CURRENT DIAGNOSIS AND TREATMENT
OBSTETRICS AND GYNECOLOGY ALAN
ESSENTIAL STUDY QUESTIONS AND ANSWERS
◉ 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.
Answer: Extremes of maternal age and previous molar pregnancy
significantly increase the risk.
◉ Clinical features of hydatidiform mole.
Answer: Patients commonly present with vaginal bleeding, uterine
enlargement greater than dates, markedly elevated β-hCG,
hyperemesis gravidarum, theca lutein cysts, hyperthyroidism, and
early preeclampsia.
◉ Diagnosis of hydatidiform mole.
Answer: Diagnosis is made by ultrasound showing a snowstorm
appearance, markedly elevated β-hCG, and histopathologic
evaluation after uterine evacuation.
,◉ Management of hydatidiform mole.
Answer: Treatment consists of suction dilation and curettage
followed by serial quantitative β-hCG monitoring.
◉ Contraception after molar pregnancy.
Answer: Patients should avoid pregnancy during β-hCG surveillance,
typically for at least 6 months after β-hCG normalization.
◉ Gestational trophoblastic neoplasia.
Answer: Gestational trophoblastic neoplasia is suspected when β-
hCG levels plateau or rise after evacuation of a molar pregnancy.
◉ Risk factors for gestational trophoblastic neoplasia.
Answer: A previous hydatidiform mole and maternal age greater
than 40 years increase the risk.
◉ Clinical features of gestational trophoblastic neoplasia.
Answer: Patients present with persistent vaginal bleeding, elevated
β-hCG, pelvic pain, and metastatic symptoms.
◉ Common metastases of gestational trophoblastic neoplasia.
Answer: The lungs and vagina are the most common metastatic
sites. Pulmonary metastases may cause dyspnea or hemoptysis.
, ◉ Evaluation of gestational trophoblastic neoplasia.
Answer: Evaluation includes pelvic ultrasound, chest radiography,
thyroid function tests, liver function tests, and renal function tests.
◉ Treatment of gestational trophoblastic neoplasia.
Answer: Chemotherapy is the primary treatment. Hysterectomy may
be considered in selected patients who have completed childbearing.
◉ First-line treatment of nausea and vomiting of pregnancy.
Answer: Lifestyle modification with dietary changes plus pyridoxine
(vitamin B6) is first-line therapy.
◉ Second-line treatment of nausea and vomiting of pregnancy.
Answer: Doxylamine is added if pyridoxine alone is inadequate. The
pyridoxine-doxylamine combination is the preferred initial
medication regimen.
◉ Hyperemesis gravidarum.
Answer: Hyperemesis gravidarum is severe persistent vomiting
causing dehydration, ketonuria, electrolyte abnormalities, and more
than 5% loss of prepregnancy weight.
◉ Risk factors for hyperemesis gravidarum.
OBSTETRICS AND GYNECOLOGY ALAN
ESSENTIAL STUDY QUESTIONS AND ANSWERS
◉ 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.
Answer: Extremes of maternal age and previous molar pregnancy
significantly increase the risk.
◉ Clinical features of hydatidiform mole.
Answer: Patients commonly present with vaginal bleeding, uterine
enlargement greater than dates, markedly elevated β-hCG,
hyperemesis gravidarum, theca lutein cysts, hyperthyroidism, and
early preeclampsia.
◉ Diagnosis of hydatidiform mole.
Answer: Diagnosis is made by ultrasound showing a snowstorm
appearance, markedly elevated β-hCG, and histopathologic
evaluation after uterine evacuation.
,◉ Management of hydatidiform mole.
Answer: Treatment consists of suction dilation and curettage
followed by serial quantitative β-hCG monitoring.
◉ Contraception after molar pregnancy.
Answer: Patients should avoid pregnancy during β-hCG surveillance,
typically for at least 6 months after β-hCG normalization.
◉ Gestational trophoblastic neoplasia.
Answer: Gestational trophoblastic neoplasia is suspected when β-
hCG levels plateau or rise after evacuation of a molar pregnancy.
◉ Risk factors for gestational trophoblastic neoplasia.
Answer: A previous hydatidiform mole and maternal age greater
than 40 years increase the risk.
◉ Clinical features of gestational trophoblastic neoplasia.
Answer: Patients present with persistent vaginal bleeding, elevated
β-hCG, pelvic pain, and metastatic symptoms.
◉ Common metastases of gestational trophoblastic neoplasia.
Answer: The lungs and vagina are the most common metastatic
sites. Pulmonary metastases may cause dyspnea or hemoptysis.
, ◉ Evaluation of gestational trophoblastic neoplasia.
Answer: Evaluation includes pelvic ultrasound, chest radiography,
thyroid function tests, liver function tests, and renal function tests.
◉ Treatment of gestational trophoblastic neoplasia.
Answer: Chemotherapy is the primary treatment. Hysterectomy may
be considered in selected patients who have completed childbearing.
◉ First-line treatment of nausea and vomiting of pregnancy.
Answer: Lifestyle modification with dietary changes plus pyridoxine
(vitamin B6) is first-line therapy.
◉ Second-line treatment of nausea and vomiting of pregnancy.
Answer: Doxylamine is added if pyridoxine alone is inadequate. The
pyridoxine-doxylamine combination is the preferred initial
medication regimen.
◉ Hyperemesis gravidarum.
Answer: Hyperemesis gravidarum is severe persistent vomiting
causing dehydration, ketonuria, electrolyte abnormalities, and more
than 5% loss of prepregnancy weight.
◉ Risk factors for hyperemesis gravidarum.
