Term
| When are ectopic pregnancies more common? |
|
Definition
| with scarring of the internal genital tract such as with multiple D&Cs, STDs, PID, adhesions, endometriosis |
|
|
Term
| Do ectopic pregnancies cause pain? |
|
Definition
|
|
Term
| What is the most common cause of maternal deaths in the 1st trimester? |
|
Definition
| pregnancies within the tube that rupture and cause hemorrhage |
|
|
Term
| With ectopic pregnancies, what might you see in the uterus? |
|
Definition
empty uterus
empty gestational sac (20% of time) |
|
|
Term
| When a pt has a positive pregnancy test, beta subunit hCG testing is begun... what does it mean if the level is rising? falling? |
|
Definition
Rising: there's a baby in there somewhere
Falling: keep checking, and make sure it goes to 0, if it plateaus before 0, suspect some sort of gestational trophoblastic dz |
|
|
Term
| What is the optimal and most cost-effective strategy for diagnosing an ectopic pregnancy? |
|
Definition
| transvaginal ultrasonography followed by quantitative hCG testing. |
|
|
Term
| At 5 weeks pregnancy, what do you see on ultrasound? |
|
Definition
| no embryo, just that the uterus is not flat anymore. |
|
|
Term
| any sexually active woman in her childbearing years who presents with lower abdominal pain must have what ruled out as a cause? |
|
Definition
|
|
Term
| What are the differential dx to ectopic pregnancy symptoms? |
|
Definition
acute appendicitis
miscarriage
ovarian torsion
PID
Ruptures corpus luteum cyst or follicle
tubo-ovarian abscess
urinary calculi |
|
|
Term
| What are the treatment options for a stable pt with ectopic pregnancy? unstable? |
|
Definition
stable: surgical removal of pregnancy and tube
~laparoscopy
~Methotrexate (PO or IM), IM more effective
unstable: surgical removal or pregnancy and tube |
|
|
Term
| What must be true for methotrexate to be an effective treatment for ectopic pregnancy? |
|
Definition
~lower hCG level, the higher it is, the less likely it is to work
~If tube has not started to rupture
~must be done in conjunction with serial beta subunit hCG to verify pregnancy is ending, check Q2-3 days |
|
|
Term
| When is expectant management of an ectopic pregnancy given? |
|
Definition
~beta-hCG level less than 1000 mIU per mL and declining
~ectopic mass less than 3 cm
~no fetal heartbeat
~pt aggrees to follow up with follow-up requirements |
|
|
Term
| Other than Methotrexate, with its disrupting of rapidly dividing trophoblastic cells, what other drugs can be used to treat ectopic pregnancy? |
|
Definition
hyperosmolar glucose
prostaglandins
mifepristone (Mifeprex) |
|
|
Term
| What are the 4 main types of Gestational Trophoblastic Disease? |
|
Definition
hydatidiform mole (complete or partial)
persistent/invasive gestational trophoblastic disease
choriocarcinoma
placental site trophoblastic tumors |
|
|
Term
| Which type of GTD is most common? |
|
Definition
|
|
Term
| How does a complete Hydatidiform mole develop? |
|
Definition
sperm fertilizes an empty egg (contains no nucleus or DNA)
~no fetal tissue
~up to 20% of pts will need additional surgery or chemo after their initial surgery |
|
|
Term
| What might complete moles develop into? |
|
Definition
choriocarcinoma
-small chance |
|
|
Term
| If a woman is expecting and placenta shows a "snowstorm appearance", what is it? |
|
Definition
|
|
Term
| What is the tx for a complete mole? |
|
Definition
|
|
Term
| how does a parital hydatidiform mole develop? |
|
Definition
when 2 sperm fertilize a normal egg
~so, contain SOME fetal tissue
~rarely viable (too many chromosomes)
~small percentage need further trreatment after their initial surgery |
|
|
Term
| Persistent GTD, is GTD that has not what? |
|
Definition
been cured by local surgery
~usually are complete moles that persist and are invasive
~usually bc D&C only removed the top layer of mole the first time and not the tumor deep inside the m. wall of the uterus. |
|
|
Term
| How is persistent GTD dxed? |
|
Definition
if B-HCG decreases but then levels off or starts to rise again.
~this could be a mole or choriocarcinoma
~pt must be reexamined, a CXR and possibly a liver scan. |
|
|
Term
| What is the tx for persistent GTD? |
|
Definition
|
|
Term
| What are 4 risk factors that increase the development of GTD-invasive mole? |
|
Definition
if there is a long time (4 mos) bw the time periods stopped and tx is started
uterus has become very large
40 years+
GTD hx |
|
|
Term
| Sometimes invasive moles disappear on their own, but if not can be treated with what? where does it metastasize to in 15% of cases? |
|
Definition
|
|
Term
| Choricarcinoma is a _________ form of GTD. |
|
Definition
|
|
Term
| Choricarcinoma can occur from a complete mole or what? |
|
Definition
after a normal pregnancy where the fetus is lost early in the pregnancy
~women keep having symptoms of pregnancy after a pregnancy |
|
|
Term
| Is choriocarcinoma usually diagnosed promptly? |
|
Definition
no
~bad bc is a very aggressive cancer |
|
|
Term
| If a choriocarcinoma is very invasive, then it destroys tissue and bleeds profusely... how does this present in the brain? lung? uterus? |
|
Definition
stroke or seizure signs
coughing up of blood
irregular bleeding |
|
|
Term
| What can indicate the presence of choriocarcinoma? |
|
Definition
|
|
Term
| What is GTD-Placental-Site-Tumor? |
|
Definition
rare form of GTD that develops where the placenta attaches to the uterus
~tumor most often develops after a normal pregnancy or abortion
~do not usually spread |
|
|
Term
| Are placental tumors sensitive to chemo? |
|
Definition
| no, surgery is the best tx |
|
|
Term
|
Definition
complete hytidaform mole: irregular vaginal bleeding during pregnancy (1st trimester, bw 6th and 16th week)
~often pass clots or pieces of the mole (grape-like)
~abdomen gets bigger faster
~hyperemesis
~preeclampsia (25%)
Partial moles: most frequently dxed after a miscarriage
~abdomen doesnt get enlarged as often
~preeclampsia (4%) |
|
|
Term
| If BP increases, and proteinuria is present after 24 wks what do you suspect? before 24 wks? |
|
Definition
preeclampsia
molar pregnancy |
|
|
Term
| What are the indications for D&C or hysterectomy? chemotherapy? |
|
Definition
|
|
Term
| In isoimmunization, Rhogam ______ sensitization, it does not treat it. |
|
Definition
|
|
Term
| A titer of what is considered sensitized? |
|
Definition
< 1:4
~worried about IgG, bc can cross placenta
~sensitized pregnancies are monitored by amniocentesis |
|
|
Term
| What are the signs of isoimmunization rxns on ultrasound? |
|
Definition
fetal ascites
placentomegaly from edema
polyhydraminos (too much amniotic fluid) |
|
|
