OMS III - OB/GYN - Complications of Pregnancy Exam

DDx for first trimester bleeding non-viable IUP: spontaneous abortion, molar pregnancy viable IUP: physiologic implantation bleeding, subchorionic hemorrhage ectopic pregnancy evaluation of first trimester bleeding TVUS hCG H&H risk factors for an ectopic pregnancy fallopian tube scarring history of ectopic pregnancy (#1 risk factor) tubal ligation chlamydial infections PID smoking - slows cilia in fallopian tubes diagnostic protocols for ectopic pregnancy should increase by 50% over 48 hours if normal IUPhCG discriminatory zone 3000 treatment options for ectopic pregnancy salpingostomy if not rupture salpingectomy if rupture MTX CI for MTX hemodynamic instability liver/kidney abnormalities acute lung disease breastfeeding inability to comply with required follow up beta-hCG testing hCG 20k fetal heartbeat factors that may cause MTX to fail gestational sac over 4cm hCG 5k heartbeatpt supplementing folate missed abortion dead baby, os closed, no passage of fetal parts incomplete abortion dead baby, os open, active evacuation complete abortion dead baby, os closed, evacuation complete threatened abortion vaginal bleeding during pregnancy NO bed rest closed os inevitable abortion rupture of membranes prior to viability, open cervixrecurrent abortion 3 or more losses prior to 20 weeks causes of first trimester abortion usually genetic/autoimmune factors can consider chromosomal evaluation if recurrent first trimester losses causes of second trimester abortion usually anatomic abnormalities or uterine anomalies antiphospholipid antibody syndrome caused by antiphospholipid antibodies hypercoagulable state (placental vessel thrombosis) pt needs chronic anticoagulation - LMWH in pregnancy, warfarin if not pregnant