Abortions, Ectopic Pregancy And Rh

Question 1

What is the date range for first trimester, second trimester, and third trimester?

Answer 1

First day of last menstrual period to 13 weeks
14-27
28-42

Question 2

Week ranges of abortion, preterm delivery, full term, and post dates? How do we estimate date of confinement?

Answer 2

Less than 20 weeks
20-36
37-42
Greater than 40
40 weeks after FDLMP

Question 3

What hCG level confirms abnormal IUP or ectopic pregnancy?

Answer 3

Rise in hCG less than 53% in 48 hours

Question 4

When is hCG first detected in serum, when does it hit its peak, and how much does it rise every 2 days?

Answer 4

6-8 days after ovulation
10 weeks
Doubles

Question 5

What is the most common cause of first trimester SABs? What is the most common one? What is the most common class?

Answer 5

Chromosomal abnormalities
45XO is the most common one
Trisomy class is most common with Trisomy 16 being most common

Question 6

2 things define the type of an abortion?

Answer 6

Products of conception have passed

Cervix being dilated or not.

Question 7

What is going on with the cervix during threatened abortion?

Answer 7

Closed with vaginal bleeding

Question 8

What is going on with the cervix during inevitable abortion?

Answer 8

Cervix is partially dilated with vaginal bleeding

Question 9

What is going on with the cervix during incomplete abortion, what contents have passed, and how do we treat?

Answer 9

Dilated cervix with bleeding and cramping/pain
Some but not all contents
Suction D and C

Question 10

What is going on with the cervix during complete abortion and what contents are passed?

Answer 10

Cervix is closed

Everything is passed, baby and placenta

Question 11

What is going on with a missed abortion and how do you treat it?

Answer 11

Fetus has died, but remains in the uterus

Wait for abortion or go in and do suction d and c

Question 12

What is going on with septic abortion and how do we treat it?

Answer 12

Retained infected products of conception

IV antibiotics and proceed with D and C

Question 13

What is a blighted or anembryonic gestation and how is it treated?

Answer 13

Fertilized egg develops a placenta, but not into an embryo. Empty gestational sac.
Misoprostol, if have to D and C, but not first choice.

Question 14

What is a more successful primary therapy to remove products of conception than what other two choices?

Answer 14

D and C

Medical management of expectant management

Question 15

How do we define recurrent abortions?

Answer 15

Three successive SABs

Question 16

What are 4 general maternal factors associated with recurrent abortions?

Answer 16

Infection, smoking and alcohol use, lots of medical conditions, and increasing maternal age.

Question 17

What are two local maternal factors associated with recurrent abortions?

Answer 17

Uterine abnormalities, like congenital anomalies due to DES or fibroids, or cervical incompetence.

Question 18

How do we treat cervical inompetence?

Answer 18

Cervical cerclage

Question 19

What is the fetal factor associated with recurrent abortions even though it is more a one time deal?

Answer 19

Chromosomal abnormalities

Turner syndrome ad trisomy 16

Question 20

What specific thing are we looking for when we do Karyotyping to check for possible risk of abortions?

Answer 20

Balances reciprocal or robertsonian translocation

Question 21

What is the most common immunologic disorder that is associated with recurrent abortions, what are the two antibodies we are looking for, and how do we treat it?

Answer 21

Antiphospholipid syndrome
Lupus anticoagulant and anti beta 2 glycoprotein 1
Give heparin and low dose aspirin

Question 22

Classic triad of patient presenting with ectopic pregnancy?

Answer 22

Lady presenting with bleeding, lower quadrant pain and missed period

Question 23

What 3 things are we thinking with a potential ectopic pregnancy lady presenting? Out of the 3 which one is most common?

Answer 23

Possible ectopic, probable ectopic, acutely ruptured ectopic.
Possible is most common

Question 24

How is probably ectopic pregnancy presentation different than possible? 3 ways?

Answer 24

Symptoms are worse
Abdominal, Adnexal, and cervical tenderness
May see ectopic on US with probable, but rarely with possible.

Question 25

2 symptoms of acutely ruptured ectopic pregnancy? 2 things to see on physical exam? What does US show?

Answer 25

Severe pain and dizziness Distended/tender abdomen and the patient has signs of hemodynamic instability Empty uterus

Question 26

What level of hCG is considered inappropriately rising, what is falling hCG indicative of, and what is the discriminatory zone value and what does it mean?

Answer 26

Less than a 53% rise Blighted ovum, resolving ectopic or abnormal pregnancy 1500-2000 and we should be able to see an intrauterine sac

Question 27

What can a transvaginal ultrasound reveal?

Answer 27

IUP and extrauterine pregnancy

Question 28

If we don’t see anything when we do TVUS, what do we need to do?

Answer 28

Follow hCG levels and do another one when the hCG is in the discriminatory zone.

Question 29

How do we treat an ectopic pregnancy with medicine? And how do we proceed once we give the medicine?

Answer 29

Give MTX, which is a folic acid antagonist. Check hCG levels on day 4 and 7. If down 15%, continue to watch as it drops. If it is dropping slowly or staying the same, give another dose If it is rising, surgery.

Question 30

What is sort of the magic cutoff for ectopic pregnancies to resolve spontaneously? What do we do with expectant management of an ectopic pregnancy?

Answer 30

80% of ectopic with hCG levels less than 1000. | Follow those hCG levels.