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Flashcards in Threatened Abortion Deck (8)
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Threatened abortion?

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

Ectopic pregnancy


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


Expected side effects of treatment with methotrexate for ectopic pregnancy?

Symptoms that would cause concern? Management?

Mild abdominal pain without hypotension

hypotension or signs of rupture – laparotomy