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Flashcards in vaginal bleeding Deck (116)
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61

pelvic pain in female ddx

PID, ovarian cysts, torsion, endometriosis
Renal stones, renal infections
Appendicitis, diverticulitis, hernia

62

RF for ectopic pregnancy (6)

1. Current intrauterine contraception (IUD)

2. Hx of ectopic pregnancy, utero exposure to diethylstilbestrol

3. Hx genital infxn, including PID, chlamydia, gonorrhea

4. Hx of tubal surgery i.e. tubal ligation

5. IVF, infertility

6. Smoking

63

ddx of ectopic pregnancy

1. Acute appendicitis
2. Miscarriage
3. Ovarian torsion
4. PID
5. Ruptured corpus luteum cyst or follicle
6. Tubo-ovarian abscess
7. Urinary calculi

64

presentation of ectopic

1. Vaginal bleeding (only in 2/3 of pts!)
2. Abdominal pain
3. Normal or slightly enlarges uterus
4. Cervical motion tenderness
5. Hypotension/syncope
6. Palpable adnexal mass

65

mngmt of ectopic

1. No evidence of tubal rupture
2. Minimal pain or bleeding
3. Starting B-hCG <1,000 and falling
4. Ectopic or adnexal mass less than 3cm or not detected
5. No embryonic heartbeat
6. Then:
a. Admit or discharge & follow serial hCGs
b. Diagnostic laparoscopy
c. Presumptive methotrexate

66

Painless, bright red bleeding in 2nd or 3rd semester

what are you worried about

Placenta Previa

DON'T do a digital or speculum exam
iv. STAT abdominal U/S
v. Call OB stat for possible C/S

67

pt comes in with chief complain of pain in 2nd or 3rd trimester and vaginal bleeding

on PE she has a Tender uterus
and Hypertonic, hyperactive uterine contractions

Premature separation of a normally implanted placenta from the uterine wall
ii. Often misdiagnosed at preterm labor

68

Placental Abruption ddx

placenta previa
preterm labor

69

complication of placental abruption


1. Maternal death from hemorrhage or DIC
2. Fetal death, fetal distress
3. Fetomaternal transfusion
4. Amniotic fluid embolism
5. Hypotension

70

rf for placenta abruption

1. MCC HTN
2. Maternal trauma
3. AMA
4. Multiparity
5. Smoking
6. Cocaine use
7. Previous abruptions

71

management of placental abruption

1. Crystalloids to maintain volume status & FFP for coagulopathy
2. Emergency OB consult whenever suspected!
3. Stat U/S for fetal viability  emergency delivery
4. Rhogam, tetanus

72

Management of 1st trimester bleeding

Quantitative B-hcg >1800-2000
no sac on ULS
ectopic or SAB


U/S shows a gestational sac

a. Follow for threatened abortion
b. Consider subchorionic hemorrhage 
hematoma b/w chorion & uterine wall

73

Bright endometrial stripe suggests on evaluation of 1st trimester bleeding

SAB

74

Gestation sac >2cm should have a

embryo

75

Embryo > 5mm crown rump should have a

Heart beat

76

if fetal heart beat present in mother with 1st trimester bleeding

1. <35yo mother  2% risk of miscarriage
2. >35yo mother  16% risk of miscarriage

pt stable
Follow serial quantitative B-hcg q 48hrs
Confirm quant B-hcg double in 48hrs
Confirm IUP when B-hcg >1800-2000

77

CC of SAB

i. MCC chromosomal abnormalities (50-60%)
ii. AMA
iii. Prior poor OB hx  SABS, fetal demise, multiple gestations, uterine s/x
iv. Concurrent medical d/o  thyroid, DM, HTN, coagulopathies, P4 deficiency, SLE
v. Maternal infxn  HIV, syphilis, TORCH, GC/CT, UTI, vaginitis
vi. Exposures-> heavy metals, chemicals, tobacco, EToH, caffeine (>200mg/d)
vii. Meds antidepressants: paroxetine, venlafaxine

78

MCC of bleeding during 1st trimester

SAB

79

HELLP syndrome

1. Hemolysis
2. Elevated Liver Enzymes
3. Low Platelet count

(Often no HTN +/- proteinuria )

80

diagnoses of HELLP

CLINICAL

get
CBC, CMP, LFTs

81

presentation of HELLP

N/V, viral like, generalized malaise

Epigastric pain, HA

** any pregnant woman who presents w/ malaise or viral type illness in 3rd trimester should be eval w/ labs asap!

82

pe of HELLP

RUQ pain & tenderness  rupture of liver capsule= hematoma

83

TX of HELLPO

1. Prompt delivery of baby!
2. Magnesium sulfate --> decrease risk of seizures
3. Blood transfusions --> anemia
4. DIC --> fresh frozen plasma
5. Anti-HTN --> i.e. labetalol, hydralazine, nifedipine

84

Causes of PID

i. Salpingitis, endometriosis, tubo-ovarian abscess, pelvic peritonitis
ii. Neisseria gonorrhea, chlamydia trachomatis (may have been asymptomatic)
iii. Untreated cervicitis

85

RF of PID

i. Multiple sex partners
ii. Unprotected intercourse
iii. Hx of STIs
iv. Frequent vaginal douching
v. Younger age

86

clinical findings with PID

i. Lower abdominal pain
ii. abnml vaginal discharge
iii. vaginal bleeding
iv. post-coital bleeding
v. dyspareunia
vi. irritative voiding sxs
vii. malaise, N/V

87

PID PE

i. Lower abd TTP, abd guarding/rebound (peritonitis)
ii. CMT, uterine/adnexal TTP, adnexal mass or fullness (TOA)
iii. RUQ tenderness and jaundice

88

labs for suspected PID


i. hcG-->ectopic, SAB
ii. saline/KOH wet mounts--> trich
iii. endocervical swabs --> GC/CT, HIV, HEP
iv. CBC, ESR, CRP, liver panel

89

parenteral tx for PID


cefotetan or cefoxitin + doxycycline

Clindamycin or gentamycin

Ofloxacin or levofloxacin w/wo metronidazole

90

Oral/outpt

cefotetan or cefoxitin + probenecid + doxycycline w/wo metronidazole