Early Pregnancy, Ectopic, RH - Moulton Flashcards
(29 cards)
Define the 3 trimesters by weeks
1 = 1 - 13.6 2 = 14 - 27.6 3 = 28 - 42
Abortion = before week \_\_\_ Preterm = before week \_\_\_ Post-term = after week \_\_\_
20
37
42
***How does hCG rise in pregnancy?
Doubles every 2 days, peaks at 10 weeks at 100,000
***At what point will a gestational sac be visible on ultrasound?
What is this called?
hCG = 1500-2000
Discriminatory level
At what point is a spontaneous abortion unlikely?
8 weeks, appropriate size, cardiac activity seen
Most common cause of spontaneous abortions
Most common one?
Most common CLASS?
Chromosome abnormalities
Turner (45 XO)
Trisomies (16 esp.)
“Types” of abortion…
- Vaginal bleeding, closed cervix
- Vaginal bleeding, cervix partially dilated
- Vaginal bleeding, cramping lower abdominal pain w/ dilated cervix
Threatened
Inevitable
Incomplete
“Types” of abortion…
- Passage of all products w/ closed cervix, resolution of all symptoms
- Fetus has expired, still in uterus,
Complete
Missed
“Types” of abortion…
- Fever, cervical tenderness, purulent discharge, retained POC
- Gestational sac, no embryo
Septic (endometritis)
Blighted ovum
Treatment of cervical incompetence
Cervical cerclage
Testing for APA syndrome (3)
Treatment?
- Lupus anticoagulant
- Anticardiolipin Ab
- Anti-B2-glycoprotein 1 Abs
Prophylactic heparin and aspirin
Most common cause of maternal death in 1st trimester
Ectopic pregnancy
Ectopic pregnancy - classic triad
- Missed menstrual cycle
- Bleeding later
- Lower abdominal pain
Ultrasound finding = thickened endometrial stripe (Arias-Stella reaction)
Ectopic pregnancy
Ultrasound finding = fluid in cul de sac…what is it?
BLOOD - ruptured ectopic pregnancy
Treatment of ectopic pregnancy
How to know if it’s working?
Methotrexate
hCG drops by 15% from day 4 to day 7
5 types of surgery for ectopic pregnancy
- Laparotomy (if unstable)
- Laparoscopy (if stable)
- Salpingectomy (remove tube)
- Salpingostomy (leave open)
- Salpingotomy (close incision)
Describe RH sensitization in pregnancy
Treatment?
Rh- mom, Rh+ baby, anti-Rh IgG’s cross placenta and cause hemolysis in baby
Prophylactic RhoGAM
What is required for RH sensitization to occur? How?
- 1 mL of fetal blood to get into the mother
- ANY cause of trauma, placental issue, etc.
If genetic testing of parents shows that the baby has a risk of developing RH hemolysis from mom, do what?
Amniocentesis - fetal antigen testing, bilirubin levels (looking for signs of hemolysis)
Signs of fetal hydrops on ultrasound (4)
- Ascites
- Pleural effusion
- Pericardial effusion
- Skin or scalp edema
TODAY, how to best determine if fetal RH hemolysis is occurring in baby? Explain.
Fetal MCA peak systolic velocity
- If getting anemic from hemolysis, will pump faster to compensate, will be detected by doppler of MCA
Treating baby with fetal hydrops
Transfusion of O- blood (umbilical vein or other)
Nonstress testing
Monitor fetal heart rate accelerations and decelerations to fully assess the fetal sleep-wake cycle
