abortion and ectopic pregnancy

normal pregnancy development landmarks: 4-5 weeks, 5-6 weeks, 6-7 weeks, 7 weeks, 8 weeks

empty g sac msd 5 mm, g sac with yolk, msd 16 mm heartbeat crl 6 mm, crl 10 mm, crl 16 mm fetal movement

vaginal blood with what color is a sign of early pregnancy failure

bright red

reasons for 1st trimester failed pregnancy

ova don’t decide, chromosomal abnormalitity, increased maternal age, drug use, corpus luteum failure

fetal heart rate less than … bpm and/or crl of less than … mm may predict demise

80, 5

normal 1st trimester heart rate …-… bpm

100-120

gestational sac fetal demise features

abnormal size, 16 mm and no embryo, 8 mm and no yolk sac, abnormal shape, trophoblastic reaction, abnormal position

g sac over 16 mm w/o fetal pole 3 names

anembryonic pregnancy, blighted ovum, pseudosac

amnion fetal demise features (2)

visualized after 7 weeks, collapsed,

yolk sac fetal demise features

less than 2 mm, greater than 5.6 mm, solid, calcified, absent with 8 mm g sac, absent with fetal pole

yolk sac is measured … to …

inner to inner

hcg: quantitative vs qualitative

level of hcg in blood, positive or negative

hcg: 1st international standard is … 2nd is, 3rd is … compared to 1st

twice, same

hcg: doubles every …-… days in a normal pregnancy until weeks ...-…

2-3, 8-9

hcg: g sac should be seen tvu when levels reach …-…, tas when …

1000-2000, 3600

9 types of abortion

threatened, inevitable, imminent, complete, incomplete, missed, anembryonic pregnancy, elective, habitual

threatened abortion: def, symptoms (3), hcg

expulsion of g sac is possible, bloody discharge, cervical softening, cramps, normal or dropping

impending abortion: def, symptoms (3)

approaching g sac expulsion, profuse bleeding, dilated cervix, contractions

imminent abortion: def, symptoms (2), hcg

expulsion in progress, pain, blood and tissue passage, falling

complete abortion: def, ultrasound appearance, hcg

expulsion of all uterine contents, normal uterus (may have some fluid), fall

incomplete abortion: def, hcg

some products are retained in the uterus following expulsion (usually placenta), slowly fall

missed abortion: def, ultrasound appearance (2), hcg

retention of fetus 4+ weeks after demise, cessation of growth, absence of cardiac activity, plateau or fall

anembryonic abortion: aka, def, g sac measures … mm or more

blighted ovum, no embryo, 16

habitual abortion: def

expulsion of non-viable fetuses in 3+ consecutive pregnancies near the same time of development

elective abortion: def

patient requests to terminate pregnancy

ectopic pregnancy: …-uterine, 2 most common sites, most deadly site

extra, ampulla, isthmus, interstitial/cornual

ectopic pregnancy: uterine reaction (3); clinical presentation (5)

enlargement, pseudosac, blood in endometrium; positive pregnancy test, abnormal bleeding, pain, adnexal mass, fluid in pelvis and/or morrison’s pouch

visualization of an intrauterine g sac with a … virtually excludes the possibility of an ectopic, visualization of an extra uterine g sac with … is 100% an ectopic pregnancy

yolk sac, cardiac motion

hcg increases … in an ectopic pregnancy (compared to an intrauterine)

slowly

ectopic pregnancy visualization compared to corpus luteum

echogenic, more vascular

ectopic pregnancy: laparotomy and sapingECtomy

removal of tube with ectopic pregnancy

ectopic pregnancy: laparotomy and sapingOStomy

incision and removal of ectopic pregnancy from tube

ectopic pregnancy: … is the surgical intervention used if an ectopic pregnancy ruptures

hysterectomy

chemotherapy drug used to kill ectopic pregnancies

methotrexate