Lecture 14- 1st trimester loss Flashcards Preview

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Flashcards in Lecture 14- 1st trimester loss Deck (46):
1

When do the majority of spontaneous abortions occur?

<12 weeks GA

2

Termination of a pregnancy before ____ weeks is considered what trimester loss.

20; First

3

What are the three most common abnormal uteri?

Septate
Asherman's syndrome
Bicornalte uterus

4

What are key things you want to know with a suspected miscarriage?

If the cervix is closed vs/ open
Presence of POC, discharge, blood
Uterine size

5

With a threatened AB what will they present like.

Bleeding
closed cervix
uterine size consistent with GA

6

What will an inevitable AB look like?

Cervix dilated
ROM
bleeding and UCs
expel POC (products of conception)

7

What will a missed AB present like.

POC reatained
Uterus < GA
Dark brown discharge
No pain & IUP symptoms cease

8

What is considered a recurrent loss?

loss on > 2 consecutive pregnancies

9

What are reasons for 2nd trimester loss?

Cervical insufficiency (painless effacement and dilation)

10

What do you do for cervical insufficiency?

Cervical cerclage

11

how do you induce labor surgically?

Vacuum aspiration

12

What are some complications with surgically induced labor?

uterine perf, cervical laceration

13

What is cervical priming?

use seaweed like plant to prime the cervix.

14

After induction what do you want to monitor?

temp, pain , bleeding
hemorrhage, incomplete evacuation, infection

15

Under how many days since LMP can you do a medical induced labor?

<49 days

16

Where do the majority of ectopic pregnancies occur?

Fallopian tube

17

What does an ectopic pregnancy look like on US?

cyst w/ wide echogenic vascular outer ring

18

What is the "classic" signs and symptoms of ectopic?

amenorrhea followed by bleeding and abdominal pain on affected side

19

What are the ominous signs of ectopic pregnancy?

Shoulder pain worsened w/ inspiration
syncope, vertigo

20

You must r/o ectopic w/out confirmation of what in utero?

chorionic villi

21

About what level with serum beta quant. level stay at with ectopic pregnancy?

600-800

22

Can serum progesterone distinguish IUP from ectopic?

No

23

Serum progesterone level < what is negative for pregnancy.

5

24

Serum progesterone level greater than what is consistent with pregnancy.

20

25

What is procedure that removes an ectopic pregnancy?

laparoscopic linear salpingostomy

26

What is where the chorionic villi continue to grow and become swollen.

hydatidiform mole (aka molar pregnancy)

27

Is molar pregnancy benign?

Usually

28

What is the name for non-malignant, non-metastatic gestational trophoblastic neoplasia.

Hydatidiform mole

29

What is the karyotype with complete hydatidiform mole?

Complete - 45XX or 45XY

30

What is the karyotype with a partial molar pregnancy?

Triploid (Partial - 69XXX or 69XXY)

31

In a molar pregnancy what is abnormal with the uterine size?

Uterine size >GA

32

WHat is the treatment for a molar pregnancy?

Hospitalization
D&C
contraception for 1 year
Watch for uterine atony or pulmonary embolism
Monitor B-hCG for rise/decline/plateau to r/o persistant GTN

33

for a localized persistent GTN what do they do?

Single agent chemotherapy

34

What is a malignant transformation of GTN?

Choriocarcinoma

35

What are reasons for 1st trimester recurrent loss?

parent karyotypes, Asherman's syndrome, antiphospholipid antibodies

36

What is post-abortal syndrome?

bleeding, dilated cervix, cramping, large, boggy uterus with hematometra

Mimics incomplete abortion

37

What should you do for septic abortion?

IV fluid, IV antibiotics, evacuate uterus

38

What are 3 outcomes of ectopic pregnancy without interventions?

Tubal abortion (POC expelled out of fimbriated end)
Tubal rupture (intra-abdominal hemorrhage)
Spontaneous resolution

39

What are risk factors for ectopic pregnancy?

tubal scarring 2ndary PID/salpingitis
Prior ectopic or tubal surgery
History of infertility

40

What are PE of ectopic pregnancy post rupture?

Marked pelvis and abdominal tenderness, CMT, pelvic fullness or mass

41

What are contraindications for Medical treatment (Methotrexate) for ectopic pregnancy?

Absolute: breastfeeding, liver disease, alcoholism, blood dyscrasias, active pulmonary disease, PUD, immunodeficiency, methotrexate sensitivity
Relative: >3.5cm, cardiac motion/fetus

42

What is the ideal candidate for methotrexate for ectopic pregnancy treatment?

<5000mlU/L and no fetal heart activity

43

What are neoplasms from spectrum of abnormal placental proliferation?

gestational trophoblastic neoplasia

44

What is the PE for a hydatidiform mole?

Uterine size> GA, absent FHT, vaginal bleeding, HTN

45

What will a complete hydatidiform mole look like on US?

no embryo/fetus, no amniotic fluid, thick and cystic placenta filled uterus; snowstorm appearance

46

What will a partial hydatidiform mole look like on US?

growth-restricted fetus, low amniotic fluid, thick cystic placenta