WH- lecture 3

Question 1

Ectopic

Answer 1

usually Ampullary portion of Fallopian tube

Question 2

Most common sx of Ectopic

Answer 2

1st trimester bleeding
abd pain

breasts tender
orthostatic dizzy/faint
back pain
shoulder pain

Question 3

Ecotpic preg sx

Answer 3

Rebound and guarding with Abdominal pain

Question 4

Normal prog level of pregnancy

Answer 4

> 20

Question 5

Prog level reflecting abnormal pregnancy

Answer 5

<5

Question 6

Discriminatory zone

Answer 6

Above a certain hCG, the landmarks of a normal pregnancy should be visible on US

3,500

Question 7

Transvag US at 5 wks, should see

Answer 7

Double ring

Question 8

Transvag US at 5.5-6 wks, should see

Answer 8

Fetal pole w cardiac activity

Question 9

Tx for Ectopic

Answer 9

Expectant: follow hCG
Meds: MTX
Surgery: SalpinECTOMY vs OSTOMY

Question 10

How often hCG measured for expectant mgmt of ectopic

Answer 10

every 48-72 hours

Question 11

if beta hcg is <200

Answer 11

most pts with experience Resolution of preg

Question 12

MTX

Answer 12

Folate antagonist

affects ACTIVELY REPLICATING TISSUE

Question 13

SE of MTX

Answer 13

Abdominal pain

Question 14

How long does MTX take to work

Answer 14

2-4 weeks, maybe up to 8 weeks

if not decreased by 15% on day 4-7, may need more MTX or Surgery instead

Question 15

Salpingostomy

Answer 15

leaving the fallopian tube in tact

just removing the ectopic

RISK for future ectopic

Question 16

SalpingECTOMY

Answer 16

removing the ectopic preg AND the fallopian tube

Question 17

Hydadiform mole

Answer 17

the MOST COMMON form of gestational trophoblastic dz

Question 18

Complete hydadi Mole

Answer 18

Paternally derived
NO Fetus

sx:
vaginal bleeding
enlarged uterus

dx:
HIGH beta hCG
“Snow storm”

definitive:
need tissue pathology

Question 19

Tx for Complete hydadi Mole

Answer 19

REMOVE uterine tissue
immediately w suction dilation and curettage

birth control

Question 20

Partial mole

Answer 20

mom and dad derived
Presence of a fetus

sx:
delayed period

Dx:
“swiss cheese”

Question 21

Partial mole tx

Answer 21

Immediate removal with suction dilation and currettage

if normal preg also present: may continue to term

Question 22

Invasive Mole

Answer 22

Following evacuation of molar pregnancy

persistent uterine bleeeding with plateau or rise in hCG after tx

Question 23

US shows Intrauterine mass and increased vascularity

Answer 23

Invasive Molar Pregnancy

Question 24

Tx for Invasive Molar Pregnancy

Answer 24

Single agent

MTX or Actinomycin-D

Question 25

Choriocarcinoma

Answer 25

malignant necrotizing tumor wks to years after pregnancy Tx: single agent MTX or multi agent EMACO

Question 26

Placental site trophoblastic tumor

Answer 26

arises from placental Tx: Hysterectomy

Question 27

1st line tx for Hyperemesis

Answer 27

Vit B6 and Doxylamine

Question 28

RH incompatible

Answer 28

Mom is negative | Baby is +

Question 29

Goal of RH tx

Answer 29

Keep mom from becoming sensitized

Question 30

RhoGAM | anti-D immunoglobulin

Answer 30

0.3 mg of Rhogam will eradicate 15 mL of fetal RBCs

Question 31

Titer 1:16 or greater is at risk for

Answer 31

Fetal hydrops

Question 32

If greater than 1:16

Answer 32

may need Amniocentesis to determine fetal blood type

Question 33

If fetal blood type +

Answer 33

Screen for fetal anemia

Question 34

How do you screen for fetal anemia?

Answer 34

Middle Cerebral Artery dopplers MCA doblers

Question 35

If fetal anemia suspected

Answer 35

proceed w Percutaneous Umbilical Blood Sampling PUBS

Question 36

Leading cause of mom morbidity and death in developed nations

Answer 36

HTN

Question 37

Chronic HTN

Answer 37

dx before 20 wks gestation

Question 38

Gestational HTN

Answer 38

after 20 wks gestation (didnt have it before) >140/90 Severe: >160/110

Question 39

Pre-ecamplsia

Answer 39

HTN after 20 wks and PROTEINURIA or if not proteinuria ``` thrombocytopenia renal insuff impaired LFT pulm edema HA ```

Question 40

Pre-eclampsia pathophys

Answer 40

Failure to establish adequate uteroplacental blood flow

Question 41

Dx of Pre-ecamp

Answer 41

TWO readings of >140/90 more than four hrs apart

Question 42

dx of Pre-examp

Answer 42

Persistent BP >160/110 requiring tx with IV

Question 43

Pre-ecamp with NO severe features tx

Answer 43

Delivery at 37 wks

Question 44

Pre-ecamp with severe features tx

Answer 44

Deliver at 34 weeks ``` In the meantime: IV Labetolol, hydralazine, PO Nifedipine Mg sulfate Steroids ```

Question 45

HELLP syndrome

Answer 45

Hemolysis Liver enzymes Low platelets " a severe form of Pre-ecamp"

Question 46

Tx of HELLP

Answer 46

all the same things + PLATELET TRANSFUSION

Question 47

IU growth restriction

Answer 47

below the 10th percentile in second half of preg

Question 48

Estimated fetal weight determined by

Answer 48

Biparital diameter head circum abdominal femur

Question 49

Screening for IUGR

Answer 49

Fundal height at every prenatal visit after 16 wks

Question 50

When to deliver IUGR with no complications

Answer 50

38-39 weeks

Question 51

When to deliver IUGR with abnormal uterine doppler

Answer 51

32-37 weeks

Question 52

When to deliver IUGR with other conditions

Answer 52

34-37

Question 53

When to screen for DM

Answer 53

24-28 weeks with 1 hr test

Question 54

If measure is >140, proceed to 3 hours test

Answer 54

if >200, diagnosed

Question 55

3 hour test

Answer 55

must be fasting for 8 hrs

Question 56

1 hour postprandial <140

Answer 56

2 hours post prandial goals <120

Question 57

1st line tx for Dm

Answer 57

Insulin