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Emergency Medicine > Vaginal bleeding in Pregnancy > Flashcards

Vaginal bleeding in Pregnancy Flashcards

1
Q

Abortion: termination at

A

20 wks; 500 g

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2
Q

Bloody vaginal discharge/bleeding + closed cervical os

A

Threatened abortion

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3
Q

Partial/complete placental separation & dilation of cervical os

A

Incomplete abortion

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4
Q

Complete expulsion of entire pregnancy

A

Complete abortion

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5
Q

Dead products retained in uterus with closed cervical os

A

Missed abortion

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6
Q

Preterm premature rupture of membranes (PPROM) at a previable gestational age

A

Inevitable abortion

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7
Q

Mgt of threatened abortion

A

Bed rest, paracetamol for suprapubic discomfort, mild cramps, pelvic pressure, or persistent low backache

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8
Q

TVS finding in threatened abortion

A

gestational sac ± subchorionic hemorrhage

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9
Q

B-Hcg levels in threatened abortion

A

1500-2000 by 4.5 weeks

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10
Q

TVS finding in complete abortion

A

minimally thickened endometrium without gestational sac

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11
Q

Mgt of missed abortion

A

dilatation & curettage

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12
Q

Mgt of incomplete abortion

A

completion curettage, misoprostol, expectant

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13
Q

Most frequent site of ectopic pregnancy

A

Ampulla (70%)

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14
Q

Common UTZ findings in ectopic pregnancy (early)

A

Hematosalpinx

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15
Q

Classic triad of ectopic pregnancy

A

Missed menses, pain, vaginal bleeding/ spotting

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16
Q

PE findings in tubal rupture

A

cervical motion tenderness; boggy mass beside uterus

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17
Q

Symptoms in hemoperitoneum

A

Diaphragmatic irritation (neck/ shoulder pain), esp on inspiration

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18
Q

Entire sloughed endometrium taking form of endometrial cavity passed from tubal pregnancy

A

Decidual cast

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19
Q

Serum B-hCG discriminatory level (DL)

A

> 1500 mIU/mL

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20
Q

Above DL but (-) IUP

A

ectopic pregnancy vs complete abortion

21
Q

Below DL

A

Declining pattern: failing IUP (serially checked 48h later)

22
Q

TVS endometrial finding b/w 4.5-5 wks AOG

A

Gestational sac

23
Q

TVS endometrial finding b/w 5-6 wks AOG

24
Q

TVS endometrial finding b/w 5.5-6 wks AOG

A

Fetal pole with cardiac activity

25
Q

Endometrial pattern in ectopic pregnancy

A

Trilaminal patter with anechoic fluid collections

26
Q

Medical mgt for ectopic pregnancy

A

Methotrexate (single dose: 50 mg/m2 BSA; multi: 1 mg/kg at days 1,3,5,7) and leucovorin (multidose: 0.1 mg/kg days 2,4,6,8)

27
Q

CI to methotrexate use

A 
Tubal rupture
Breast feeding
IUP
PUD
Active pulmonary dse
Immunodeficiency
Hepatic, renal or hematologic dysfx
28
Q

Preferred surgical mgt for ectopic pregnancy

A

Laparoscopy

29
Q

Sx mgt to remove small unruptured ectopic pregnancy

A

SalpingoStomy

30
Q

Sx mgt that inimizes recurrence of ectopic pregnancy

A

Tubal resection

31
Q

Group of tumors typified by abnormal trophoblast proliferation

A

Gestational trophoblastic disease (GTD)

32
Q

GTD with villi

A

Hydatidiform mole

33
Q

Is a complete Hmole benign or malignant?

34
Q

Is an invasive Hmole benign or malignant?

35
Q

Nonmolar trophoblastic malignant neoplasms lack villi. Name 3.

A

Choriocarcinoma
Placental site trophoblastic tumor
Epithelioid trophoblastic tumor

36
Q

A mass of clear vesicles with abN chorionic villi

A

Complete Hmole

37
Q

Mass with focal and less advanced hydatidiform changes; may contain some fetal tissue

A

Partial molar pregnancy

38
Q

TVS finding in complete mole

A

Snowstorm appearance (numerous anechoic cystic spaces

39
Q

Ddx in b-hCG increased above AOG

A

Hmole; ectopic pregnancy

40
Q

Mgt of Hmole

A

Termination by suction curretage

41
Q

Hallmark sx of placenta previa

A

Painless sentinel bleeding (begins w/o warning/ pain/ contractions)

42
Q

Clinical examination for placenta previa suspects should be done using the ___ technique

A

Double set-up

43
Q

Most accurate method of assessment of placenta previa

44
Q

Mgt for placental abruption

A

Emergency CS

45
Q

S/Sx of placental abruption

A

Sudden abdominal pain, vaginal bleeding and uterine tenderness

46
Q

Bleeding starts at the ___ in abruptio placenta

A

decidua basalis

47
Q

Evidence seen in placenta for abruption

A

Circumcised depression on the maternal surface

48
Q

DX of placenta accreta

A

TVS with doppler color flow (myometrial invasion)

49
Q

3 classifications of morbidly adherent placenta (accrete syndromes)

A
  1. Placenta accrete: attached to myometrium
  2. Placenta increta: invade myometrium
  3. Placenta percreta invade serosa

Emergency Medicine (7 decks)

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