Term
| ectopics are % of pregnancies |
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Definition
|
|
Term
| ectopics are % of ED visits in 1T |
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Definition
|
|
Term
| leading cause of 1T pregnancy related death |
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Definition
|
|
Term
| rate of mortality ectopic |
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Definition
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|
Term
| % normal pregnancies with abnormal hCG rise |
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Definition
|
|
Term
| % ectopics normal hCG rise |
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Definition
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|
Term
| recurrence rate after 1 ectopic |
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Definition
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|
Term
| recurrence rate after 2 ectopics |
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Definition
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|
Term
| rate of tubal ectopic pregnancy, breakdown where and % in the tube |
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Definition
| ampula 80%, ischmic 12%, fimbriae 5%, corneal/interstitial/horn 2% |
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Term
| rate of abdominal ectopics |
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Definition
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Term
| rate of cervica, heterotopic, C-section scar ectopics |
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Definition
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Term
| signs of a CD scar ectopic |
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Definition
| empty uterus, no myometrium around pregnancy or between pregnancy and bladder |
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|
Term
| complications CD scar ectopic - 2 |
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Definition
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|
Term
| risk of ectopic after salpingectomy |
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Definition
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|
Term
| risk of ectopic after salpingestomy |
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Definition
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|
Term
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Definition
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Term
|
Definition
| overall 50% less but 3-4% rate |
|
|
Term
| progesterone association with pregnancy viability |
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Definition
| <5 abnormal 99% specificity, 5-20 equivocal (most ectopics), >20 IUP |
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|
Term
| % ectopics where hCG will look like SAB |
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Definition
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|
Term
| % ectopics that will have a GS |
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Definition
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|
Term
| success rate for expectant management ectopic |
|
Definition
| overall 20-60%, if hCG <200 80% |
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|
Term
| requirements for ectopic expectant management - 3 |
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Definition
| falling hCG, early gestational age, asymptomatic |
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|
Term
| success rate overall of MTX for ectopic |
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Definition
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|
Term
| #1 factor for MTX success for ectopic |
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Definition
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|
Term
|
Definition
| folinic acid antagonist inhibits dihydrofolate reductase which is needed for DNA/RNA synthesis |
|
|
Term
| relative contraindications MTX - 4 |
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Definition
| GS >4cm, cardiac activity, high hCG )generally >5000), refusal of blood products |
|
|
Term
| absolute contraindications MTX - 14 |
|
Definition
| IUP, immune deficiency, thrombocytopenia, leukopenia, anemia, allergy to MTX, PUD, pulmonary/liver/renal disease, breastfeedig, ruptured, unstabe, unreliable |
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|
Term
| when on MTX you have to tell the patient not to - 6 |
|
Definition
| NSAIDS, alcohol, sun, sex, working out, PNV |
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|
Term
|
Definition
| day 1 - 50mg/m2 …. day 4 hCG…. day 7 hCG should be 15% decreased from day 4 if not redoes MTX |
|
|
Term
| what % of single dose MTX will need second dose |
|
Definition
|
|
Term
| success rate of single dose MTX based on hCG level |
|
Definition
| <1000 98%, <5000 86%, >15000 68% |
|
|
Term
|
Definition
| day 1 50 mg/m2 …. day 4 50 mg/m2, hcg …. day 7 hCG should be 15% decreased if not redoes on day 11 |
|
|
Term
|
Definition
| 1 mg/kg MTX and hCG - days 1, 3, 5, 7 … folinic acid 0.1mg/kg days 2, 4, 6, 8. if no decreases after 4 doses do surgery |
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|
Term
| when is the multi dose MTX regimen indicated - 3 |
|
Definition
| higher GA, hCG >5000, fetal cardiac activity |
|
|
Term
|
Definition
| abdominal pain, vaginal bleeding, stomatitis, transaminitis, nausea, vomiting, alopecia, dizziness, neutropenia, pneumonitis, diarrhea |
|
|
Term
| indications for surgical removal of ectopic pregnancy - 4 |
|
Definition
| contraindication to MTX, failed MTX, unstable, heterotopic |
|
|
Term
| contraindications to surgical management ectopic |
|
Definition
| medically treatable ectopic |
|
|
Term
| when to do a laparotomy for ectopic - 4 |
|
Definition
| unstable, cornual, experience, anticipate difficult LSC |
|
|
Term
| success rate of salpingestome |
|
Definition
|
|
Term
| indications to just do a salpingectomy for ectopic - 6 |
|
Definition
| ruptured, severe tube damage, other tube is normal, future fertility not desired, history of ectopic in same tube, hemorrhage of salpingestomy |
|
|
Term
| why don't we treat CD scar ecotpic with systemic MTX |
|
Definition
| 61% rate of need for blood transfusion |
|
|
Term
| how can CD scar ectopic be treated - 3 |
|
Definition
| direct injection with MTX or KCL, hysteroscopic excision, uterine artery embolization |
|
|
Term
| how can a cervical ectopic be treated |
|
Definition
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|
Term
|
Definition
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|
Term
|
Definition
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|
Term
|
Definition
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|
Term
| #1 chromosomal cause of SAB |
|
Definition
|
|
Term
|
Definition
|
|
Term
| #2 chromosomal cause of SAB |
|
Definition
|
|
Term
| #1 single gene disorder causing SAB |
|
Definition
|
|
Term
| #3 chromosomal cause of SAB |
|
Definition
|
|
Term
| 4 predictive signs of sab |
|
Definition
| abnormal YS, slow HR, small HS, subchorionic hematoma (controversial) |
|
|
Term
| rate of subchorionic hematoma |
|
Definition
|
|
Term
| risks in pregnancy with subchorionic hematoma - 5 |
|
Definition
| SAB (contriversia), PPROM, abruption, stillbirth, PTD |
|
|
Term
| signs of anembryonic gestation - 6 |
|
Definition
| +YS, GS >1.8cm, irregular GS, no FP, decidual cast, arias stella reaction |
|
|
Term
|
Definition
| necrotic decidua, rare villi |
|
|
Term
| what is an anembryonic gestation associated with |
|
Definition
|
|
Term
| bug causing most septic Ab |
|
Definition
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|
Term
| hCG should increase __% in __h |
|
Definition
|
|
Term
| level of hCG at time of ovulation and missed period in early pregnancy |
|
Definition
| ovulation 8-100, period 50-100 |
|
|
Term
| within the 99%ile when should a GS, YS, and FP be seen |
|
Definition
GS hCG 3500 / 5wk
YS hCG 18000 / 6wk
FP hCG 48000 / 6+5wk |
|
|
Term
| 4 diagnostic SAB criteria |
|
Definition
| CRL 7mm without FCA, GS 25mm without FP, no FHR >2wk after GS, no FHR >11d after YS |
|
|
Term
| what percent of PUL will be IUP and which ectopic |
|
Definition
|
|
Term
| in PUL when do you do sampling for villi |
|
Definition
| hCG >3500 with nothing on ultrasound |
|
|
Term
| expectant management success |
|
Definition
| 80% by 8wk, 60% if enambryonic, most by 2wk |
|
|
Term
| 3 regimens for medical SAB management and their success |
|
Definition
| cytotec 1 dose 800mcg vaginally 71% - cytotec 2 dose 800mcg vaginally 84% - mifepristone 200mg PO, in 24h 800mcg cytotec PV 90% |
|
|
Term
| after medical management for SAB what is the follow up |
|
Definition
| TVUS in 7-10d should have no GS and EMS <3cm, if no TVUS available can follow hCG |
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|
Term
|
Definition
|
|
Term
|
Definition
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|
Term
| trimester of most abortion complications |
|
Definition
|
|
Term
| use of osmotic dilatiors and miso in D+C |
|
Definition
| 20-24 wk - osmotic dilators decrease cervical laceration and hemorrhage...…. <20wk miso decreases complications, can do dilators too |
|
|
Term
| which do you prime with mifepristone - medical abortion, delivery for fetal demise - and why |
|
Definition
| medical abortion- decreases time to delivery, decreases retained placenta, unclear for fetal demise |
|
|
Term
| when is it beneficial to do KCL injection or cord transection prior to medical abortion |
|
Definition
|
|
Term
|
Definition
|
|
Term
| race with highest stillbirth |
|
Definition
|
|
Term
| risks for still birth - 4 |
|
Definition
|
|
Term
| 3 studies that may actually give you the cause of stillbirth and % they will |
|
Definition
| placental histology/cultures 30%, perimortum fetal eval 30%, fetal karyotype 8-13% (if structural abnormality >20%) |
|
|
Term
| what are the 3 best ways to perform fetal karyotype in stillbirth and which is best |
|
Definition
| amniocentesis 84% > placenta at cord insertion 30% > chostochondral junction / patella |
|
|
Term
| what labs should every mom with a still birth get - 6 |
|
Definition
| KHB, parvo, RPR, APAS, CBC, TSH |
|
|
Term
| what labs can you consider in select patients with stillbirth - 5 |
|
Definition
| thrombophilia, paternal karyotype, HBA1C, UDS screen |
|
|
Term
| which stillbirth patients shoulg get thrombophilia work up - 3 |
|
Definition
| severe placental abnormalities, IUGR, FHX |
|
|
Term
| which stillbirth patients should get HBA1C - 2 |
|
Definition
| LGA, maternal risk factors |
|
|
Term
| which stillbirth patients should get UDS - 2 |
|
Definition
| abruption, suspect drug use |
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