCG < 1000
Fever, uterine, cervical motion tenderness, purulent discharge, hemorrhage, and rarely renal failure is what?
Tx?
Septic abortion
IV Abs - Ampicillin, Gentamycin
What surgical management of ectopic results in better long-term tubal fx?
Incision is sutured closed?
Salpingostomy
Salpingotomy
What hCG levels confirm ectopic pregnancy/abnormal IUP?
If hCG rises less than 53% in 2 days
what is the problem in rhesus isoimmunization?
Rh (-) mom, Rh (+) fetus
D antigen
How to tx ectopic pregnancy?
Methotrexate (folic acid antagonist) 50 mg
Check hCG levels and if decrease by 15%, follow weekly until negative. If they plateau/fall slowly give another dose
If pt symptomatic or hCG INC, do surgery
Vaginal bleeding and a closed cervix means what?
Threatened abortion
25-50% result in abortion
Absolute contraindications to methotrexate?
Breast feeding Immunodeficiency Alcoholism Blood dyscrasia Active pulmonary disease PUD Renal/hepatic dysfx
Probable ectopic pregnancy find what on PE?
Abdominal or adnexal tenderness
Cervical motion tenderness
What medical disorder most commonly causes recurrent abortions?
What else is common?
Antiphospholipid Ab syndrome
Advanced maternal AGE
How long is the 3rd trimester?
28-42 weeks
What dosage for RhoGAM?
When?
Single dose 300 mci
28 weeks and w/in 72 hours after delivery or Rh (+) baby
What is severe fetal anemia due to Rh?
Management?
Hct < 30%, or 2 SDs below
Intrauterine transfusions peformed bw 18-35 weeks
using group O, Rh (-) rbc’s for < 20 weeks
Differential dx of falling hCG?
Blighted ovum
Spontaneous resolving ectopic
Abnormal pregnancy
What test identifies fetal rbcs in maternal blood?
Kleinhauer-Betke test
Acutely ruptured ectopic has what symptoms?
Severe abdominal pain and dizziness (secondary to intraperitoneal hemorrhage)
Symptoms of missed abortion?
Management?
None
Check fibrinogen weekly until SAB occurs or do DandC
What hCG level is negative for pregnancy?
Titer < 5 IU/L
What may indicate an ectopic on US?
Thickened endometrial stripe (Arias-Stella reaction)
What defines recurrent abortions?
3 in a row excluding ectopic and moles
Vaginal bleed, cramping lower abdominal pain with dilated cervix means what?
Incomplete abortion
How to treat Antiphospholipid Ab syndrome?
Propyylactic dose of heparin and low dose ASA
Vaginal bleed and cervix partially dilated means what?
Inevitable abortion
What infections linked to recurrent abortions?
Mycoplasma
Chlamydia
Listeria
Toxo
How long is the 1st trimester?
13 weeks, 6 days
Abortion is classified as what?
< 20 weeks or < 500 gms
When can the gestational sac been seen on US?
1500-2000 hCG
