Abortion/Ectopic Pregnancy - Hill Flashcards Preview

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Flashcards in Abortion/Ectopic Pregnancy - Hill Deck (23):
1

Where are most ectopic pregnancies located?

Ampulla of the fallopian tube

2

What is the most dangerous ectopic location?

Interstitial/Cornual

3

Which ectopic location bleeds the most?

cervical

4

What are risk factors for an ectopic pregnancy?

1) PID
2) hx of tubal surgery
3) prior ectopic
4) ART
5) smoking
6) hx of abdominal/pelvic surgery

5

What lab diagnosis is found in an ectopic pregnancy?

1) Normal serum hCG
2) progesterone (< 5) - not often used

6

At what hCG level should you be able to see an IUP (intra uterine pregnancy)?

1,500 - 2,000

7

What is seen on imaging in a normal IUP?

1) gestational sac (double echogenic rings)
2) yolk sac
3) fetal pole
4) cardiac activity (5.5-6 weeks hCG > 5,000)

8

What rules out an ectopic pregnancy?

identifiable IUP

9

Who is a candidate for medical treatment of an ectopic pregnancy?

1) hCG < 5,000
2) mass < 3.5 cm
3) no FHR

10

What are the absolute contraindications for medical treatment for an ectopic?

1) breastfeeding
2) immunodeficient
3) liver or renal dysfunction
4) blood dyscrasias
5) allergy to MTX
6) active pulmonary disease
7) PUD

11

What are the relative contraindications for medical treatment of an ectopic?

1) gestational sac > 3.5 cm
2) cardiac activity

12

What drug is used to medically treat an ectopic pregnancy and how does it work?

1) Methotrexate
a) folic acid antagonist - inhibits DNA syn,
irreversibly binds DHFR
b) renally cleared

13

What are the side effets of methotrexate?

N/V, stomatitis, diarrhea, gastritis

14

How is methotrexate administered to someone to treat an ectopic pregnancy?

1) IM injection on day 1
2) check hCG on day 4 and day 7
3) should see 15% decrease by day 7
- if not redose
4) weekly hCG check until < 15

15

What are the types of spontaneous abortions?

1) threatened
2) inevitable
3) incomplete
4) missed
5) septic

16

What is a threatened abortion?

1) closed os
2) vaginal spotting/bleeding

17

What is an inevitable abortion?

1) cervical dilation
2) gross ROM
3) bleeding

18

What is an incomplete abortion?

1) os open
2) POC not all expelled

19

What is a missed abortion?

1) demised fetus - no HB on US
2) POC retained
3) closed os

20

What is a septic abortion?

infection with fetal demise

21

What causes most spontaneous abortions?

chromosomal abnormalities

22

How do you manage an incomplete/inevitable or missed abortion?

1) surgical
2) medical
a) misoprostol
b) methergine
3) expectant

23

What is the most common medical treatment for a missed abortion?

1) Mifepristone + misoprostol
a) 95-99% success rate
b) vaginal administration
c) can be used up to 63 days GA