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Flashcards in Early pregnancy complications Deck (29)
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1
Q

Risk of ectopic following 1 episode? 2?

A

10% with one prior, 25% after more

2
Q

How to diagnose intrauterine vs. ectopic pregnancy?

A

IUP b-HCG doubles every 48 hours.

3
Q

At what b-HCG level do you see an IUP on transvaginal U/S?

A

1500 to 2000 mIU/mL

4
Q

At what b-HCG level do you see fetal heartbeat on transvaginal U/S?

A

> 5000 mIU/mL

5
Q

What to do for an UNSTABLE patient with ruptured ectopic

A

1) Stabilize with IV fluids, blood products, vasopressor meds if needed
2) Ex-lap to stop bleeding

6
Q

If patient with ruptured ectopic is stable then you…

A

…proceed with ex-lap right away then

1) evacuate the hemoperitoneum
2) coagulate ongoing bleeding
3) Resect the ectopic pregnancy

7
Q

Salpingostomy vs. salpingectomy?

A

For removing ectopic.

  • OSTOMY is when you LEAVE TUBE IN PLACE
  • ECTOMY is removal of tube
8
Q

How do you treat enraptured ectopic? Parameters for that?

A

Methotrexate!
-Small ectopic < 5000
-No fetal heartbeat
(Can still use it outside these parameter but with higher failure rates)

9
Q

How is the mtx administered?

A

Single dose - 50mg/m2 of INTRAMUSCULAR mtx
Monitor b-HCG which should fall by 10-15% in the first week of rx. If not, give a second dose.

Should also record baseline transaminases and creatinine

10
Q

Not-so-obvious risk factors for ectopic pregnancy?

A

-Current use of exogenous hormones like progesterone or estrogen

  • DES or congenital abnormalities
  • Smoking
  • IVF or assisted reproduction
11
Q

Spontaneous abortion? Rates?

A

Before 20 wks

15-25% of all pregs

60-80% of these are associated with CHROMOSOME ABNORMALITIES

12
Q

Differential dx of first trimester bleeding

A
  • Spontaneous abortion
  • Ectopic pregnancy
  • Extrusion of molar pregnancy
  • Postcoital bleeding
  • Vaginal or cervical lacerations (eg STDs)
  • Nonpregnancy causes
13
Q

What do you do when someone comes in with bleeding likely due to first trimester abortion?

A
  • Pelvic exam to look for source
  • Lab tests: quantitative b-HCG, CBC, blood type, antibody screen
  • U/s to look at baby, placenta
14
Q

Options with incomplete abortion?

A
  • Expectant management
  • Surgery: D&C (this is the only option if the patient is hemodynamically unstable)
  • Medical: Prostaglandins +/- Mifepristone
15
Q

Threatened abortion treatment?

A

Pelvic rest with nothing per vagina. Bleeding often resolves.
Note that pt is at inc risk of PRETERM LABOR & PPROM.
Give the Rh-negative moms RhoGAM (in any bleeding situation)

16
Q

What are the most common etiologies of 2nd trimester abortions?

A

Infection
Maternal uterine or cervical anatomic defects
Exposure to fetotoxic agents
Trauma

NOT CHROMOSOMAL ABNORMALITIES USUALLY

17
Q

What can you do about fetal loss occurring between 16-24 wks?

A
  • D&E (use laminaria to aggressively dilate the cervix; placed the day before and dilate by absorbing water)
  • Induction of labor with high doses of prostaglandins or oxytocin
18
Q

Preterm labor vs. incompetent cervix?

A

PTL starts with contractions leading to cervical change. Rx: TOCOLYSIS.

Incompetent cervix is PAINLESS DILATION and EFFACEMENT. Rx: Cerclage.

19
Q

Risk factors for cervical incompetence

A
  • Cervical trauma like D&C, LEEP, or cervical conization
  • Hx of cervical lacerations with vaginal delivery
  • Uterine anomalies
  • Hx of DES exposure
20
Q

Timing of cerclage placement?

A

Around 12 to 15 weeks placed, taken out at 36 to 38 wks

Transabdominal cerclage is an option if the vaginal ones have failed. It’s at internal os. C/s needed.

21
Q

Risk of SAB following 1? 2? 3?

A

20-25%; 25-30%; 30-35%

22
Q

Weird reasons for recurrent pregnancy loss? (that are actually the 2 most common diagnosed ones)

A
  • Antiphospholipid syndrome

- Luteal phase defect

23
Q

5 things to look for with recurrent pregnancy loss?

A

1) Karyotypes of mom, dad, POC (via CGH)
2) Maternal anatomy inspection (via HSG)
3) Screening tests for hypothyroidism, DM, APA syndrome, hypercoagulability, and SLE (Lupus anticoagulant, Factor V leiden deficiency, prothrombin G202…mutn, ANA, anticardiolipin antibody, Russel viper venom, antithrombin III, protein S, protein C
4) Serum progesterone level in luteal phase (also an EMB to look for proliferative endometrium in luteal phase).
5) Cultures of cervix, vagina, endometrium (to r/o infection

NO ETIOLOGY FOUND IN 30-50%

24
Q

Rx of luteal phase defect

A

Progesterone

25
Q

Rx of APA syndrome

A

low-dose aspirin

26
Q

Rx of thrombophilia

A

SQ heparin (either LMW or unfractionated)

27
Q

Presentation that makes you want to r/o ectopic right away?

A

Vaginal bleeding & abdominal pain

28
Q

Incompetent cervix can lead to…

A

Preterm labor, infection, or ROM

29
Q

Recurrent pregnancy loss is…

A

3 OR MORE CONSECUTIVE SABs

2/3 of subsequent pregnancies will be totally normal without therapy. Yay.