Bleeding in early pregnancy Flashcards
(44 cards)
Criteria of US to diagnose Missed Abortion
1st trimester:
- No cardiac activity + CRL >7mm
- No yolk sac or embryo + GSD >25mm
2nd:
- No cardiac activity
TTT of missed abortion
- Expectant management: for spontaneous expulsion.
- Medical Evacuation: (1st) Misoprostol (2nd) +- oxytocin
- Surgical: (1st) D&C (2nd) Hysterectomy
- Don’t forget: antibiotics, Anti D for RH-ve.
TTT of inevitable or incomplete abortion
1\ stabilization of pt’s general condition.
2\ Termination of pregnancy:
- Suction curettage (1st) if the patient’s condition is not fair
- Medical if it’s fair: misoprostol (1st), +- oxytocin (2nd)
- Surgical: D&C (1st), hysterectomy (2nd)
Complications of septic abortion (*)
1\ Local:
Salpingo Oophiritis, Peritonitis, Parametritis,Thrombophlebitis
2\ Systemic:
Bacteremia, Septicemia, Septic Shock, Multi Organ Failure.
3\Remote:
Asherman’s Syndrome, Amonneroha, Tubal adhesion, Ectopic pregnancy
ttt of Septic abortion
IV broad spectrum AB should be given with stabilization (Ampicillin, Gentamicin, Metronidazole)
after patient being afebrile for 48hrs
oral AB for 10-14days
Invest. for recurrent pregnancy Loss (*)
- Karytyping
- uterine asses.
3D US, Sonohysterography
hysteroscopy, Laparoscopy, MRI, thyriod funtion tests - screening for APL $, DM, thrombophilia
Manag. of Cervical insufficiency
2 or more Abortion OR PTL + ccc
Cerclage at 12-14 weeks + Hydroxyprogesterone at 16 weeks
1 abortion OR PTL + ccc
TVS measurement of cervical Length :
(<25 mm ) Cerclage + Hydroxyprogesterone
(>= 25 mm) Hydroxyprogesterone and no Cerclage
No abortion OR PTL
TVS measurement of cervical Length :
< 20 mm - - - Hydroxyprogesterone
>= 20 mm - - - - Routine Antenatal care
Q8) SITES OF TUBAL ECTOPIC PREGNANCY
- The Ampulla “ 80%”
- The isthmus
- The fimbriae
- The interstitial part
09) SITES OF ECTOPIC PREGNANCY
- Tubal
- Ovarian
- Cervical
- Cesarean scar
- Abdominal
010) CAUSES OF ECTOPIC PREGNANCY
- Previous tubal ectopic
- Salpingitis “ PID or Tubal obstruction “
- Tubal Surgery “ Ligation “
- Peritubal adhesions “ PID + Endometriosis OR Appendectomy”
- Congenital Anomalies
- iatrogenic “ ART, IVF “
- Infertility “ Use IUCD OR OCP “
Q11) PATHOLOGICAL TYPES OF ECTOPIC
Undisrupted Tubal Pregnancy
Disrupted Tubal Pregnancy
Q12) INVESTIGATIONS OF TUBAL ECTOPIC PREGNANCY:
B-HCG + US
Laproscopy “ Rare “
CBC, LFT, KFT , Coagulation profile” normal complementary
Q13) ADVANTAGES AND DISADVANTAGES OF SETTING DZ AT 3500 IU/L (N = 2000 IU/L ) “TAKE CARE “
Minimize the risk of interfering with a viable IUP
- Increase the risk of delaying diagnosis and so complications can occur
Q14) MENTION US FINDING IN ECTOPIC
- No intrauterine gestational sac
- Adnexal mass :
- Homogeneous mass in tube
- Tubal gestational sac
- Yolk Sac OR Embryo
- Positive fetal cardiac activity
Q15) HOW TO TREAT ECTOPIC PREGNANCY
- Medical “ Methotrexate “
- Dose: 50 mg / m? body surface area
- 0 1 4 7
- Day 0: make B- HCG + TVS
- Day 1 : Give single Dose of MTX
- Day 4: B HCG continue to rise
- Day 7 : if decrease, >= 15% —- FU by B- HCG measure
‹15 : Give 2nd dose “ Max three doses”
If Failed —– Surgical
Q16) WHEN TO TREAT MEDICALLY
- B- HCG <=5000
- Ectopic mass <3 to 4 cm
- Absent Fetal cardiac activity
- Hemodynamically Stable
- No MTX Hypersensitivity
- No Hepatic, Renal, Lung … Diseases
- Pt comply with FU
**Absent one of these criteria OR Failed medical Therapy —- Surgical
017) PROCEDURE OF SURGERIES AND INDICATIONS OF EACH TYPE
Salpingectomy “ removal of fallopian tube “
* Healthy contralateral tube * Ipsilateral tube is ruptured or severely damaged
- Salpingostomy “ Removal of the tubal gestation but leaving reminder of tube “
* Pathology in contralateral tube * Ipsilateral tube not severely damaged
018) TYPES OF SURGICAL APPROACH AND ITS INDICATIONS
Laproscopy: Laparotomy:
- Short time - Hemodynamic instability or Acute bleeding
- Short hospital stay - Lack of instruments
- Less bleeding - Lack of well trained medical staff
- L e s s Cost - Presence of contraindication for laparoscopy
Don’t forget to stabilize patient firstly in disrupted type and give Anti D
Q19) PATHOLOGICAL TYPES OF VESICULAR MOLE :
- Complete Mole
“ Empty Ovum + Single sperm duplicate
or Two sperms - 46 XX OR 46 XY “
- No Fetal Tissue - Partial M o l e
“ Active nucleus ovum + 2 sperms - 69 XXX, XXY, XYY”
- Fetal Tissue P r e
Complications of vesicular mole (*)
Gestational HTN
hyperemesis gravidgrum
hyperthyroidism,
Severe bleeding up to shock
infection, DIC - ARDS- recurrence
Investigations of vascular mole
Us - best- snow Storm appearance
B- HCG → > 100 000 Iu/ L
Abdomenal US, X-ray & CT for metastasis
Other routine CBC
Treatment of vesicular Mole
- Stabilize the patient
- suction evacuation ( best)
- hysterectomy en Toto (for some )
- follow up with b-hcg
- patient shouldn’t convieve till follow up complet & 1 year later
- use barrier method until b-hcg is normal → combined OCPs,
- never use IUCD
- anti D
- Theca Lutein will regress spontaneously
- Laparotomy only if cyst complicated
INDICATIONS OF HYSTERECTOMY IN TOTO IN VESICULAR MOLE
- Old multiparous Pt
- Multiparous with severe hemorrhage and infections
- Invasive mole
