Class notes
OBGYN
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- Emory University
This is notes from my OBGYN class.
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OBGYN Notes- First Trimester Bleeding and miscarriageA threatened abortion is when a pregnant woman and bleeding the cervix is closed without a
passage of products of conception the fetal is still moving on an ultrasound. Although there is
bleeding there is no sign of the fetus being dead although it may die.
Approximatley 25% of pregnancies will experience bleeding in the first trimester.
● Pain and heavy bleeding are associated with increased risk of pregnancy loss
Even though this is there is a 50/50 chance that the fetal will survive
● The vast majority of pregnancy losses are due to chromosomal anomalies
Differential
● Threatened abortion
Miscarriage
● Inevitable abortion
● Incomplete abortion
● Complete abortion
● Ectopic pregnancy
● Molar pregnancy (partial hydatidiform mole)
● Nun OB causes: Vulvar, Vagina, Cervical trauma/ rough s*x ; cervical polyp
Workup: First Trimester Bleeding
Physical exam
● Rule out trauma. vulvar, vaginal, cervical trauma
● speculum exam to evaluate the cervix. Open SAB. look for clots. Products of conception
Quantitative B-HCG, serum (compare to past and future measurements)
Should be double every 48 hours. Compare to estimated dates on LMP.
If women is bleeding a CBC is whats needed. A complete blood count, also known as a full
blood count, is a set of medical laboratory tests that provide information about the cells in a
person's blood. The CBC indicates the counts of white blood cells, red blood cells and platelets,
the concentration of hemoglobin, and the hematocrit.
To see if the baby is still alive and has a heart beat a Transvaginal ultrasound is used.
The steps of a bleeding pregnant woman are a speculum exam on the OS if the Os is closed
then a Transvaginal ultrasound should be done to examine the baby if the fetus is alive/viable to
detect heart motion. This means there is a Threatened abortion A 50/50 chance of the fetus
making it.But if there is no heartbeat detected from the fetus it is non viable this is called a
missed abortion. Let's say the OS is opened, this is a SAB/Spontaneous abortion. Next step
would be to look at a Transvaginal ultrasound observing how much tissue is left if all remains
this is an inevitable abortion but if some remains its called a incomplete abortion. If no tissue
remains at all thin is a complete abortion. All three of these are managed the same way.
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