Purpose: To distinguish appropriate uses for choosing different types of pregnancy tests. For the following scenarios, indicate whether you would use a high sensitivity urine pregnancy test (HSPT) or a serum quantitative hCG test, the reasons why. Address related questions.
- A patient comes to your office requesting pregnancy confirmation and to discuss her options. She is 4 weeks 2 days LMP.
- A patient is 6 weeks by LMP with a pregnancy of unknown location (transvaginal ultrasound examination shows no intrauterine gestational sac and no ectopic pregnancy). The patient has been spotting intermittently but is otherwise asymptomatic. A quantitative hCG you draw comes back at 1000, and another 48 hours later comes back at 1400.
- What is the differential diagnosis?
- Would your approach to care differ with a desired vs. undesired pregnancy?
- A patient returns for a follow-up visit 3 weeks after a first-trimester aspiration because of intermittent bleeding since. The patient started taking oral contraceptive pills the day following the abortion, and has been sexual active since the uterine aspiration.
Purpose: To review key information about ultrasound in early pregnancy.
- What is the differential diagnosis of the following ultrasound findings? What steps would you take to clarify the diagnosis?
- Mean gestational sac diameter 18 mm with no yolk sac or embryo visible.
- Embryonic pole length 5 mm with no visible cardiac activity.
- 3 mm x 3 mm central anechoic sac in pregnant patient 5w3d by LMP with history of intermittent right lower quadrant cramping.
- Embryonic pole length 8 mm with no visible cardiac activity.
- Irregular, flattened gestational sac without embryo, with cystic changes present resembling “swiss cheese” pattern in patient who is 8 weeks LMP.
Purpose: To identify conditions prior to uterine aspiration that may warrant special management, consider how you would manage the following case scenarios. Not all material is covered in the Chapter.
- A 41-year-old patient presents for uterine aspiration at 5 weeks LMP. Pelvic examination reveals an irregular uterus that is 17 weeks in size. Ultrasound examination shows an intrauterine sac in the fundus consistent with 5 weeks gestation and multiple submucosal uterine fibroids.
- A 26-year-old patient presents to your office at 7 weeks gestation. They had a chest x-ray and abdominal series after a motor vehicle accident 2 weeks ago and decided to have an abortion because of concerns about the effects of the radiation on the fetus.
- You are preparing to perform a uterine aspiration for a patient who is 5 weeks pregnant. When you insert the speculum, you note that the cervix looks inflamed and friable and has pus at the os.
- A 40-year-old G4P3 patient at 7w4d presents for uterine aspiration. She has a BMI of 35 and a history of 3 previous cesareans.
- A 29-year-old patient presents for uterine aspiration at 7 weeks gestation. They have a prior history of venous thromboembolism and is currently anticoagulated on warfarin; the INR is in the therapeutic range.
- A 38-year-old patient presents for a uterine aspiration at 6 weeks gestation, with a blood pressure of 170/110 and a headache.
- A 26-year-old patient with a history of diabetes presents for a uterine aspiration at 8 weeks gestation. A pre-operative glucose level is 520 mg/dL.