Flashcards in Threatened Abortion Deck (8)
vaginal spotting during the first half of pregnancy
HCG threshold – Definition? Normal value? If level exceeds threshold, but not visible on ultrasound – Suggests?
Level of hCG such that an intrauterine pregnancy should be visible on ultrasound
1500 to 2000
Patient under threshold with vaginal spotting and hCG under threshold – options and interpretation?
1. Repeat hCG in 48 hours to establish viability of pregnancy
2. Single progesterone level – levels greater than 25 indicate normal intrauterine gestation (levels less than 5 indicate nonviable gestation – either Ectopic pregnancy or spontaneous abortion)
Patient with uterine bleeding and single progesterone assay less than 5 – next step?
Other indication for same management?
Uterine curettage – chorionic
Villi suggests miscarriage versus no villi suggests ectopic pregnancy
If repeat hCG shows abnormal rise
Women with asymptomatic, ectopic pregnancy <3.5 cm – treat with?
Treatment for nonviable intrauterine pregnancy?
Misoprostol or D&C
Patient with vaginal spotting and hCG level over threshold – Next steps?
1. If transvaginal ultrasound shows intrauterine gestational sack – diagnose threatened abortion and have close follow-up
2. If no evidence of intrauterine pregnancy, laparoscopy to diagnose/treat ectopic pregnancy
When to consider laparoscopy or laparotomy without measuring serum hCG or doing ultrasound?
1. Hypertension or volume depletion
2. Severe abdominal/pelvic pain
3. Adnexal mass