SAB, Rh - Moulton

Question 1

Painless dilation and delivery usually seen w/2nd trimester loss is what?

Answer 1

Cervical incompetence

Question 3

What anembryonic gestation or a gestational sac too large to not have embryo (> 25mm)?

Answer 3

Blighted ovum

Empty gestational sac aka no embryo

Question 4

Classic triad for ectopic pregnancy?

Answer 4

Missed menses
Vaginal bleeding
Lower abdominal pain

Question 5

What ethnicity has highest incidence of Rh D (-)?

Answer 5

Caucasians - 15%

Sickle cellers - 8%

Question 7

How long is the 2nd trimester?

Answer 7

14-27 weeks + 6 days

Question 10

What fetal MCA peak systolic velocity is predictive of mod-severe fetal anemia?

Need to do what next?

Answer 10

> 1.5

Percutaneous umbilical blood sampling
Maybe intrauterine transfusion

Question 11

What surgery method is preferred for ectopic pts who are hemodynamically unstable?

Stable pts?

Answer 11

Laparotomy

Laparoscopy

Question 12

What should every pregnant woman get at her 1st prenatal appointment?

Answer 12

ABO
Rh D
Antibody screen

Question 13

What is the most common single chromosomal abnormality of spontaneous abortion?

Most common class?

Answer 13

45 XO

Trisomy 16

Question 15

Any women presents with vaginal bleeding, what is the 1st step?

Answer 15

Pregnancy test

Question 17

What is preterm delivery?

Full term?

Answer 17

20-36 weeks + 6 days

37-42 weeks

Question 18

Rh-Ab Titers less than 1:8 indicate what?

> 1:16?

Answer 18

Fetus ok, recheck q4wk

Need doppler of MCA

Question 20

Where does ART increase ectopic pregnancy?

Answer 20

Ampulla - 93%
Cornual - 7.3%
Ovarian/abdominal - 4.6%

Question 21

80% of what ectopics will not rupture and resolve spontaneously?

Answer 21

hCG < 1000

Question 22

Fever, uterine, cervical motion tenderness, purulent discharge, hemorrhage, and rarely renal failure is what?

Tx?

Answer 22

Septic abortion

IV Abs - Ampicillin, Gentamycin

Question 23

What surgical management of ectopic results in better long-term tubal fx?

Incision is sutured closed?

Answer 23

Salpingostomy

Salpingotomy

Question 26

What hCG levels confirm ectopic pregnancy/abnormal IUP?

Answer 26

If hCG rises less than 53% in 2 days

Question 27

what is the problem in rhesus isoimmunization?

Answer 27

Rh (-) mom, Rh (+) fetus

D antigen

Question 28

How to tx ectopic pregnancy?

Answer 28

Methotrexate (folic acid antagonist) 50 mg

Check hCG levels and if decrease by 15%, follow weekly until negative. If they plateau/fall slowly give another dose

If pt symptomatic or hCG INC, do surgery

Question 33

Vaginal bleeding and a closed cervix means what?

Answer 33

Threatened abortion

25-50% result in abortion

Question 34

Absolute contraindications to methotrexate?

Answer 34

Breast feeding
Immunodeficiency
Alcoholism
Blood dyscrasia
Active pulmonary disease
PUD
Renal/hepatic dysfx

Question 35

Probable ectopic pregnancy find what on PE?

Answer 35

Abdominal or adnexal tenderness

Cervical motion tenderness

Question 36

What medical disorder most commonly causes recurrent abortions?

What else is common?

Answer 36

Antiphospholipid Ab syndrome

Advanced maternal AGE

Question 37

How long is the 3rd trimester?

Answer 37

28-42 weeks

Question 38

What dosage for RhoGAM? When?

Answer 38

Single dose 300 mci 28 weeks and w/in 72 hours after delivery or Rh (+) baby

Question 39

What is severe fetal anemia due to Rh? Management?

Answer 39

Hct < 30%, or 2 SDs below Intrauterine transfusions peformed bw 18-35 weeks using group O, Rh (-) rbc's for < 20 weeks

Question 41

Differential dx of falling hCG?

Answer 41

Blighted ovum Spontaneous resolving ectopic Abnormal pregnancy

Question 42

What test identifies fetal rbcs in maternal blood?

Answer 42

Kleinhauer-Betke test

Question 45

Acutely ruptured ectopic has what symptoms?

Answer 45

Severe abdominal pain and dizziness (secondary to intraperitoneal hemorrhage)

Question 46

Symptoms of missed abortion? Management?

Answer 46

None Check fibrinogen weekly until SAB occurs or do DandC

Question 47

What hCG level is negative for pregnancy?

Answer 47

Titer < 5 IU/L

Question 50

What may indicate an ectopic on US?

Answer 50

Thickened endometrial stripe (Arias-Stella reaction)

Question 51

What defines recurrent abortions?

Answer 51

3 in a row excluding ectopic and moles

Question 52

Vaginal bleed, cramping lower abdominal pain with dilated cervix means what?

Answer 52

Incomplete abortion

Question 55

How to treat Antiphospholipid Ab syndrome?

Answer 55

Propyylactic dose of heparin and low dose ASA

Question 60

Vaginal bleed and cervix partially dilated means what?

Answer 60

Inevitable abortion

Question 62

What infections linked to recurrent abortions?

Answer 62

Mycoplasma Chlamydia Listeria Toxo

Question 65

How long is the 1st trimester?

Answer 65

13 weeks, 6 days

Question 67

Abortion is classified as what?

Answer 67

< 20 weeks or < 500 gms

Question 69

When can the gestational sac been seen on US?

Answer 69

1500-2000 hCG