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