SAB's, Ectopic, and Rh Isoimmunization

Question 1

1st trimester =

Answer 1

FDLMP –> 13+6 wks

Question 2

2nd trimester =

Answer 2

14 wks –> 27+6 wks

Question 3

3rd trimester =

Answer 3

28 wks –> 42 wks

Question 4

Estimated Date of Confinement (EDC) =

Answer 4

FDLMP + 40 wks

Question 5

Preterm delivery =

Answer 5

20 wks –> 36+6 wks

Question 6

Full term delivery =

Answer 6

37 wks –> 42 wks

Question 7

Postdates =

Answer 7

> 42 wks

Question 8

When is hCG first detected in urine

Answer 8

6-8 days after ovulation

Question 9

At what hCG level is pregnancy detected in the urine

Answer 9

25

Question 10

What is the rate at which hCG rises and when does it peak

Answer 10

Doubles every 2 days

Peak at 10 wks (100,00)

Question 11

At what hCG level can a gestational sac be seen

Answer 11

1500-2000

Question 12

At what hCG level can a fetal pole be seen

Answer 12

5200 (5 wks)

Question 13

Which abnormalities are the most common causes of SAB’s in the 1st trimester

Answer 13

Chromosomal

Question 14

What is the most common chromosomal abnormality causing SAB

Answer 14

Turner syndrome

Question 15

What is the most common class to cause an SAB and which member of the class is most common

Answer 15

Trisomy’s

Trisomy 16

Question 16

Def = vaginal bleeding and a closed cervix with 50% chance of loss

Answer 16

Threatened abortion

Question 17

Def = vaginal bleeding and partially dilated cervix with definite loss

Answer 17

Inevitable abortion

Question 18

Def = vaginal bleeding, dilated cervix, lower ab cramping with some passage of conception products

Answer 18

Incomplete abortion

Question 19

Def = passage of all conception products with resolution of Sx’s

Answer 19

Complete abortion

Question 20

Def = expired fetus with remains staying in uterus and no Sx’s

Answer 20

Missed abortion

Question 21

Def = retained, infected conception products causing fever, hemorrhage, purulent discharge, and cervical tenderness

Answer 21

Septic abortion

Question 22

Gestational sac but no fetus

Answer 22

Blighted ovum

“Anembryonic gestation”

Question 23

What is the definition of recurrent abortions

Answer 23

3 successive SAB’s (not including ectopic and molar)

Question 24

What is the classic triad of Sx’s for an ectopic pregnancy

Answer 24

Missed menses
Vaginal bleeding
Lower ab pain

Question 25

Sx's = ab pain, vaginal spotting/bleeding, normal uterus, and no adnexal mass

Answer 25

Possible ectopic

Question 26

Sx's = ab/pelvic pain, vaginal spotting/bleeding, cervical tenderness, and adnexal tenderness

Answer 26

Probably ectopic

Question 27

Sx's = severe ab pain and dizziness with distended/tender ab, cervical tenderness, and hemodynamic instability

Answer 27

Acutely ruptured ectopic

Question 28

What are the signs you'd see on US for the 3 types of ectopic pregnancies

Answer 28

``` Possible = thickened endometrial stripe Probable = fluid in cul de sac Ruptured = empty uterus with lots of free fluid ```

Question 29

What is the protocol for Methotrexate Tx of ectopic pregnancy

Answer 29

Check hCG levels at 4 and 7 days

Question 30

What vitamin should pts avoid when they are on Methotrexate

Answer 30

Folate

Question 31

What is the preferred surgical ectopic Tx for hemodynamically unstable pts

Answer 31

Laparotomy

Question 32

What is the preferred surgical ectopic Tx for stable pts

Answer 32

Laparoscopy

Question 33

What is the term for complete removal of the tubes

Answer 33

Salpingectomy

Question 34

Which surgical ectopic Tx results in better long-term tubal function and allows healing by 2˚ intention

Answer 34

Salpingostomy

Question 35

What is the term for the surgical ectopic Tx where the tubes are closed with sutures

Answer 35

Salpingotomy

Question 36

When is RhoGAM given

Answer 36

28 wks | W/in 72 hours of delivery of Rh+ baby

Question 37

What is the Kleinhauser-Betke test

Answer 37

Determines if more RhoGAM is needed by sensing fetal RBCs in maternal blood

Question 38

Sx's = ascites, pleural effusion, scalp edema, polyhydramnios

Answer 38

Fetal hydrops

Question 39

What is the most useful tool for detecting fetal anemia

Answer 39

Doppler of the MCA

Question 40

At what Hct level is severe fetal anemia determined

Answer 40

Hct < 30%