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Vaginal Bleeding 2 (repro age w/ poss pregnancy) (Abortions abortions…
Vaginal Bleeding 2 (repro age w/ poss pregnancy)
vaginal bleeding in reproductive age: must consider pregnancy :pregnant_woman:
Abortions
abortions must pass through predictable phases
Intrauterine pregnancies (IUP)
Threatened Abortion
at this point, bed rest may rescue the pregnancy
can proceed as normal
Beyond this point, abortion will resume to completion
Inevitable
Incomplete
Complete
(+) clots/parts
closed
nothing
(+) clots or fetal parts
open
more to come
retained parts :skull_and_crossbones:
not everything is expelled yet
none
open
ready to expel dead baby
dead baby :skull:
none
closed
live baby :baby::skin-tone-2:
Missed abortion
baby is dead
mom should expel it
but body doesn't recognize aborted baby
none
closed
dead baby :skull:
Tx: misoprostol (RU486) in 1st Tri
OCT for induction of dead baby :skull:
D&C if wants to speed up process, or retained parts
:warning:Rh (+) moms need Rhogam if potential for Rh(+) baby
none
closed
live baby :baby::skin-tone-2:
Ectopic pregnancies
Pt: (+) UPT w/ Vaginal bleeding
Transvaginal US
look @ baby
IUP
see something in uterus
Molar
Snowstorm patten
Tx: evacuation w/
suction curretage
& OCP
can't become pregnant
monitor ßHcG
watch for choriocarcinoma :crab: development
Normal Pregnancy
Abortion
Ectopic pregnancy
US
beta Quant (ßHcG in blood)
(+) rupture or hemodynamic instability
Tx: Salping
ectomy
removal of Fallopian tubes
(-) rupture
Tx: Salping
ostomy
open tube, suck out contents, close
Medical therapy (rare, usually sx)
MTX ± leucovorin
can use, even if it doesn't meet the criteria
for
shelf/step
need to meet certain criteria
use 8,000 & 3cm = high success rate
evidence for 5,000 & 3.5cm success
ßHcG must be < 5,000
gestational size <3.5cm
no fetal heart tones :forbidden::<3:
mom didn't use folate
Don't see anything :shrug::skin-tone-3:
ß-Quant
ßHcG in blood
gives an actual number, vs UPT
discriminatory zone (1,500-2,000)
if more than that, should be able to see IUP :baby::skin-tone-2:
ß-Quant ≥ 1,500 (or 2,000)
Should see IUP
No IUP still?
Treat as ectopic pregnancy
#
ß-Quant < 1,500 (or 2,000)
too soon to tell
Come back in 48 hr to repeat ß-Quant
if ß-Quant doubles, it is IUP
#
guaranteed IUP
ß-Quant fails to double = ectopic
#
Passage of contents
Os
US