Midterm Flashcards Preview

Natural Childbirth > Midterm > Flashcards

Flashcards in Midterm Deck (77)
Loading flashcards...
1

Between what weeks gestation do we want babies born?

36-42 weeks

2

By what week does terminating a pregnancy need to done by?

week 24

3

What is a miscarriage?

Pregnancy that ends before the fetus has reached 20 weeks gestation.
After 20 weeks it is called an intrauterine fetal death, or stillbirth.

4

How might a miscarriage present clinically?

Amenorrhea
Vaginal bleeding
Pelvic pain

5

How would you Dx a miscarriage?

with Ultrasound - see an "empty sac" (no yolk sac, no embryo) or blood around the sac

6

How might an inevitable miscarriage present clinically?

Increasing uterine bleeding
Cramping
Dilated cervix

most occur early in gestation and are due to chromosomal abnormalities - "blighted ovum"

7

How would you manage an inevitable miscarriage?

Labs: ABOrh, hCG, CBC
Surgically / medically / expectantly

8

How long should you monitor hCG following miscarriage?

until it returns to zero - risk of tumor growth if retained tissue

9

What's a D&C?

Dilation and curettage - early abortion

10

What's a D&E?

Dilation and evacuation - late abortion, after 12-13 weeks

11

What inexpensive tablets are used p.o. or p.v. to induce contractions (start labor, induce abortion)?

Misoprostol

12

What are the 5 subcategories of miscarriage?

* threatened miscarriage - viable pg with bleeding
* inevitable miscarriage - non-viable pg
* complete miscarriage - all tissue passed
* incomplete miscarriage - some tissue passed
* missed abortion - fetal demise, no tissue passed

13

How long would you expect to manage an inevitable miscarriage?

Typically passed in 2 weeks
Reasonable to manage expectantly for 1 month

14

How much cervical dilation is needed to miscarry?

2-3 cm
blood with become bright, cramping will increase, then tissue will pass, and all sx should decrease

15

What is the MC cause of bleeding in pregnancy?

maternal source (but can't always be determined)
20-40% of women bleed in early pregnancy

16

How does a threatened miscarriage present?

Viable intrauterine pregnancy
Uterine bleeding - often small quantity
Often painless

17

What are the MC causes of threatened miscarriage?

** placental abruption: disruption of decidual vessels**

subchorionic hematoma (blood clot)
marginal sinus rupture

18

How would you manage a threatened miscarriage?

* bed rest
* pelvic rest
* labs: hCG, ABOrh, CBC
* consider progesterone - oral micronized 100-200mg BID through 1st trimester
* botanicals: viburnum, dioscorea, valerian, hammamelis
* supplements: vit E, vit C, citrus bioflavinoids

19

What is the most concerning risk in missed abortion?

DIC

20

What is the most concerning risk in bleeding of early pregnancy?

ectopic pregnancy

Ddx:
spontaneous abortion
placental abruption/hematoma
trophoblastic dz
vaginitis/cervicitis/trauma/cancer/warts/fibroids/etc
cervical ectropion
physiologic/implantation bleeding

21

What are the MC sx of early pregnancy?

* Amenorrhea
* N/V
* Breast enlargement & tenderness
* Urinary frequency
* Fatigue

22

How likely is a miscarriage if a woman has bleeding btw 7-11 weeks gestation?

low risk - 90-96% of pregnancies with a viable intrauterine fetus and bleeding will not miscarry

23

What is hCG?
When do we usually test for it?

Human chorionic gonadotropin

secreted by placental cell line into maternal circulation after implantation (which is 5-7 days after fertilization)

test at 9 days after implantation

24

How often should hCG double?
For how long?

every 2-3 days
for about one month (useful to 7 weeks of pregnancy)

25

What might a falling hCG indicate?
Plateau or slow rising?

falling - nonviable pregnancy, miscarriage
slow - ectopic

26

Is hCG useful to determine gestational age or EDD?

NO!!

27

What are 2 ways to test hCG?

Serum - qualitative or quantitative; most sensitive, positive around 9 days after implantation/conception

Urine - positive around missed menses; first morning void

28

Why do we draw serial hCGs?

to determine viability of pregnancy

29

How is viability of pregnancy diagnosed & when?

TVUS - typically order at 7 weeks

gestational sac - 4.5-5 weeks
yolk sac - 5 weeks
*cardiac activity - 5.5-6 weeks* - viable
fetal pole (crown to rump length) - 6 weeks

30

What is the name of the halo seen on US in early pg?

double decidual sign