CURRENT DIAGNOSIS AND TREATMENT
OBSTETRICS AND GYNECOLOGY ALAN
COMPLETE COURSE REVIEW GUIDE
◉ Structural causes of recurrent pregnancy loss.
Answer: Uterine fibroids, intrauterine adhesions (Asherman
syndrome), endometrial polyps, and cervical insufficiency increase
the risk of recurrent miscarriage.
◉ Chromosomal causes of recurrent pregnancy loss.
Answer: Common chromosomal causes include fetal aneuploidy,
balanced parental translocations, chromosomal rearrangements,
and mosaicism.
◉ Immunologic cause of recurrent pregnancy loss.
Answer: Antiphospholipid syndrome is the most common treatable
immunologic cause of recurrent pregnancy loss.
◉ Endocrine causes of recurrent pregnancy loss.
Answer: Endocrine causes include thyroid disease, diabetes mellitus,
polycystic ovary syndrome, and hyperprolactinemia.
◉ Other causes of recurrent pregnancy loss.
,Answer: Advanced maternal age, decreased ovarian reserve,
defective endometrial receptivity, and celiac disease may contribute
to recurrent miscarriage.
◉ Most common location of ectopic pregnancy.
Answer: The ampulla of the fallopian tube is the most common site
of ectopic implantation.
◉ Cornual (interstitial) ectopic pregnancy.
Answer: Cornual pregnancy implants within the interstitial portion
of the fallopian tube. Rupture can cause massive hemorrhage
because of increased uterine blood supply.
◉ Classic presentation of ectopic pregnancy.
Answer: Ectopic pregnancy classically presents with amenorrhea,
unilateral pelvic pain, and vaginal bleeding.
◉ Physical examination in ectopic pregnancy.
Answer: Common findings include cervical motion tenderness,
adnexal tenderness, and occasionally a palpable adnexal mass.
◉ Diagnosis of ectopic pregnancy.
Answer: Transvaginal ultrasound combined with quantitative β-hCG
measurement is the preferred diagnostic approach.
,◉ Ultrasound findings in ectopic pregnancy.
Answer: An adnexal mass with an empty uterus in a patient with a
positive pregnancy test strongly suggests ectopic pregnancy.
◉ Hemodynamically unstable ectopic pregnancy.
Answer: Hemodynamically unstable patients require immediate
surgical consultation and operative management. Methotrexate is
contraindicated.
◉ Stable ectopic pregnancy.
Answer: Stable patients with an unruptured ectopic pregnancy and
no contraindications may be treated with methotrexate.
◉ Contraindications to methotrexate.
Answer: Contraindications include hemodynamic instability,
ruptured ectopic pregnancy, liver disease, renal disease, blood
dyscrasias, breastfeeding, and inability to follow up.
◉ β-hCG rise in viable pregnancy.
Answer: In a normal viable intrauterine pregnancy, β-hCG increases
by at least 35-50% every 48 hours.
◉ β-hCG in ectopic pregnancy.
, Answer: Ectopic and nonviable pregnancies usually demonstrate a
rise in β-hCG of less than 35% over 48 hours or plateauing values.
◉ β-hCG after complete miscarriage.
Answer: β-hCG levels progressively decrease following complete
spontaneous abortion until becoming undetectable.
◉ Diagnostic dilation and curettage in pregnancy of unknown
location.
Answer: Dilation and curettage may distinguish ectopic pregnancy
from failed intrauterine pregnancy when the diagnosis remains
uncertain.
◉ β-hCG after dilation and curettage.
Answer: A falling β-hCG after uterine evacuation indicates a failed
intrauterine pregnancy. Persistent elevation suggests ectopic
pregnancy.
◉ Serum progesterone level.
Answer: A progesterone level less than 5 ng/mL suggests an
abnormal or ectopic pregnancy, whereas a level greater than 25
ng/mL supports a viable intrauterine pregnancy.
◉ Risk factors for hydatidiform mole.
OBSTETRICS AND GYNECOLOGY ALAN
COMPLETE COURSE REVIEW GUIDE
◉ Structural causes of recurrent pregnancy loss.
Answer: Uterine fibroids, intrauterine adhesions (Asherman
syndrome), endometrial polyps, and cervical insufficiency increase
the risk of recurrent miscarriage.
◉ Chromosomal causes of recurrent pregnancy loss.
Answer: Common chromosomal causes include fetal aneuploidy,
balanced parental translocations, chromosomal rearrangements,
and mosaicism.
◉ Immunologic cause of recurrent pregnancy loss.
Answer: Antiphospholipid syndrome is the most common treatable
immunologic cause of recurrent pregnancy loss.
◉ Endocrine causes of recurrent pregnancy loss.
Answer: Endocrine causes include thyroid disease, diabetes mellitus,
polycystic ovary syndrome, and hyperprolactinemia.
◉ Other causes of recurrent pregnancy loss.
,Answer: Advanced maternal age, decreased ovarian reserve,
defective endometrial receptivity, and celiac disease may contribute
to recurrent miscarriage.
◉ Most common location of ectopic pregnancy.
Answer: The ampulla of the fallopian tube is the most common site
of ectopic implantation.
◉ Cornual (interstitial) ectopic pregnancy.
Answer: Cornual pregnancy implants within the interstitial portion
of the fallopian tube. Rupture can cause massive hemorrhage
because of increased uterine blood supply.
◉ Classic presentation of ectopic pregnancy.
Answer: Ectopic pregnancy classically presents with amenorrhea,
unilateral pelvic pain, and vaginal bleeding.
◉ Physical examination in ectopic pregnancy.
Answer: Common findings include cervical motion tenderness,
adnexal tenderness, and occasionally a palpable adnexal mass.
◉ Diagnosis of ectopic pregnancy.
Answer: Transvaginal ultrasound combined with quantitative β-hCG
measurement is the preferred diagnostic approach.
,◉ Ultrasound findings in ectopic pregnancy.
Answer: An adnexal mass with an empty uterus in a patient with a
positive pregnancy test strongly suggests ectopic pregnancy.
◉ Hemodynamically unstable ectopic pregnancy.
Answer: Hemodynamically unstable patients require immediate
surgical consultation and operative management. Methotrexate is
contraindicated.
◉ Stable ectopic pregnancy.
Answer: Stable patients with an unruptured ectopic pregnancy and
no contraindications may be treated with methotrexate.
◉ Contraindications to methotrexate.
Answer: Contraindications include hemodynamic instability,
ruptured ectopic pregnancy, liver disease, renal disease, blood
dyscrasias, breastfeeding, and inability to follow up.
◉ β-hCG rise in viable pregnancy.
Answer: In a normal viable intrauterine pregnancy, β-hCG increases
by at least 35-50% every 48 hours.
◉ β-hCG in ectopic pregnancy.
, Answer: Ectopic and nonviable pregnancies usually demonstrate a
rise in β-hCG of less than 35% over 48 hours or plateauing values.
◉ β-hCG after complete miscarriage.
Answer: β-hCG levels progressively decrease following complete
spontaneous abortion until becoming undetectable.
◉ Diagnostic dilation and curettage in pregnancy of unknown
location.
Answer: Dilation and curettage may distinguish ectopic pregnancy
from failed intrauterine pregnancy when the diagnosis remains
uncertain.
◉ β-hCG after dilation and curettage.
Answer: A falling β-hCG after uterine evacuation indicates a failed
intrauterine pregnancy. Persistent elevation suggests ectopic
pregnancy.
◉ Serum progesterone level.
Answer: A progesterone level less than 5 ng/mL suggests an
abnormal or ectopic pregnancy, whereas a level greater than 25
ng/mL supports a viable intrauterine pregnancy.
◉ Risk factors for hydatidiform mole.
