Medicine an Surgery notes

Apr 25th, 2015
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Issues in Early PregnancyACOG District I Medical StudentTeaching Module 2008When a woman presents with an earlypregnancy Ask yourself two questionsWhere is this pregnancy?Is it viable?Where is this pregnancy?In a woman with an early pregnancy you mustdetermine if the pregnancy is intrauterine oran ectopic,ectopic because her life could depend onit!How to you determine location of thepregnancy? First determine dating by LMP Then perform ultrasound If you can see location of the pregnancy, youare done! If you cannotit becomes more complicatedEarly pregnancy with unknownlocation Check a serum BHCG If it is above the discriminatory zone (DZ)(this is different at every hospital) anintrauterine pregnancy should be seen Then do an ultrasound to see if you see thepregnancyEarly pregnancy with unknownlocation If BHCG>DZ and pregnancy seen in the uterus,you are done If BHCG>DZ and no pregnancy seen in theuterus, it is an ectopic until proven otherwise!Ectopic pregnancy 2% of all pregnancies Risk factors include prior tubal surgery, priorectopic, current IUD use, history of PID, or DESexposure A woman can present with abdominal pain orbleeding or be asymptomatic!Ectopic Pregnancy 95% are in the fallopiantube (70% ampulla, 12%isthmus, 11% fimbria,2% interstitial/cornual) Ovarian occurs about3% of the time,abdominal 1% of thetime and cervical <1%of the timeSeeber

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