Vaginal Bleeding and UCG Flashcards
Who get’s screened for chlamydia
Sexually active or pregnant women 24 and younger
High risk women 25+ (Regardless of pregnancy)
No good evidence of men to get screened
Risk factors fo chlamydia
Past infection (any STD counts)
Multiple sex partners
Poor condom use
Sex for things
Folic acid recommendations
- Normal
- Diabetic or epileptic
- Hx of child with NT defect
400 to 800 mcg
1 mg
4 mg
Carrier screening (ethinic)
Sickle cell
Thalassemia
Tay-sachs
Carrier screening (family hx)
Cystic fibrosis
Nonsyndromic hearing loss
- Connexin-26
Infectinous disease screening
HIV Syphilis Hep B (vaccine) Rubella & Varicella (Vaccines) Toxo (cat litter, dirt, and raw meat) CMV Parvo B19
Environmental toxins
Paint thinners, strippers, solvents, and pesticides
Smoking cessation
EtOH and Drug use
Medical assessment Diabetes HTN Epilepsy DVT Deprssion/Anxiety
Optimize control, Folic acid, and DC ACEI DC ACEI, ARBS, and Thiazides Optimize control & Folic acid Switch to heparin Avoid benzos
Lifestyle
Avoid hot tubes Good weight management Domestic violence Nutritional deficiencies Avoid Vitamin A overuse (750 to 3000 mcg) Vitamin D Limit caffine to two cups perday
Amenorrhea Fatigue Nausea Vomiting Breast changes (Tenderness)
Suprise!!!!
You’re pregnant
Goodell’s sign
Soft cervix
Hergar sign
Soft uterus
Chadwick’s sign
Bluish-purple hue in cervix and vaginia
- Hyperemia
Enlargement of the uterus on exam
8 weeks bimanual
12 weeks above pubic symphysis
20 to 36 wks can estimate age
Fetal heart tones
10 to 12 weeks
Fetal movement
18 to 20 weeks
Estimated due date
- Naegele’s rule
1st day of LNMP + 1 yr - 3 months + 1 week
Last week abortion is legal
22 weeks
Who gets Rhogam?
Rh negative moms
- Give at 28 weeks & within 72 hrs of delivery
What vital sign will change first in significant blood loss?
HR will increase
- Then BP will drop
Red cervix produced by mucous-producing endocervical epithelium protruding through the cervical os
Ectropion
- No clinical significance
Chance of miscarriage with significant bleed in first trimester bleeding
25 to 50%
EGA
First trimester
Second trimester
Third trimester
Crown-rump length
- Change EGA and EDD if > 1 week difference from LMP
Biparietal diameter, head circumference, abdomen circumference, and femur length
- Change dates if > 2 week difference from LMP
Do not use 3rd trimester dates
Most common cause of abortion
Chromosomal abnormalities
Recurrence of abortion
87%
HEEADSSS
Home Education/Employment Eating Activites Drugs Sex Suicide Safety
Most common cause of first trimester bleeding
Spontaneous abortion
Ectopic pregnancy
idiopathic bleeding of viable pregnancy
Open cervical os with obvious bleeding
Spontaneous abortion
Acute distended abdomen
Ruptured ectopic
When can’t an US be used to evaluate an IUP
Quants
Caution about using US
Do not assume ectopic pregnancy if patient is in stable condition.
- Best to do quants
- Then serial US looking for IUP (48 to 72 hrs)
Less likely cause of 1st trimester bleeding
Gestational trophoblastic disease
- Quants will be > 100,000
Vaginal trauma or cervical pathology
- Chlamydia or gonorrhea
Initial pregnancy labs
CBC Rubella titer Hep B surface antigen Blood type RPR HIV
Where will hCG be highest?
In the serum
- Not necessary to do serum hCG
First trimester bleeding labs
CBC
Wet mount perp
Progesterone
- > 25 good;
How high does hCG need to be to see IUP with ultrasound
> 5000
How do quants present in ectopics or abortions
Lower and would not double by 48 hrs
Bleeding at
Threatened abortion
Dilated cervical os
Inevitable abortion
Some products of conception have been expelled
Incomplete abortion
Fetal demise w/o cervical dilation or uterine activity
Missed abortion
Wit intrauterine infection
Septic abortion
Produce of conception have completely passed
Complete abortion
Management of an inevitable abortion
Expectant management - 75% success; can take up to a month Surgical - Choice if bleeding is heavy Medical - 95% success - 800 mcg misoprostol - 3 to 4 days is typical, may take 2 weeks
Should Rhogam be given to an Rh- mom who went through an abortion
Yes!
