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NCB > Week 3 > Flashcards

Week 3 Flashcards

1
Q

Is bleeding in early pregnancy common?

A

YES, occurs in 20-40% of pregnant women, source is almost always maternal

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2
Q

Name 7 DDXs of bleeding in early pregnancy

A
  1. spontaneous abortion/miscarriage
  2. ectopic pregnancy
  3. placental bleeding/abruption/hematoma
  4. trophoblastic dz
  5. vaginitis, cervicitis, trauma, CA, warts, polyps, fibroids
  6. cervical ectropion
  7. physiologic or implantation bleeding
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3
Q

When a pregnant pt presents to your office with bleeding what questions do you need to ask? What do you need to review?

A

how much blood loss?
cramping or pain?
any tissue present?
review medical hx especially for previous gynecological/obstetrical issues that would increase risk for ectopic pregnancy (LNMP, hx of PID, prior ectopics, adnexal surgery)

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4
Q

on a PE of pregnant women with bleeding what do you need to do?

A

vitals
abd exam
pelvic exam
auscultate fetal heart tones (after 10-12 wks gestation)

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5
Q

what is quantitative hCG helpful for?

A

helpful in interpreting U/S findings

serial hCG’s can be helpful in the first 6 weeks of pregnancy

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6
Q

hCG should be doing in a normal intrauterine pregnancy?

A

doubling every 48-72 hours

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7
Q

what is a falling hCG indicative of? a plateaued or slowly rising hCG

A

falling hCG–> nonviable pregnancy

plateaued/slow–> ectopic

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8
Q

what 3 blood tests must you do on a newly pregnant mom?

A

quantitative hCG
ABO-rh
CBC w/diff

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9
Q

what can imaging NOT tell you about bleeding in early pregnancy?

A

whether it is vaginal or cervical bleeding

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10
Q

definition of spontaneous abortion

A

pregnancy that ends before fetus has reached 20 weeks

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11
Q

5 subcategories of abortions

A
  1. threatened miscarriage
  2. inevitable miscarriage
  3. complete miscarriage
  4. incomplete miscarriage
  5. missed abortion= confirmed non-viable pregnancy but no sxs yet
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12
Q

7 main risk factors for a spontaneous abortion?

A
  1. advancing maternal age
  2. previous spontaneous abortion
  3. smoking >10 cigs/day
  4. cocaine
  5. NSAIDs, excluding acetominophen
  6. low or high maternal BMI
  7. celiac dz
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13
Q

5 inconclusive risk factors for abortion

A
  1. EtOH
  2. gravidity
  3. fever of >100 deg F
  4. caffeine
  5. low folate (MTHFR and MTRR genes)
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14
Q

50% of all miscarriages are from what type of ‘change?’ The other causes of an abortion are what?

A

chromosomal abnormalities, many are aneuploidies

can also be dt congenital anomalies or trauma or host factors

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15
Q

clinical presentation of a spontaneous abortion?

A

hx of amennorhea, vaginal bleeding or pelvic pain

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16
Q

definition of an inevitable miscarriage, when does it most likely occur and why?

A

increasing uterine bleeding and cramping in the presence of a dilated cervix
most often in early pregnancy and usu dt chromosomal abnormalities (empty sac)

17
Q

what is included in the management of an inevitable miscarriage?

A

ABO-rh and CBC

can be treated surgically (D&C), medically (misoprostol orally or vaginally) or expectantly

18
Q

what are the dosages for a missed abortion vs an incomplete abortion?

A

missed abortion: 800 mcg vaginally or 600 mcg sublingually

incomplete abortion: 600 mcg orally

19
Q

who is a good candidate for an expectant abortion? majority occur when? risks?

A

hemodynamically stable
majority occur in women at less then 13 weeks w/no sxs of infxn
risks: unplanned D and C if infxn occurs
can happen w/in 2 weeks of dx but can last up to 4 wks

20
Q

definition of a threatened miscarriage? quality of bleeding? amount? color?

A

viable intrauterine pregnancy in the presence of uterine bleeding, bleeding often painless, may be pink, brown or bright red, could be large or small amount

21
Q

what is the etiology of a threatened miscarriage?

A

disruption of decidual vessels, will see as a

subchorionic hematoma but usu can’t see b/c bleeding at edge of placenta

22
Q

what must you always ask if a pt presents w/a threatened miscarriage? labs and imaging? give them what? suggest what?

A

intercourse in the past 24 hrs
ABO-rh, CBC and U/S
progestins or progesterone
bed rest and pelvic rest

23
Q

what 4 herbs can help to stop a threatened miscarriage? what vitamins?

A

viburnum prunus, dioscorea villosa, valerian officianalis, hammamelis
vitamin E, C and citrus bioflavinoids

24
Q

definition of a complete miscarriage? when is it likely to occur before? what will imaging show?

A

all products of conception have been passed
likely to occur before 12 wks gestation
U/S shows empty uterus

25
Q

what herbs can help with an incomplete miscarriage? what homeopathics?

A

caulophylum thalictroides
cimicifuga racemosa
hammamelis virginiana

sabina
viburnum op
ferrum
cimicifuga

26
Q

definition of an incomplete miscarriage? when is is more likely to happen? ssxs? imaging will show? tx?

A

miscarriage has occurred but there are still products of conception in the uterus
can happen at any gestation age but more likely >12 wks
variable bleeding, cramping common
U/S confirms retained tissue
medical or surgical tx recommended

27
Q

definition of a missed abortion? ssxs? imaging shows? at risk of what if prolonged? tx?

A

in-utero death of fetus, retained products of conception
all ssxs of PG disappear
at risk of infxn
D and C if can’t wait for inevitable, inevitable or medication

28
Q

definition of an ectopic pregnancy? sites it can occur?

A

developing blastocyst becomes implanted at site other than endometrium
common sites: fallopian tube (MC), ovar, abd/pelvic region, cervix

29
Q

risks of an ectopic pregnancy? where does it rank as far as causes of pregnancy related maternal deaths? what %age of all pregnancy related deaths?

A

risk is rupture of ectopic= hemorrhage, maternal shock and potentially death
leading cause of pregnancy related maternal death in 1st trimester
4-10% of all pregnancy related deaths
untreated, they are often fatal

30
Q

when do sxs of an ectopic pregnancy usu present? rupture? sxs of an ectopic?

A

6-8 wks after LNMP, but can be later, majority of rupture occur 6-12 wks gestation
normal pregnancy sxs, abd pain, amenorrhea, vaginal bleeding

31
Q

PE of a woman with an ectopic PG will reveal what?

A

low grade fever, adnexal, CM and/or abd tenderness, adnexal mass, PE may be unremarkable

32
Q

limits of an U/S with a suspected ectopic pregnancy?

A

difficult to dx intra vs extrauterine pregnancy when [hCG]

33
Q

tx of an ectopic? who is a good candidate for the rx? indications for 2nd line tx?

A

methotrexate-folic acid antagonist or surgical
for methotrexate-folic acid antagonist tx need to be hemodynamically stable, will f/u, hCG less than 500
2ndary tx if: Hemodynamic instability, Impending or ongoing rupture of ectopic mass, Failed medical therapy, Women with contraindications to medical treatment

34
Q

definition of gestational trophoblastic dz? hydatidiform moles are usu benign or malignant? lab? ssxs?

A

proliferative d/o of trophoblastic cells
hydatidiform moles are usu benign
elevated serum hCG
ssxs: vaginal bleeding, enlarged uterus, pelvic pain/pressure/theca lutein cysts, anemia, hyperemesis gravidarum

35
Q

definition of a complete mole and partial mole

A

complete mole: fertilization of an empty ovum by 2 sperm, no fetus
partial mole: fertilization of a haploid ovum by 2 sperm, may result in fetus w/trophoblastic tissue

36
Q

what 3 types of trophoblastic cells are malignant? when do they generally occur?

A

invasive moles, choriocarcinoma and placental site trophoblastic tumors
generally occur after a molar pregnancy but can also occur after SAB, TAB, ectopic or normal pregnancy

37
Q

management of trophoblastic dz? possible complications?

A

refer to OB/GYN
D&C usu performed
serial hCGs afterwards until reaches zero
localized or metastatic dz can occur

38
Q

3 other causes of early bleeding in pregnancy?

A

growths: vaginitis, trauma, CA, warts, polyps, fibroids
ectropion
physiologic or implantation bleeding

39
Q

bleeding in the 2nd & 3rd trimester DDX (7)

A
  1. miscarriage, stillbirth
  2. cervical, vaginal or uterine pathology
  3. cervical insufficiency
  4. placenta previa
  5. placental abruption
  6. vasa previa
  7. uterine rupture

NCB (9 decks)

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