1st Trimester Bleeding and Pregnancy Complications
Questions With Complete Solutions
what is an emergency for 1st trimester bleeding
>=1 pad an hour x 3 hours
passing large clots
lightheadedness/syncope
pelvic pain
GO TO ER
DDX for 1st trimester bleeding
ectopic
spontaneous abortion
cervical insufficiency
cervical and vaginal disorders
physiologic or implantation bleeding
gestational trophoblastic disease
what is important hx to get in 1st trimester bleeding
intrauterine pregnancy documented
had an US
,quantify the bleeding
associated pelvic pain
prior miscarriage
PE done in 1st trimester bleeding
abdominal exam
-midline pain = pregnancy loss
-lateral pain = ectopic
speculum exam
-assess volume of bleeding and source
-clots
-cervical os open
bimanual exam
1st trimester bleeding work up
confirm pregnancy
pelvic US
-asses for IUP, gestational sac, cardiac activity
-adnexal masses
-subchorionic hemorrhage
, hCG serum quants
baseline CBC
RhD type
when are Rh neg pregnant pts screened for RBC antibodies
first prenatal visit
28 weeks gestation
when is Rhogam given
28 weeks and within 72 hours of delivery (if baby is Rh+)
(only lasts 12 weeks)
what can occur in Rh alloimmunization
fetal hemolysis, anemia, heart failure, hydrops fetalis, hyperbili,
death
what monitoring is done for Rh alloimmunization
be seen by a maternal fetal medicine specialist
antibody titers
antenatal testing
MCA dopplers
what is the leading cause of maternal mortality in the first
trimester
Questions With Complete Solutions
what is an emergency for 1st trimester bleeding
>=1 pad an hour x 3 hours
passing large clots
lightheadedness/syncope
pelvic pain
GO TO ER
DDX for 1st trimester bleeding
ectopic
spontaneous abortion
cervical insufficiency
cervical and vaginal disorders
physiologic or implantation bleeding
gestational trophoblastic disease
what is important hx to get in 1st trimester bleeding
intrauterine pregnancy documented
had an US
,quantify the bleeding
associated pelvic pain
prior miscarriage
PE done in 1st trimester bleeding
abdominal exam
-midline pain = pregnancy loss
-lateral pain = ectopic
speculum exam
-assess volume of bleeding and source
-clots
-cervical os open
bimanual exam
1st trimester bleeding work up
confirm pregnancy
pelvic US
-asses for IUP, gestational sac, cardiac activity
-adnexal masses
-subchorionic hemorrhage
, hCG serum quants
baseline CBC
RhD type
when are Rh neg pregnant pts screened for RBC antibodies
first prenatal visit
28 weeks gestation
when is Rhogam given
28 weeks and within 72 hours of delivery (if baby is Rh+)
(only lasts 12 weeks)
what can occur in Rh alloimmunization
fetal hemolysis, anemia, heart failure, hydrops fetalis, hyperbili,
death
what monitoring is done for Rh alloimmunization
be seen by a maternal fetal medicine specialist
antibody titers
antenatal testing
MCA dopplers
what is the leading cause of maternal mortality in the first
trimester
