Vaginal Bleeding and UCG

Question 1

Who get’s screened for chlamydia

Answer 1

Sexually active or pregnant women 24 and younger
High risk women 25+ (Regardless of pregnancy)
No good evidence of men to get screened

Question 2

Risk factors fo chlamydia

Answer 2

Past infection (any STD counts)
Multiple sex partners
Poor condom use
Sex for things

Question 3

Folic acid recommendations

• Normal
• Diabetic or epileptic
• Hx of child with NT defect

Answer 3

400 to 800 mcg
1 mg
4 mg

Question 4

Carrier screening (ethinic)

Answer 4

Sickle cell
Thalassemia
Tay-sachs

Question 5

Carrier screening (family hx)

Answer 5

Cystic fibrosis
Nonsyndromic hearing loss
- Connexin-26

Question 6

Infectinous disease screening

Answer 6

HIV
Syphilis
Hep B (vaccine)
Rubella & Varicella (Vaccines)
Toxo (cat litter, dirt, and raw meat)
CMV
Parvo B19

Question 7

Environmental toxins

Answer 7

Paint thinners, strippers, solvents, and pesticides
Smoking cessation
EtOH and Drug use

Question 8

Medical assessment
Diabetes
HTN
Epilepsy
DVT
Deprssion/Anxiety

Answer 8

Optimize control, Folic acid, and DC ACEI
DC ACEI, ARBS, and Thiazides
Optimize control & Folic acid
Switch to heparin 
Avoid benzos

Question 9

Lifestyle

Answer 9

Avoid hot tubes
Good weight management
Domestic violence
Nutritional deficiencies 
Avoid Vitamin A overuse (750 to 3000 mcg)
Vitamin D
Limit caffine to two cups perday

Question 10

Amenorrhea
Fatigue
Nausea
Vomiting
Breast changes (Tenderness)

Answer 10

Suprise!!!!

You’re pregnant

Question 11

Goodell’s sign

Answer 11

Soft cervix

Question 12

Hergar sign

Answer 12

Soft uterus

Question 13

Chadwick’s sign

Answer 13

Bluish-purple hue in cervix and vaginia

- Hyperemia

Question 14

Enlargement of the uterus on exam

Answer 14

8 weeks bimanual
12 weeks above pubic symphysis
20 to 36 wks can estimate age

Question 15

Fetal heart tones

Answer 15

10 to 12 weeks

Question 16

Fetal movement

Answer 16

18 to 20 weeks

Question 17

Estimated due date

- Naegele’s rule

Answer 17

1st day of LNMP + 1 yr - 3 months + 1 week

Question 18

Last week abortion is legal

Answer 18

22 weeks

Question 19

Who gets Rhogam?

Answer 19

Rh negative moms

- Give at 28 weeks & within 72 hrs of delivery

Question 20

What vital sign will change first in significant blood loss?

Answer 20

HR will increase

- Then BP will drop

Question 21

Red cervix produced by mucous-producing endocervical epithelium protruding through the cervical os

Answer 21

Ectropion

- No clinical significance

Question 22

Chance of miscarriage with significant bleed in first trimester bleeding

Answer 22

25 to 50%

Question 23

EGA
First trimester
Second trimester
Third trimester

Answer 23

Crown-rump length
- Change EGA and EDD if > 1 week difference from LMP
Biparietal diameter, head circumference, abdomen circumference, and femur length
- Change dates if > 2 week difference from LMP
Do not use 3rd trimester dates

Question 24

Most common cause of abortion

Answer 24

Chromosomal abnormalities

Question 25

Recurrence of abortion

Answer 25

87%

Question 26

HEEADSSS

Answer 26

``` Home Education/Employment Eating Activites Drugs Sex Suicide Safety ```

Question 27

Most common cause of first trimester bleeding

Answer 27

Spontaneous abortion Ectopic pregnancy idiopathic bleeding of viable pregnancy

Question 28

Open cervical os with obvious bleeding

Answer 28

Spontaneous abortion

Question 29

Acute distended abdomen

Answer 29

Ruptured ectopic

Question 30

When can't an US be used to evaluate an IUP

Answer 30

Quants

Question 31

Caution about using US

Answer 31

Do not assume ectopic pregnancy if patient is in stable condition. - Best to do quants - Then serial US looking for IUP (48 to 72 hrs)

Question 32

Less likely cause of 1st trimester bleeding

Answer 32

Gestational trophoblastic disease - Quants will be > 100,000 Vaginal trauma or cervical pathology - Chlamydia or gonorrhea

Question 33

Initial pregnancy labs

Answer 33

``` CBC Rubella titer Hep B surface antigen Blood type RPR HIV ```

Question 34

Where will hCG be highest?

Answer 34

In the serum | - Not necessary to do serum hCG

Question 35

First trimester bleeding labs

Answer 35

CBC Wet mount perp Progesterone - > 25 good;

Question 36

How high does hCG need to be to see IUP with ultrasound

Answer 36

> 5000

Question 37

How do quants present in ectopics or abortions

Answer 37

Lower and would not double by 48 hrs

Question 38

Bleeding at

Answer 38

Threatened abortion

Question 39

Dilated cervical os

Answer 39

Inevitable abortion

Question 40

Some products of conception have been expelled

Answer 40

Incomplete abortion

Question 41

Fetal demise w/o cervical dilation or uterine activity

Answer 41

Missed abortion

Question 42

Wit intrauterine infection

Answer 42

Septic abortion

Question 43

Produce of conception have completely passed

Answer 43

Complete abortion

Question 44

Management of an inevitable abortion

Answer 44

``` Expectant management - 75% success; can take up to a month Surgical - Choice if bleeding is heavy Medical - 95% success - 800 mcg misoprostol - 3 to 4 days is typical, may take 2 weeks ```

Question 45

Should Rhogam be given to an Rh- mom who went through an abortion

Answer 45

Yes!