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Flashcards in Early Pregnancy Complications Deck (51)
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1

incidence of ectopic pregnancy

1 in 100

2

why has the incidence of ectopic pregnancy increased over the past 10 years?

increase in assisted fertility, STDs and PID

3

RFs for ectopic pg'y

hx of STs or PID
Previous ectopic pg'y
previous tubal surgery
prior pelvic or ab'l surgery (adhesions)
endometriosis
current use of exogenous hrms
IVF/assisted repro
DES-exposed pts w/congenital abnormalities
congenital abnormalities of fallopian tubes
use of an IUD

4

presenting sx's of ectopic pg'y

unilateral pelvic or lower ab'l pain
vag bleeding
may be hypotensive or w/peritoneal signs

5

lab findings of ectopic pg'y

b-hCG levels low for GA, does not increase at expected rate (doesn't double q48h)

6

how is ectopic pg'y definitively dx'd?

urine pg'y test is +
u/s shows extrauterine pg'y. If too early to show on u/s, then follow serial b-hCGs and see that it does not double q48h

7

at what b-hCG level should you be able to see an intrauterine pg'y

1500-2000

8

tx of ruptured ectopic pg'y

stabilize first w/IVF, blood, pressors PRN
ex lap after stabilization to remove pg'y
If they were stable to begin w/, then do ex laparoscopy

9

tx of unruptured ectopic pg'y

monitor for signs of rupture
MTX
ex laparoscopy

10

what kind of f/u is required if MTX is used to tx unruptured ectopic pg'y?

obtain baseline AST and ALT and Cr, then give IM MTX, then serially follow b-hCG levels. Will at first rise, then will drop by 10-15% by 4-7d. If not, give second MTX dose.

11

what is a SAB? Incidence?

pg'y that ends before 20 weeks. 15-25% of all pg'ies end in SAB.

12

abortus =

the fetus lost before 20 weeks, or weighing < 500g, or < 25cm long

13

complete abortion =

complete expulsion of all POC before 20 weeks

14

incomplete abortion =

partial expulsion of POC

15

inevitable abortion =

no expulsion of products, but bleeding & dilation of cervix, making a viable pg'y unlikely

16

threatened abortion =

any intrauterine bleeding before 20 weeks, w/o cervical dilatation or expulsion of POC

17

missed abortion =

death of fetus/embryo but with no expulsion of POC. Usually proceed to complete abortions in 1-3 weeks.

18

Most first-trimester SABs are due to what?

chromosomal abnormalities

19

DDx of first-tri bleeding:

SAB
postcoital bleeding
ectopic pg'y
vaginal or cervical lesions or lacerations
extrusion of molar pg'y
nonpg'y bleeding

20

sx's of first trimester abortion:

bleeding
cramping
ab'l pain
decreased sx's of pg'y

21

how do you w/u a pt presenting w/vaginal bleeding & cramping in 1st tri?

Hx of sx's
Physical - pelvic exam, vitals to r/o infection & shock
labs - b-hCG, CBC, blood type & screen
u/s to assess fetal viability & placentation

22

tx of 1st-tri complete abortion

1) stabilize if hypotensive
2) follow for recurrent bleeding and signs of infection
3) send any expelled tissue to pathology

23

tx of 1st-tri incomplete abortions

1) stabilize
2) either do expectant mgt or D&C or admin of misoprostol
3) send tissue to pathology

24

mgt of inevitable abortion & missed abortion

1) stabilize if hypotensive
2) either do expectant mgt, or D&C
3) send tissue to pathology

25

mgt of threatened abortion

1) monitor for bleeding
2) bedrest, nothing per vagina
3) give RhoGam if Rh-

26

what are pts w/threatened abortion at increased risk for?

PTL
PPROM

27

most common causes of 2nd-tri abortions

maternal systemic dis, infection, fetotoxic agents, trauma, uterine or cervical abnormalities. Chromosomes not a common cause.

28

tx of 2nd-tri abortion

1) r/o ectopic pg'y, stabilize
2) follow for recurrent bleeding, signs of infection,
3) expectant mgt, or D&E or labor induction if retained POC

29

D&C vs. D&E

D&C = done during 1st tri
D&E = done during 2nd tri

30

D&E vs. labor induction

D&E is faster, but aggressive dilation w/laminaria is necessary. Increased risk of uterine perforation & cervical laceration. Labor induction takes longer, uses high doses of oxytocin & PG's. Lower risk of trauma 2/2 instrumentation.