Early Pregnancy, Ectopic, RH - Moulton Flashcards Preview

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Flashcards in Early Pregnancy, Ectopic, RH - Moulton Deck (29):
1

Define the 3 trimesters by weeks

1 = 1 - 13.6
2 = 14 - 27.6
3 = 28 - 42

2

Abortion = before week ___
Preterm = before week ___
Post-term = after week ___

20
37
42

3

***How does hCG rise in pregnancy?

Doubles every 2 days, peaks at 10 weeks at 100,000

4

***At what point will a gestational sac be visible on ultrasound?

What is this called?

hCG = 1500-2000

Discriminatory level

5

At what point is a spontaneous abortion unlikely?

8 weeks, appropriate size, cardiac activity seen

6

Most common cause of spontaneous abortions

Most common one?
Most common CLASS?

Chromosome abnormalities

Turner (45 XO)

Trisomies (16 esp.)

7

"Types" of abortion...
- Vaginal bleeding, closed cervix
- Vaginal bleeding, cervix partially dilated
- Vaginal bleeding, cramping lower abdominal pain w/ dilated cervix

Threatened

Inevitable

Incomplete

8

"Types" of abortion...
- Passage of all products w/ closed cervix, resolution of all symptoms
- Fetus has expired, still in uterus,

Complete

Missed

9

"Types" of abortion...
- Fever, cervical tenderness, purulent discharge, retained POC
- Gestational sac, no embryo

Septic (endometritis)

Blighted ovum

10

Treatment of cervical incompetence

Cervical cerclage

11

Testing for APA syndrome (3)

Treatment?

- Lupus anticoagulant
- Anticardiolipin Ab
- Anti-B2-glycoprotein 1 Abs

Prophylactic heparin and aspirin

12

Most common cause of maternal death in 1st trimester

Ectopic pregnancy

13

Ectopic pregnancy - classic triad

- Missed menstrual cycle
- Bleeding later
- Lower abdominal pain

14

Ultrasound finding = thickened endometrial stripe (Arias-Stella reaction)

Ectopic pregnancy

15

Ultrasound finding = fluid in cul de sac...what is it?

BLOOD - ruptured ectopic pregnancy

16

Treatment of ectopic pregnancy

How to know if it's working?

Methotrexate

hCG drops by 15% from day 4 to day 7

17

5 types of surgery for ectopic pregnancy

- Laparotomy (if unstable)
- Laparoscopy (if stable)
- Salpingectomy (remove tube)
- Salpingostomy (leave open)
- Salpingotomy (close incision)

18

Describe RH sensitization in pregnancy


Treatment?

Rh- mom, Rh+ baby, anti-Rh IgG's cross placenta and cause hemolysis in baby

Prophylactic RhoGAM

19

What is required for RH sensitization to occur? How?

0.1 mL of fetal blood to get into the mother
- ANY cause of trauma, placental issue, etc.

20

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)

21

Signs of fetal hydrops on ultrasound (4)

- Ascites
- Pleural effusion
- Pericardial effusion
- Skin or scalp edema

22

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

23

Treating baby with fetal hydrops

Transfusion of O- blood (umbilical vein or other)

24

Nonstress testing

Monitor fetal heart rate accelerations and decelerations to fully assess the fetal sleep-wake cycle

25

Girl comes in with minimal vaginal bleeding and cramping sensation. Pregnant, blood in uterus, cervix is closed. AB negative. Dx?

Plan? (3)

Threatened abortion

- SAB precautions
- Follow up in 1 week
- RhoGAM (bleeding + pregnancy + Rh-)

26

Woman w/ previous abortions, mild cramping. Positive pregnancy test. hCG 1000. Ultrasound shows nothing. Potential Dx? (2)

Plan? Why?

Normal IUP or SAB

Repeat testing in 2 days -- hCG will be in discriminatory zone

27

Contraindications of methotrexate for ectopic pregnancy (10)

- Breastfeeding
- Immunodeficiency
- Alcoholism or liver disease
- Blood disease
- Sensitivity to MTX
- Active pulmonary disease
- Peptic ulcer disease
- Large gestational sac
- Embryonic cardiac activity

28

MTX - MoA

Folic acid antagonist -- inhibit DNA synthesis and cell replication

29

If giving MTX and hCG is falling normally, do what?

If NOT falling normally, do what?

If symptomatic or bHCG starts rising?

Follow weekly until negative

Give another dose

Surgery