Exam 3 Abn Preggo 1

Question 1

Ectopic Pregnancy is?

Predisposing factors?

Answer 1

Implantation other than in endometrial cavity

Any that impairs tube’s ability to transport gametes or embryos

Question 2

Ectopic Pregnancy presentation? (3)

Answer 2

Pelvic/abd pain, bleeding
Hemoperitoneum sxs: shoulder pain, subdiaph pain
Orthostatic sxs: dizzy, syncope, weak from blood loss

Question 3

Ectopic Pregnancy physical exam should include? (3)

Answer 3

Vitals for ortho ∆s, signs of shock
Abd tenderness
Pelvic: unilat mass, tender, cervical tender

Question 4

Ectopic Pregnancy labs? (3)

Answer 4

CBC: for anemia
Quant hCG: ↑ >53% over 48hrs in N preggo, less in ectopic
Serum progest: 20 is N, ectopic is lower

Question 5

Ectopic Pregnancy: Trans Vag US?

If “preg of unknown location”, next step?

Answer 5

Visualize IUP or ectopic
IUP = Gestational sac as double ring at 5 wks, cardiac activity @ 5-6 wks

If can’t confirm either = preg of unknown location

If unknown loc -> follow w/ serial QhCG and TVUS until confirmation

Question 6

Ectopic Pregnancy tx? (4)

Answer 6

Methotrexate for fetal reabsorb
Serial QhCGs
Laparoscopy
Salpingectomy/ostomy

Question 7

Ectopic Pregnancy: When use meds instead of surgery? (5)

Answer 7

< 3.5 cm
QhCG < 5k
Cardiac activity
Ruptured vs unrup
Reliable to f/u

Question 8

Gestational Trophoblastic Dz (GTD) is?

Unique marker?

Answer 8

Tumors from abnormal trophoblast cells ->
grow inside the uterus after conception

hCG

Question 9

Hydatidiform mole is? (5)

Answer 9

Most C GTD
35yo
Chorionic villi become mass of clear “grapes”
Partial: Fetus U present (fertilized by 2 sperm), missed abortion
Complete: fetus absent (fertilization of empty egg), theca lutein cysts

Question 10

Hydatidiform mole presentation? (6)

Answer 10

Abn bleeding
Enlarged uterus
Snow storm on US
QhCG high
Preeclampsia before 20 wks
Thyroid storm

Question 11

Hydatidiform mole tx? (3)

Answer 11

Evacuation of uterus
Monitor QhCG x 6-12 mo
Avoid preggo for 1 yr

Question 12

Choriocarcinoma is?

Answer 12

Malignant tumor from any trophoblastic tissue (mole, ectopic, normal preg)
Mets everywhere

Question 13

Choriocarcinoma presentation? (6)

Answer 13

U not sen until already mets
Irreg vag bleeding
Dyspnea/Cough/Hemoptysis
CNS
Rectal bleed
Enlarged uterus

Question 14

Choriocarcinoma dx? (2)

Answer 14

High QhCG and snowstorm on US

CT abd, pelvis, head

Question 15

Choriocarcinoma tx? (3)

Answer 15

Chemo
Methotrexate
Monitor QhCG

Question 16

Hyperemesis Gravidarum is?

Causes what?

Tx?

Answer 16

Unexplained, intractable N/V in 1st tri
Causes dehyd, ketonuria, wgt loss
U resolves by 20 wks
Antiemetics, hydration

Question 17

Rh D Alloimmunization pathophys?

Answer 17

Rh - mom w/ Rh + fetus

Mom makes IgG Ab’s against baby RBCs

Question 18

Rh D Allo presentation?

Answer 18

None in mom

Affected baby = mild anemia/↑bilirubin -> ↓tone, poor feed, apnea, seizures death

Question 19

Rh D Allo dx studies? (2)

Answer 19

Draw titers 26-28 wks
↑titers = sensitization
Doppler -> measure middle cerebral artery flow (high velocity = anemia)

Question 20

Rh D Allo tx?

Prevention?

Answer 20

Fetal transfusion

Anti-D IG at 28 wks and w/i 72hrs of delivery
Binds fetal Rh -> prevents anti-Rh Ab development