OB-Miscarriage & management

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  1. What occurrs with free B-hCG?
    • -Promotes growth & invasion in non-gestational pregnancies
    • -poor prognosis
  2. What is the importance of H-hCG?
    • -Essential for cell to burrow into endometrium
    • -Usually gone by 6 weeks in pregnancy
    • **if persistent--> gestational trophoblastic neoplasia (molar)
  3. What is the importance of intact hCG of both alpha & beta?
    -Promotes progesterone production by CL & spiral artery angiogenesis
  4. How long does a positive pregnancy test show up (with the line)?
    • 14 weeks
    • -it's sensitive to hCG ~25mlu/ml
  5. What is the average hCG level at 4 weeks?
    100 at 28-30days
  6. What is the normal rise of hCG during pregnancy?
    Doubles q 36-48hrs x 10 weeks

    **PEAKS ~ 70days
  7. At about how many days does the hCG decrease to 5-20?
    @ 120 days
  8. What should you consider with a rapid rise in hCG?
    molar pregnancy
  9. When is the normal peak of hCG?
    7-10weeks (@ 100,000 via urine hCG)
  10. If a patient is bleeding and the hCG is not 0... what should you do?
    Monitor hCG q 2 days to figure out the rise and pattern
  11. What is an inevitable abortion?
    -dilated cervix, but POC not expelled
  12. What is a missed abortion?
    -known fetal demise, but still in uterus
  13. What is a threatened abortion?
    -Pregnancy complicated by bleeding <20 weeks gestation (viable baby)
  14. About how many pregnancies end in miscarriage?
  15. What are some maternal risk factors for miscarriage?
    • -AMA
    • -substance use (tobacco, ETOH)
    • -anesthetic gas exposure
    • -chronic maternal disease (DM)
    • -Rapid repeat pregnancy
    • -IUD use
    • -Maternal infection
    • -Meds/toxins
    • -mult previous elective abortions
    • -previous SAB
    • -uterine anomaoly (bicornate uterus)
  16. When bleeding presents in the 1st trimester, list 6 DD.
    • 1. Cervical/vaginal abnormality (polyp, trauma, cancer)
    • 2. ectopic/molar
    • 3. idiopathic bleed
    • 4. vaginal/cervical infection
    • 5. SAB
    • 6. subchorionic bleed
  17. What are the steps in the 1st TM workup for vaginal bleeding?
    • -Quant hCG
    • -wet prep, GC
    • -CBC, ABO
    • -U/S
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OB-Miscarriage & management
2013-05-20 19:14:03

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