HY lecture notes:
Labor in first trimester often presents as severe cramping/pelvic pain. Most abortions occur in first trimester and are due to chromosomal abnormalities.
Threatened abortion –> closed cervix + bleeding per vaginum + live fetus; Tx = bedrest.
Inevitable abortion –> open cervix + bleeding per vaginum + live fetus; Tx = dilatation & curettage (D&C) or suction curettage.
Missed abortion –> closed cervix + no passage of uterine contents per vaginum; USS shows intrauterine fetal demise; Tx = dilatation & curettage (D&C) or suction curettage.
Complete abortion –> closed cervix + all products of conception have passed.
Incomplete abortion –> open cervix + passage of clots + variable ultrasound findings.
Septic abortion –> fever + purulent vaginal discharge + severe cramping/pain. USMLE will often say there’s a laceration on the cervix from an attempt at self-termination of an unwanted pregnancy.
Pelvic inflammatory disease (PID) –> Tx with IM ceftriaxone PLUS oral azithromycin or oral doxycycline. Can cause Fitz-Hugh-Curtis (inflammation/extension to liver capsule).
Chorioamnionitis + endometritis are treated with ampicillin + gentamicin + clindamycin.
Chorioamnionitis = woman is clearly pregnant. Endometritis = woman is not pregnant.
Chorioamnionitis usually caused by prolonged rupture of membranes (PROM; >18 hours), e.g., if ROM <24 weeks gestation (non-viable period; chance of survival at best obgyn specialty centers ~50% at 23.5 weeks gestation), where the pregnancy is kept going with tocolysis + antibiotics until fetus is viable. This may occur in the setting of cervical incompetence, e.g., from prior conization.
Endometritis usually post-partum endometritis, e.g., after C-section –> diffuse abdominal pain + fever following C-section.
Group B Strep prophylaxis = considered successful if IV penicillin or ampicillin given within four hours of delivery of fetus.
Indications for GBS prophylaxis:
Firstly, DO NOT give if there was mere colonization in prior pregnancy (i.e., she merely tested + on rectovaginal swab in prior pregnancy).
Give if:
- Prior pregnancy resulting in early-onset GBS disease (i.e., meningitis, pneumonia, sepsis in the neonate).
- Current pregnancy there is positive rectovaginal swab at 36 weeks.
- Current pregnancy there is GBS bacteriuria at any stage, even if it’s first trimester and she’s treated successfully.
- If maternal status is unknown, give if:
- Maternal fever >38C.
- ROM >18 hours.
- Preterm <37 weeks gestation.
