SAB's, Ectopic, and Rh Isoimmunization Flashcards
1st trimester =
FDLMP –> 13+6 wks
2nd trimester =
14 wks –> 27+6 wks
3rd trimester =
28 wks –> 42 wks
Estimated Date of Confinement (EDC) =
FDLMP + 40 wks
Preterm delivery =
20 wks –> 36+6 wks
Full term delivery =
37 wks –> 42 wks
Postdates =
> 42 wks
When is hCG first detected in urine
6-8 days after ovulation
At what hCG level is pregnancy detected in the urine
25
What is the rate at which hCG rises and when does it peak
Doubles every 2 days
Peak at 10 wks (100,00)
At what hCG level can a gestational sac be seen
1500-2000
At what hCG level can a fetal pole be seen
5200 (5 wks)
Which abnormalities are the most common causes of SAB’s in the 1st trimester
Chromosomal
What is the most common chromosomal abnormality causing SAB
Turner syndrome
What is the most common class to cause an SAB and which member of the class is most common
Trisomy’s
Trisomy 16
Def = vaginal bleeding and a closed cervix with 50% chance of loss
Threatened abortion
Def = vaginal bleeding and partially dilated cervix with definite loss
Inevitable abortion
Def = vaginal bleeding, dilated cervix, lower ab cramping with some passage of conception products
Incomplete abortion
Def = passage of all conception products with resolution of Sx’s
Complete abortion
Def = expired fetus with remains staying in uterus and no Sx’s
Missed abortion
Def = retained, infected conception products causing fever, hemorrhage, purulent discharge, and cervical tenderness
Septic abortion
Gestational sac but no fetus
Blighted ovum
“Anembryonic gestation”
What is the definition of recurrent abortions
3 successive SAB’s (not including ectopic and molar)
What is the classic triad of Sx’s for an ectopic pregnancy
Missed menses
Vaginal bleeding
Lower ab pain
Sx’s = ab pain, vaginal spotting/bleeding, normal uterus, and no adnexal mass
Possible ectopic
Sx’s = ab/pelvic pain, vaginal spotting/bleeding, cervical tenderness, and adnexal tenderness
Probably ectopic
Sx’s = severe ab pain and dizziness with distended/tender ab, cervical tenderness, and hemodynamic instability
Acutely ruptured ectopic
What are the signs you’d see on US for the 3 types of ectopic pregnancies
Possible = thickened endometrial stripe Probable = fluid in cul de sac Ruptured = empty uterus with lots of free fluid
What is the protocol for Methotrexate Tx of ectopic pregnancy
Check hCG levels at 4 and 7 days
What vitamin should pts avoid when they are on Methotrexate
Folate
What is the preferred surgical ectopic Tx for hemodynamically unstable pts
Laparotomy
What is the preferred surgical ectopic Tx for stable pts
Laparoscopy
What is the term for complete removal of the tubes
Salpingectomy
Which surgical ectopic Tx results in better long-term tubal function and allows healing by 2˚ intention
Salpingostomy
What is the term for the surgical ectopic Tx where the tubes are closed with sutures
Salpingotomy
When is RhoGAM given
28 wks
W/in 72 hours of delivery of Rh+ baby
What is the Kleinhauser-Betke test
Determines if more RhoGAM is needed by sensing fetal RBCs in maternal blood
Sx’s = ascites, pleural effusion, scalp edema, polyhydramnios
Fetal hydrops
What is the most useful tool for detecting fetal anemia
Doppler of the MCA
At what Hct level is severe fetal anemia determined
Hct < 30%
