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Questions and Answers
What is a common symptom of ectopic pregnancy that is seen in 50% of patients?
What is a common symptom of ectopic pregnancy that is seen in 50% of patients?
In diagnosing ectopic pregnancy, which of the following indicates a possible surgical emergency?
In diagnosing ectopic pregnancy, which of the following indicates a possible surgical emergency?
What is the expected rate of increase for a serial serum quantitative beta-hCG level if the initial level is 3,000 mIU/mL?
What is the expected rate of increase for a serial serum quantitative beta-hCG level if the initial level is 3,000 mIU/mL?
Which of the following treatments is recommended for a confirmed ectopic pregnancy in stable women?
Which of the following treatments is recommended for a confirmed ectopic pregnancy in stable women?
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At what hCG discriminatory level should ultrasound evidence of an intrauterine pregnancy be expected?
At what hCG discriminatory level should ultrasound evidence of an intrauterine pregnancy be expected?
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What is the primary consideration for medical management of gestational hypertension?
What is the primary consideration for medical management of gestational hypertension?
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Which medication is considered safe for treating chronic hypertension in pregnancy?
Which medication is considered safe for treating chronic hypertension in pregnancy?
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When should insulin be considered in the treatment of gestational diabetes?
When should insulin be considered in the treatment of gestational diabetes?
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What is the goal for fasting blood glucose levels in patients with gestational diabetes?
What is the goal for fasting blood glucose levels in patients with gestational diabetes?
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In hypertension during pregnancy, which condition is characterized by blood pressure exceeding 150/90 after 20 weeks?
In hypertension during pregnancy, which condition is characterized by blood pressure exceeding 150/90 after 20 weeks?
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What is the risk associated with using Glyburide for managing diabetes in pregnant patients?
What is the risk associated with using Glyburide for managing diabetes in pregnant patients?
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What is the monitoring frequency for women with chronic hypertension during pregnancy?
What is the monitoring frequency for women with chronic hypertension during pregnancy?
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Which treatments are contraindicated for managing hypertension in pregnant patients?
Which treatments are contraindicated for managing hypertension in pregnant patients?
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Study Notes
Ectopic Pregnancy
- 50% of patients with ectopic pregnancy experience abdominal pain, vaginal bleeding, and amenorrhea.
- Other potential signs include:
- Painful fetal movements (in advanced abdominal pregnancy)
- Dizziness or weakness
- Fever
- Flu-like symptoms
- Vomiting
- Syncope
- Cardiac arrest
- Signs suggesting a surgical emergency include:
- Abdominal rigidity
- Involuntary guarding
- Severe tenderness
- Evidence of hypovolemic shock (orthostatic blood pressure changes, tachycardia)
Diagnosis of Ectopic Pregnancy
- Serial serum quantitative beta-hCG levels are used, with an expected increase of 33% in 48 hours if the initial level is 3,000 mIU/mL.
- Ultrasound imaging is necessary to visually determine the location of the pregnancy.
- Visualization of a gestational sac with a yolk sac or embryo on ultrasound is essential for confirming an intrauterine pregnancy.
- An hCG discriminatory level of 3,500 mIU/mL indicates the potential for visualizing landmarks of an intrauterine pregnancy on ultrasound.
Treatment of Ectopic Pregnancy
- Medical management with intramuscular methotrexate is an option for hemodynamically stable women with a confirmed or suspected ectopic pregnancy, without rupture, and no contraindications.
- Methotrexate is not FDA-approved for this use, but it is endorsed by ACOG.
- Medical management is more cost-effective and avoids the risks of surgery and anesthesia.
- hCG values should be less than 1,500 mIU/mL for methotrexate therapy to be effective.
Medications During Pregnancy
- Hypertension: Labetalol, Nifedipine, Methyldopa
- Mood Disorders: Zoloft
- Diabetes: Insulin
Hypertension in Pregnancy
- Gestational hypertension: BP > 150/90 after 20 weeks of pregnancy, resolving within 12 weeks postpartum.
- Clinically asymptomatic.
- Elevated BP without proteinuria.
- Medications may be withheld, but hydralazine or labetalol are safe if treatment is needed.
- Chronic hypertension: BP > 140/90 before 20 weeks of gestation, persisting for > 6 weeks postpartum.
- Symptoms include headache and visual symptoms if severe.
- Mild BP > 140/90, Severe > 180/110 without proteinuria.
- Monitor every 2-4 weeks, then weekly at 34-36 weeks and deliver at 39-40 weeks.
- Severe HTN (BP > 150/100): Labetalol or intermediate-acting/extended-release nifedipine. Oral hydralazine can be added if needed. Methyldopa is a safe alternative but less effective.
- Avoid ACE inhibitors and diuretics.
Gestational Diabetes
- Treatment: Daily blood glucose monitoring after fasting overnight and after each meal.
- Review home glucose levels at each office visit.
- Fasting glucose > 105 mg/dL or 2-hour postprandial glucose > 120 mg/dL may require insulin.
- Insulin is the treatment of choice, aiming for fasting glucose < 95 mg/dL.
- NPH/Regular insulin regimen: 2/3 in the morning and 1/3 in the evening.
- Glyburide (oral hypoglycemic) can be used initially, but it carries a higher risk of eclampsia.
- Early delivery by c-section at 38 weeks if the child is macrosomic.
- Good glucose control is defined as normal results on a 2-hour glucose tolerance test.
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Description
This quiz covers the signs and symptoms of ectopic pregnancy, along with its diagnosis methods. Understand the critical indicators of this medical condition and learn how to identify when a surgical emergency may occur. Test your knowledge on the importance of beta-hCG levels and ultrasound imaging in the diagnosis.
