Week 8 pt 1 highlights

Question 1

Define ectopic pregnancy and name a risk

Answer 1

Anywhere other than within the uterus
-previous ectopic pregnancies

Question 2

True or false: Depending on site, ectopic pregnancies may or may not cause pain

Answer 2

True

Question 3

Name a LEADING cause of maternal deaths in the 1st trimester

Answer 3

Pregnancies within the tube can rupture and cause hemorrhage

Question 4

Are numbers of fallopian ectopic pregnancies rising or falling?

Answer 4

Rising

Question 5

If early and small, ectopic pregnancies may have _____ clinical symptoms

Answer 5

no

Question 6

What is the most common symptom of ectopic pregnancies?

Answer 6

Amenorrhea followed by vaginal bleeding and abdominal pain on the affected side

Question 7

Marked tenderness on abdominal and pelvic exams & increased pain with cervical manipulation are symptoms of what?

Answer 7

Ruptured ectopic pregnancy

Question 8

Describe the highlights of testing for ectopic pregnancy

Answer 8

1) Urine hCG (or serum β-hCG)
2) TVUS: should demonstrate an intrauterine pregnancy when hCG 1000-2000 IU/L
3) If the patient has a positive urine pregnancy test, begin beta subunit hCG testing (serum)
-If level is rising, there’s an embryo somewhere
-If level is falling, keep checking and make sure it goes to 0

Question 9

Combined _________________________ + ______________________ measurements are approximately 96 percent sensitive and 97 percent specific for diagnosing ectopic pregnancy.

Answer 9

transvaginal ultrasonography + serial quantitative beta-hCG

Question 10

Ectopic pregnancy Tx: What only works if tube has not started to rupture?

Answer 10

Methotrexate (PO or IM)

Question 11

Must have EFFECTIVE contraception and avoid pregnancy for 3 months after use of what?

Answer 11

Methotrexate for ectopic pregnancy

Question 12

True or false: medical therapy for ectopic pregnancy is only an option if tube has not started to rupture

Answer 12

True

Question 13

80% of recognized miscarriages occur within the first ________________ and are most likely due to chromosomal abnormalities in the developing embryo

Answer 13

12 weeks

Question 14

The other 20% of spontaneous abortions occur between 12- 20 weeks gestation and more likely due to what?

Answer 14

systemic disease, abnormal placentation, or other anatomic considerations

Question 15

Threatened abortion: Patient of less than 20 weeks’ gestation who presents with _________________ and no cervical dilation or effacement

Answer 15

vaginal bleeding

Question 16

If cardiac motion + by US, 95% of ______________ will carry to term

Answer 16

threatened abortions

Question 17

Inevitable abortion is defined as patients with an open cervical os found on pelvic examination but without a history or evidence of _____________________

Answer 17

passage of tissue

Question 18

Only part of the POC has passed through the cervical os is called what?

Answer 18

Incomplete abortion

Question 19

Incomplete abortion: On examination, patients may have a closed or open cervical os, and ultrasonography reveals what?

Answer 19

fetal or placental tissue remaining in the uterus

Question 20

Who needs a D&C within 1-3 days to limit risk of infection and sepsis?

Answer 20

Incomplete abortion pts

Question 21

On pelvic examination the cervical os is closed, and ultrasonography demonstrates an empty uterus. This describes what?

Answer 21

Complete abortion

Question 22

What do missed abortion pts need?

Answer 22

OB Consult for D&C

Question 23

1) Define septic abortion
2) What are 3 reasons it may occur?

Answer 23

1) An intrauterine infection
2) elective terminations; inadequate evacuation of the uterus; spontaneous abortions

Question 24

When pregnancy status is not checked, patients who have ______________________ are commonly misdiagnosed as having pelvic inflammatory disease (PID).

Answer 24

septic miscarriage

Question 25

What is super important with septic miscarriages?

Answer 25

OB CONSULT FOR URGENT D&

Question 26

Genetics are a risk factor for ____________ trimester spontaneous abortions

Answer 26

first

Question 27

What must spontaneous abortion PE include?

Answer 27

Speculum exam to visualize os; os must be visualized as this dictates the management.

Question 28

Healthy pregnancy levels of serum HCG double every ____ hrs (know this)

Answer 28

48

Question 29

Describe diagnosing the types of spontaneous abortion

Answer 29

1) Is cervical OS closed? 2) Is it open? -RULE OUT ECTOPIC -If not ectopic, are there POC within the uterus? --If no, dx is complete miscarriage or an ectopic was MISSED --If yes, is there heart motion (7 weeks)? ----If yes, it is a threatened miscarriage (cervix closed, + POC, +FHR)

Question 30

Serial hCG pregnancy: 1) If a normal pregnancy, will double every _____ hours. 2) If a “___________” pregnancy, levels will not rise as expected

Answer 30

1) 48 2) failing

Question 31

Serial hCG testing: 1) If an _____________ or __________ miscarriage, rates will decrease 2) If an ____________ pregnancy, rates will rise, but not double

Answer 31

1) incomplete or complete 2) ectopic

Question 32

If a molar pregnancy (hydatidiform mole), rates of hCG will ______________________

Answer 32

skyrocket (will be much higher than dating by US suggests)

Question 33

What are 3 things you should do for spontaneous abortion treatment?

Answer 33

1) Arrange for serial hCG testing 2) Rh-negative mothers should receive RhoGAM 3) Follow up 2-6 weeks after the loss of a pregnancy.

Question 34

Medication-induced abortions are appropriate up until the _________ day of pregnancy

Answer 34

49th

Question 35

Define recurrent abortions

Answer 35

Three successive spontaneous abortions