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Flashcards in 2: Early complications Deck (22)
1

most common site of ectopic pregnancy

ampulla of fallopian tube

2

hCG levels in ectopic pregnancies

low for gestational age, does not increase at expected rate (doubling every 48 hrs); due to poorly implanted placenta with less blood supply than in the endometrium

3

fetal heartbeat should be seen at what hCG levels

>5000 mIU/mL

4

heterotopic pregnancy

multiple gestation with at least one IUP and at least one ectopic pregnancy

5

unstable ectopic management

IVF, blood products, vasopressors
exploratory laparotomy

6

stable ectopic management

exploratory laparoscopy

7

salpingostomy vs salpingectomy

former, ectopic removed, tube in place; the latter entire ectopic pregnancy is removed

8

uncomplicated, nonthreatening ectopic management;

MTX, 50mg/m2 IM
for all: follow AST/ALT, Cr, hCG
hCG should rise then fall

9

complete abortion

complete expulsion of all POC before 20 wks gestation

10

Incomplete abortion

partial expulsion of some but not all POC before 20 weeks’ gestation

11

Inevitable abortion

no expulsion of products, but vaginal bleeding and dilation of the cervix such that a viable pregnancy is unlikely

12

Threatened abortion

any vaginal bleeding before 20 weeks, without dilation of the cervix or expulsion of any POC (i.e., a normal pregnancy with bleeding).

13

Missed abortion

death of the embryo or fetus before 20 weeks with complete retention of all POC.

14

ddx for first trimester bleeding

SAB
postcoital bleeding
ectopic pregnancy
vaginal or cervical lesions/lacerations
extrusion of molar preg
nonpreg causes of bleeding

15

surgical management of a first-trimester abortion

D&C
if unstable, prostaglandins (e.g., misoprostol) with or without mifepristone to induce cervical dilatation, uterine contractions, and expulsion of the pregnancy

16

difference between D&C and D&E

D&E for 2nd trimester Between 16 and 24 weeks, either a D&E may be performed or labor may be induced with high doses of oxytocin or prostaglandins

17

incompetent cervix

painless dilation and effacement of the cervix, often in the second trimester of pregnancy
-infection, vaginal discharge, and rupture of the membranes are common findings

18

management of incompetent cervix

expectant management (+betamethasone and tocolysis), elective termination, emergent cerclage (may place in subsequent pregnancies at 12-14 wks)

19

cerclage

a suture placed vaginally around the cervix either at the cervical–vaginal junction (McDonald cerclage) or at the internal os (Shirodkar cerclage).
-to close the cervix. Complications: ROM, PTL, and infection

20

15% of pts with recurrent preg losses have ? condition

antiphospholipid antibody (APA) syndrome
others: luteal phase defect, lack of adequate progesterone levels
-may tx with ASA

21

dx of recurrent pregnancy loss (3+)

-karyotype of both parents and POC-->complete genome hybridization (CGH)
-examine anatomy with hysterosalpingogram (HSG)
-screen for DM, hypothyroidism, SLE, APA syndrome, hyper coagulability: lupus anticoagulant, factor V Leiden deficiency, prothrombin G20210A mutation, ANA, anticardiolipin antibody, Russell viper venom, antithrombin III, protein S, and protein C
-level of serum progesterone during luteal phase, possibly endometrial biopsy
-cx of cervix, vagina, endometrium

22

Most second-trimester abortions are secondary to ??

uterine or cervical abnormalities, trauma, systemic disease, or infection.