10. Pregnancy-Related Complications Flashcards Preview

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Flashcards in 10. Pregnancy-Related Complications Deck (17)
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1
Q

Describe history: Approach to the Patient with Bleeding in T1/T2 (8)

A
  • risk factors for ectopic pregnancy
  • previous spontaneous abortion
  • recent trauma
  • characteristics of the bleeding (including any tissue passed)
  • characteristics of the pain (cramping pain suggests spontaneous abortion)
  • history of coagulopathy
  • gynecological/obstetric history
  • fatigue, dizziness, syncopal episodes due to hypovolemia, fever (may be associated with septic abortion)
2
Q

Describe physical: Approach to the Patient with Bleeding in T1/T2 (5)

A
  • vitals (including orthostatic changes)
  • abdomen (symphysis fundal height, tenderness, presence of contractions)
  • perineum (signs of trauma, genital lesions)
  • speculum exam (cervical os open or closed, presence of active bleeding/clots/tissue)
  • pelvic exam (uterine size, adnexal mass, uterine/adnexal tenderness, cervical motion tenderness)
3
Q

Describe investigations: Approach to the Patient with Bleeding in T1/T2 (4)

A
  • β-hCG (may be lower than expected for GA in spontaneous abortion, can be used to diagnose viable pregnancy vs. ectopic pregnancy vs. abortion)
  • U/S (confirm intrauterine pregnancy and fetal viability)
  • CBC
  • group and screen
4
Q

Describe treatment: Approach to the Patient with Bleeding in T1/T2 (2)

A
  • IV resuscitation for hemorrhagic shock
  • treat the underlying cause
5
Q

Define: First trimester bleeding (1)

A

vaginal bleeding within the first 12 wk

6
Q

Define: Second trimester bleeding (1)

A

12-20 wk

7
Q

Name DDX of: First and second trimester bleeding (6)

A
  • Physiologic bleeding: spotting, due to implantation of placenta – reassure and check serial β-hCGs
  • Abortion (threatened, inevitable, incomplete, complete)
  • Abnormal pregnancy (ectopic, molar)
  • Trauma (post-coital or after pelvic exam)
  • Genital lesion (e.g. cervical polyp, neoplasms)
  • Subchorionic hematoma
8
Q

Every woman of childbearing age presenting to ER with abdominal or pelvic pain should have ___ measured

A

β-hCG

9
Q

Name: Classification of Spontaneous Abortions (7)

A
  • Threatened
  • Inevitable
  • Incomplete
  • Complete
  • Missed
  • Recurrent
  • Septic
10
Q

Describe: Threatened

  • History
  • Clinical
  • Management (± Rhogam®)
A
  • History: Vaginal bleeding ± cramping
  • Clinical: Cervix closed and soft
  • Management (± Rhogam®): Watch and wait <5% go on to abort
11
Q

Describe: Inevitable

  • History
  • Clinical
  • Management (± Rhogam®)
A
  • History: Increasing bleeding and cramps ± rupture of membranes
  • Clinical: Cervix closed until products start to expel, then external os opens
  • Management (± Rhogam®):
    • a) Watch and wait
    • b) Mifepristone 200 mg PO followed by Misoprostol 800 μg PV 24 h later
    • c) D&C
12
Q

Describe: Incomplete

  • History
  • Clinical
  • Management (± Rhogam®)
A
  • History: Extremely heavy bleeding and cramps ± passage of tissue noticed
  • Clinical: Cervix open
  • Management (± Rhogam®):
    • a) Watch and wait
    • b) Mifepristone 200 mg PO followed by Misoprostol 800 μg PV 24 h later
    • c) D&C
13
Q

Describe: Complete

  • History
  • Clinical
  • Management (± Rhogam®)
A
  • History: Bleeding and complete passage of sac and placenta
  • Clinical: Cervix closed, bleeding stopped
  • Management (± Rhogam®): No D&C – expectant management
14
Q

Describe: Missed

  • History
  • Clinical
  • Management (± Rhogam®)
A
  • History: No bleeding (fetal death in utero)
  • Clinical: Cervix closed
  • Management (± Rhogam®):
    • a) Watch and wait
    • b) Mifepristone 200 mg PO followed by Misoprostol 800 μg PV 24 h later
    • c) D&C
15
Q

Describe: Recurrent

  • History
  • Clinical
  • Management (± Rhogam®)
A
  • History: ≥3 consecutive spontaneous abortions
  • Clinical: -
  • Management (± Rhogam®): Evaluate mechanical, genetic, environmental, and other risk factors
16
Q

Describe: Septic

  • History
  • Clinical
  • Management (± Rhogam®)
A
  • History: Contents of uterus infected – infrequent
  • Clinical: -
  • Management (± Rhogam®): IV broad spectrum antibiotics and prompt uterine evacuation
17
Q

Embryonic demise can be diagnosed how? (3)

A

ultrasound based on

  • an intrauterine gestational sac
  • embryonic crown-rump length ≥7 mm
  • and no cardiac activity