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