Ectopic Pregnancy || with 100% Verified Solutions.
First trimester bleeding
-occurrence?
-outcomes? correct answers occurs in 20-30% of all pregnancies
-up to 50% will go on to miscarry
Any female of reproductive age who presents with abnormal vaginal bleeding or pelvic pain
must be _____________________ correct answers screened for an unrecognized pregnancy.
NO EXCEPTIONS!!!
Spontaneous abortion: correct answers loss of pregnancy before 20 weeks gestation
Spontaneous abortion
-occurrence? correct answers estimated to occur in 35-45% of a; pregnancies
-80% occur in 1st trimester
-most d/t chromosomal abnormality
-risk increases w/ age (about 50% in mothers >45 yo)
incompetent cervix: correct answers painless cervical dilation in 2nd trimester, recurrent with
subsequent pregnancies
incompetent cervix risk factors? correct answers Previous surgery to cervix or uterus, including
D&C (dilation and curettage), conization, cauterization, LEEP, or previous delivery trauma,
congenital cervical abnormality
Rx for incompetent cervix? correct answers cerclage (a purse-string suture to strengthen cervix)
Threatened abortion: correct answers bleeding/cramping in first trimester, without cervical
dilation or loss of pregnancy.
Bleeding is generally light. First trimester bleeding or spotting is common, occurs in about 25%
of pregnancies.
Inevitable abortion: correct answers bleeding/cramping, with cervical dilation and/or membrane
rupture
Incomplete abortion: correct answers fetal tissue in cervical os, or already has passed, but
bleeding persists due to retained placenta
Missed abortion: correct answers death of embryo, with retained products of conception in uterus
for several weeks
Septic abortion: correct answers accompanied by endometritis. May progress to peritonitis or
septic shock
, Signs and symptoms of spontaneous abortion (SAb)? correct answers Vaginal bleeding,
cramping, progressive ↑ in severity
Lightheadedness (hypotension) if excessive bleeding.
Exam of possible SAb? correct answers check vitals for orthostasis; perform pelvic exam to
determine type of miscarriage (cervix closed?)
-Ultra sound: can look for ectopic, retained products, viable fetus (seen if >6 weeks)
Labs of possible SAb? correct answers CBC, Quantitative βHCG, Blood Type and Rh
Management of SAb? correct answers Often self resolved, but:
-may need Suction curettage is needed if there is
severe or persistent bleeding (due to
probable retained products of conception)
-Misoprostol may be used instead of curettage in stable patients, but 50% will require a
subsequent curettage
-grief and a sense of loss are common; counseling is often indicated
Management of Rh issues? correct answers If patient is Rh negative, Rhogam (Rh immune
globulin) is given (50 mcg in 1st trimester, 300 mcg in 2nd trimester)
Persistant bleeding, persistant BetaHCG = ? correct answers -consider hydatidiform mole
(BetaHCG should be decreasing)
Occurrence/recurrence of ectopic pregnancy? correct answers 2% of all pregnancies; 10% of all
pregnancy-related deaths
Recurrence Rate ~ 15%
High Risk factors for ectopic pregnancy? correct answers Tubal corrective surgery, tubal ligation
Previous ectopic
DES exposure in utero
IUD (intrauterine device), particularly progestin IUDs
Other tubal disease, esp. salpingitis, pelvic inflammatory dz (PID)
Infertility w/ hx assisted reproductive technology, such as IVF and GIFT, which can ↑ risk of
heterotopic pregnancy to 1 in 100
Morning-after pill
Moderate risk for ectopic pregnancy? correct answers History of sexually transmitted disease
First trimester bleeding
-occurrence?
-outcomes? correct answers occurs in 20-30% of all pregnancies
-up to 50% will go on to miscarry
Any female of reproductive age who presents with abnormal vaginal bleeding or pelvic pain
must be _____________________ correct answers screened for an unrecognized pregnancy.
NO EXCEPTIONS!!!
Spontaneous abortion: correct answers loss of pregnancy before 20 weeks gestation
Spontaneous abortion
-occurrence? correct answers estimated to occur in 35-45% of a; pregnancies
-80% occur in 1st trimester
-most d/t chromosomal abnormality
-risk increases w/ age (about 50% in mothers >45 yo)
incompetent cervix: correct answers painless cervical dilation in 2nd trimester, recurrent with
subsequent pregnancies
incompetent cervix risk factors? correct answers Previous surgery to cervix or uterus, including
D&C (dilation and curettage), conization, cauterization, LEEP, or previous delivery trauma,
congenital cervical abnormality
Rx for incompetent cervix? correct answers cerclage (a purse-string suture to strengthen cervix)
Threatened abortion: correct answers bleeding/cramping in first trimester, without cervical
dilation or loss of pregnancy.
Bleeding is generally light. First trimester bleeding or spotting is common, occurs in about 25%
of pregnancies.
Inevitable abortion: correct answers bleeding/cramping, with cervical dilation and/or membrane
rupture
Incomplete abortion: correct answers fetal tissue in cervical os, or already has passed, but
bleeding persists due to retained placenta
Missed abortion: correct answers death of embryo, with retained products of conception in uterus
for several weeks
Septic abortion: correct answers accompanied by endometritis. May progress to peritonitis or
septic shock
, Signs and symptoms of spontaneous abortion (SAb)? correct answers Vaginal bleeding,
cramping, progressive ↑ in severity
Lightheadedness (hypotension) if excessive bleeding.
Exam of possible SAb? correct answers check vitals for orthostasis; perform pelvic exam to
determine type of miscarriage (cervix closed?)
-Ultra sound: can look for ectopic, retained products, viable fetus (seen if >6 weeks)
Labs of possible SAb? correct answers CBC, Quantitative βHCG, Blood Type and Rh
Management of SAb? correct answers Often self resolved, but:
-may need Suction curettage is needed if there is
severe or persistent bleeding (due to
probable retained products of conception)
-Misoprostol may be used instead of curettage in stable patients, but 50% will require a
subsequent curettage
-grief and a sense of loss are common; counseling is often indicated
Management of Rh issues? correct answers If patient is Rh negative, Rhogam (Rh immune
globulin) is given (50 mcg in 1st trimester, 300 mcg in 2nd trimester)
Persistant bleeding, persistant BetaHCG = ? correct answers -consider hydatidiform mole
(BetaHCG should be decreasing)
Occurrence/recurrence of ectopic pregnancy? correct answers 2% of all pregnancies; 10% of all
pregnancy-related deaths
Recurrence Rate ~ 15%
High Risk factors for ectopic pregnancy? correct answers Tubal corrective surgery, tubal ligation
Previous ectopic
DES exposure in utero
IUD (intrauterine device), particularly progestin IUDs
Other tubal disease, esp. salpingitis, pelvic inflammatory dz (PID)
Infertility w/ hx assisted reproductive technology, such as IVF and GIFT, which can ↑ risk of
heterotopic pregnancy to 1 in 100
Morning-after pill
Moderate risk for ectopic pregnancy? correct answers History of sexually transmitted disease
