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obstetric - gynecol STEP 2 > abortion, ectopic, choriocarcinoma, mole, hyperemesis > Flashcards

abortion, ectopic, choriocarcinoma, mole, hyperemesis Flashcards

(48 cards)

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1
Q

parts of fallopian tube?? (from ovarie to uterus)

which is the MC site of ectopic pregnancy?

A
  • Fimbria - Infundibulum - Ampulla - Isthmus

- AMPULLA (70-80%)

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2
Q

ectopic pregnancy - risk factors (which is the strongest?)

A
  1. pelvic inflammatory disease
  2. intrauterine devices
  3. Previous ectopic pregnancies (strongest)
  4. smoking
  5. prior tubal surgery
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3
Q

ectopic pregnancy - presentation

A
  1. unilateral lower abdominal or pelvic pain
  2. vaginal bleeding
  3. if ruptured –> hypotensive with peritoneal irritation
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4
Q

ectopic pregnancy - diagnostic test

A
  • β-HCG: to comfirm the presence of a pregnancy
  • US: to locate the site of implantation (transvaginal)
  • Laparoscopy: invasive test + treatment to visualize the ectopic pregnancy
    (HCG and TRANSVAGINAL U/S)
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5
Q

ectopic pregnancy - treatment (generally)

A
  1. IF not ruptured: medical or surgical treatment

2. IF ruptured: surgery if stable, IV fluids, blood products, dopamine if unstable and then surgery

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6
Q

ectopic pregnancy - medical exam should begin with baseline exams such as

A
  1. CBC to monitor anemia
  2. Blood type/screen
  3. Transaminases to detect changes indicating hepatotoxicity from medications
  4. β-HCG to assess for success of treatment via decrease it
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7
Q

ectopic pregnancy - medical treatment after baseline exams

A

methotrexate
- β-HCG is followed to see if there is 15% decrease in 4-7 days
IF decreased: continue to observe for side effects, no other treatment necessary
IF not decreased: 2nd dose and evaluate again. IF drop observe for side effects without other treatment. IF not surgery

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8
Q

exclusion criteria for methotrexate

A
  1. immunodeficiency (is immunosuppressive drugs)
  2. noncompliant patient
  3. liver disease
  4. Ectopic is 3.5 cm or larger
  5. fetal heartbeat auscultated
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9
Q

ectopic pregancy - surgery

A

surgery is done to try + preserve the fallopian tube BY CUTTING A HOLE IN IT (SALPINGOSTOMY). However, REMOVAL OF THE WHOLE FALLOPIAN TUBE (SALPINGECTOMY) may be necessary

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10
Q

beside medical or surgical treatment for ectopic pregnancy - what else?

A

mothers who are Rh (-) should receive anti-D Rh immunoglobulin (RhoGAM)

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11
Q

suspected ectopic pregnancy but transvaginal is nondiagnostic - next step

A

serum HCG levels
if less than 1500: repeat it in 2 days
more: repeat it and also repeat transvaginal U/S

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12
Q

abortion - definition

A

pregnancy that ends 20 wks gestation or fetus less than 500g. Almost 80% f spontaneous abortion occur prior to 12 weeks gestation

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13
Q

etiological factor for abortion (MC?)

A
  1. chromosomal abnormalities (60-80%)
  2. anatomic abnormalities
  3. STDs
  4. immunological factors (antiphospholipid syndrome)
  5. endocrinological factors (uncontrolled hyperthyroidism or diabetes)
  6. Malnutrition
  7. Traume
  8. Rh isoimmunization
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14
Q

abortion - presentation

A
  1. cramping abd pain
  2. vaginal bleeding
  3. may be stable or unstable, depending on the amount of blood loss
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15
Q

abortion - diagnostic tests

A
  1. CBC: to evaluate blood loss / need of transfusion
  2. Blood type Rh screen: should blood need to be transfused, evaluation for anti-D Rh globulin
  3. US: to distinguish between types of abortion
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16
Q

value of US on abortion diagnosis

A

you cannot answer the “most likely diagnosis” question about abortion without US

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17
Q

spontaneous abortion - treatment

A

hemod stable: expectant or medical induction

unstable –> suction curretage if infection oR unstable

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18
Q

types of abortion

A
  1. complete 2. incomplete 3. inevitable

4. threatened 5. missed 6. septic

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19
Q

complete abortion - US findings / treatment

A

US: no products of conception found
treatment: follow up in office

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20
Q

Incomplete abortion - US findings / treatment

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A

US: some products of conception found
treatment: Dilation and curettage (D&C) / medical

21
Q

inevitable abortion - US findings / treatment

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A

US: products of conception intact, but intrauterine bleeding present and dilation of cervix
treatment: D&C/medical

22
Q

threatened abortion - US findings / treatment

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A

US: products of conception intact, intrauterine bleeding present, NO dilation of cervix
treatment: bed rest, pelvic rest

23
Q

missed abortion - US findings / treatment

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A

death of fetus, but all products of conception present in the uterus
treatment: D&C/medical

24
Q

septic abortion - US findings / treatment

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A

infection of the uterus and the surrounding areas

treatment: D&C and antibiotics (such as levofloxacin and metronidazole)

25
spetic abortion - RF
retained product of conception from 1. elective abortion with nonsterile techinge 2. missed or incomplete abortion
26
spetic abortion - clinical presentation
- fever, chills, abdominal pain sanguinopurulent vaginal discharge boggy tender uterus, dilated cervix pelvic U/S retained product of abortion, thick endometrial stripe
27
spetic abortion management
IV fluids broad spectrum antibiotics suction curettage
28
medical treatment of abortion
- can occur via giving medications that induce labor such as misoprostol (prostagladin E1 analog) --> help open the cervix + expulse the fetus - also anti-D is needed in Rh (-) mothers)
29
how to confirm the diagnosis of choriocarcinoma
elevated HCG
30
choriocarcinoma - RF / treatment
advanced maternal age prior complete hydatidiform mole treatment: chemo
31
management of hydatidiform mole management
suction currettage --> weekly β-HCG until undetectable: - increasing/plateauing --> diagnosis of gestational trophoblsastic neoplasia - decreasing --> monthly β-HCG levels for 6 months --> if detectable it is gestational troph neoplasia. If undetectable then surveillance complete and can attempt pregnancy contraception during the surveillance period (so can estimate the HCG)
32
Hydatidiform mole - presentation
1. vaginal bleeding 2. uterine enlargement more than expected 3. pelvic pressure/pain 4. hCG-mediated sequelae (a. early preeeclampsia (before 20wk), b. theca-lutein cysts) c. hyperthyroidism, d. hyperemesis gravidarum) 5. Sometimes vaginal passage of grape-like cysts
33
Hydatidiform mole - hCG-mediated sequelae
a. early preeeclampsia (before 20wk) b. theca-lutein cysts c. hyperthyroidism d. hyperemesis gravidarum
34
Hydatidiform mole - management
1. dilation and curettage and methotrexate | 2. Monitor β-hCG
35
Hydatidiform mole - types and definition of each type
1. complete mole --> no embryo or normal placental tissue | 2. partial mole --> there's an abnormal embryo and possibly some normal placental tissue
36
Hydatidiform mole - complete vs partial according to mechanism
complete --> Most commonly enucleated egg + single sperm (subsequently duplicates paternal DNA) or 2 sperm + 1 egg (enucleated) partial --> 2 sperm + 1 egg (nucleated)`
37
Hydatidiform mole - complete vs partial according to karyotype
complete --> 46, XX, 46, XY | partial --> 69 XXX, 69 XXY, 69 XYY
38
Hydatidiform mole - complete vs partial according to fetal parts
complete --> no | partial --> yes
39
Hydatidiform mole - complete vs partial according to uterine size
complete --> increased | partial --> normal
40
Hydatidiform mole - complete vs partial according to imaging
complete --> "Honeycombed uterus or clustes of grapes, snowstorm on US partial --> fetal parts
41
Hydatidiform mole - complete vs partial according to risk of malignancy (gestational trophoblastic neoplasia)
complete --> 15-20% | partial --> less than 5%
42
Hydatidiform mole - complete vs partial according to risk of choriocarcinoma
complete --> 2% | partial --> rare
43
Hydatidiform mole - classically present ... (when)
in the 2nd trimester as passage of grape like masses through the vaginal canal
44
hyperemesis gravidarum - RF
1. hydatidiform mole 2. multifetal gestation 3. history of hyperemesis gravidarum
45
Hyperemesis gravidarum - cliical features
1. severe persistent vomiting 2. loss of more than 5% of prepragnancy weight 3. dehydration 4. ortostatic hypotension
46
Hyperemesis gravidarum - labs
1. KETONURIA 2. hypochloeremic metabolic alkalosis 3. hypokalemia 4. hemoconcentration
47
hyperemesis gravidorum - treatmnet
admission antiemetics IV fluids
48
pregnant with hyperemesis and nystagmus - think ...
``` thiamine def (treat with IV thiamine followed by glucose ```

obstetric - gynecol STEP 2 (22 decks)

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