Keppler - 6

Question 1

2 types of bleeding during pregnancy

Answer 1

pregnancy related

non-pregnancy related

Question 2

pregnancy-related causes of first trimester bleeding

Answer 2

ectopic

spontaneous abortion

subchorionic bleeding

Question 3

when should you be able to see viable fetus in uterus

Answer 3

6-7 weeks

Question 4

what is the discriminatory zone

Answer 4

level of hcg that you expect to see viable fetus → 2000-3000

Question 5

how do you localize/find location of fetus

Answer 5

US

Question 6

next step if you don’t see fetus on US

Answer 6

order hcg → is it w.in discriminatory zone?

Question 7

suspect __ on any pregnant pt. that comes in w. pain and bleeding in the first trimester

Answer 7

ectopic pregnancy

Question 8

tx for ectopic pregnancy

Answer 8

methotrexate → inhibits folate

Question 9

contraindication for methotrexate

Answer 9

hemodynamic instability

Question 10

evaluation of spontaneous abortion

Answer 10

US findings

hcg for change/discriminatory zone

Question 11

diagnostic criteria for spontaneous abortion

Answer 11

empty gestational sac 2.5 cm or unchanged

HCG above discriminatory zone w.o viable fetal pole

previous viable fetus w. no cardiac activity

fetal pole > 7 weeks by CRL w.o cardiac activity

Question 12

management of spontaneous abortion (3)

Answer 12

expectant

medical (misoprostol)

surgical (d&c)

Question 13

obstetric causes of second/third trimester bleeding

Answer 13

labor

abruption

placenta/vasa previa

Question 14

2 major causes of 2nd/3rd trimester bleeding to know

Answer 14

placental abruption

placenta previa

Question 15

rf for placental abruption

Answer 15

HTN

nicotine/tobacco, amphetamines, caffeine

trauma

rupture of membranes

prior hx

Question 16

dx for for placental abruption

Answer 16

clinical → painful bleeding in 2nd/third trimester

Question 17

management of placental abruption

Answer 17

acute blood loss protocol (type and screen)

fetal monitoring

+/- steroids

consider timing and mode of delivery

Question 18

major rf to know for placenta previa

Answer 18

prior uterine surgery

Question 19

painless vaginal bleeding in 3rd trimester is highly suggestive of

Answer 19

placenta previa

Question 20

major differentiating sx between placental abruption and placenta previa

Answer 20

abruption: painful bleeding
previa: painless bleeding

Question 21

exam to avoid for placenta previa

Answer 21

digital exam

Question 22

t/f: speculum exam is ok in placenta previa

Answer 22

T!

just not digital

Question 23

management of placenta previa

Answer 23

acute blood loss protocol (type and screen)

+/- steroids

inpt vs outpt (3 strikes rule)

consider timing of delivery

Question 24

2 common causes of early pregnancy bleeding

Answer 24

ectopic pregnancy

spontaneous abortion

Question 25

miscarriage management (3)

Answer 25

expectantly

medically

surgically

Question 26

ectopic pregnancy management (2)

Answer 26

medical

surgical

Question 27

2 major causes of 2nd/3rd trimester bleeding

Answer 27

placental abruption → painful

placenta previa → painless

Question 28

2 major rf for postpartum bleeding

Answer 28

happened before

atony

Question 29

what is atony

Answer 29

loss of tone of uterus

Question 30

mc cause of postpartum hemorrhage

Answer 30

atony!

Question 31

big warning sign for postpartum hemorrhage

Answer 31

bleeding gets heavier a week after delivery

Question 32

initial management of PPH

Answer 32

uterotonics