(On Tuesday of April 4, 2023). On the Matter of First Trimester Bleeding and Miscarriage by MD Paul W. Bolin (CRASH! Medical Review Series) on Obstetrics/Gynecology (ObGyn): 1) Epidemiology of First Trimester Bleeding (FTB): 1) One Quarter of Pregnancies have FTB; b) Heavy Bleeding and Pain have an Association with Pregnancy Loss; c) Chromosomal Abnormality is usually the Aetiology of Pregnancy Loss (Trisomy, Monosomy, Uniparental Disomy, and the Like) which has a an Association to Maternal Age And/or Paternal Age; 2) Differential Diagnosis (DDx): 1) Threatened Abortion has the Cervical Os Closed (Visualization via Speculum) with FTB (Less than 20th Week Gestational Age and Positive Qualitative B-hCG Test), without Passage of Products of Conception or Absent Evidence of Fetal/Embryonic Demise (TVUS), which nevertheless can progress onto Miscarriage later on; 2) Miscarriage and/or Spontaneous Abortion (SAB) will have an Open Os but Transvaginal Ultrasound (TVUS) will show a Fetus absent of Cardiac Motion: a) Inevitable Abortion Type has Hemorrhage, an Open Cervical Os but No Passage of Fetal Tissue on TVUS, and/or no Detectable Motion within the Embryo Heart; b) Incomplete abortion has FTB, Open Cervical Os with Passage of Some But not all Fetal Debris; c) Complete Abortion will have an Close Cervical Os and TVUS will show all Fetal Tissue has Cleared. The Uterus will be Empty/Evacuated; d) Missed Abortion has No Hemorrhage with a Closed Cervical Os. The Fetus on TVUS is Deemed Dead (Visualization Yield no Cardiac Motion). Mx of all SABs Possible include RhoGam Vaccination (Prophylaxis For Alloimmunogeneicity) at 300 micrograms IM ; 3) Ectopic Pregnancy is a Pregnancy incompatible with Life, Qualitative B-hCG are Positive, TVUS shows no Fetus, and Management is Localization of Fetus (Tubal Ampulla and Phallopian Tube). Also, Cervical Os Status is Variable (Dilated or Constricted). SSx may be Amenorrhea, Vaginal Bleeding or FTB, Lower Abdomen Tenderness/Pain, Adnexal Tenderness And/or Mass, Some Cervical Motion Tenderness; and Tx via Salpingotomy Or Salpingectomy Surgery; Mx: 1) Expectant Conservative Mx when B-hCG is Less than 2,000 mIU/mL and Hemodynamically Stable; 2) Medical Mx via Methotrexate (Folate Antagonist) with B-hCG Less than 5,000 mIU/mL and Hemodynamically Stable; or 3) Surgical Mx via Salpingostomy/Salpingectomy with B-hCG greater than 5,000 mIU/mL, or Hemodynamically Unstable (IV Fluid Resuscitation Therapy), or Symptomatic Ongoing Rupture of Ectopic Mass, Signs of Intraparietal Hemorrhage, or Contraindications to MTX (Intrauterine Pregnancy [Teratogen and Birth Defects], Evidence of Immunosuppression, Moderate to Severe Anemia, Leukopenia, or Thrombocytopenia, Etcetera); All Subjects should be Follow up with Serial Ultrasounds and Quantitative B-hCG Levels until such are Undetectable; FTB warrants RhoGAM Prophylaxis due to the Possibility of Antigen Activation of the Maternal Immune System (Antigen D Immunoglobulin from Donation of Plasma Specimens Prepared Commercially and Controversially Used nonetheless); 4) Molar Pregnancy ([MP] Usually due to a Hydatidiform Mole) is Incompatible with Life usually due to Chromosomal Abnormalities (Trisomy, Polyploidy, Nondisjunction and the like) with FTB, N/V, Uterus Abnormality (28%) for Gestational Age (Close is Large; Partial is Small) with Hydropic Villi Morphology (Grape-like Profusive Pattern) and Hemorrhage within. B-hCG is abnormally High for Gestational Age (Greater than 100,000 mIU/mL); Types of MPs: 1) Complete Hydatidiform Mole with Uniparental Disomy with Sonography showing Prominent Villi and Snowstorm Appearance without a Visible Fetus. CXR to Look For Possible Metastases and Monitor (Follow Up) with Serial Quantitative B-hCG Levels (Progression to Gestational Trophoblastic Disease [GTD] of Neoplasia [Proliferation Disease Process] if no Normalization). Tx is Debridement and Curettage (D&C Surgery) and Suction; Hysterectomy can be done if Subject does not wish further Pregnancy (Nulliparous Decision); 2) Partial Hydatidiform Mole with Triploidy (69 Chromosomes out of 46 in Euploidy) and Sonography showing a Fetal Pole (Absent Cardiac Motion and No Viability Possible) and Often Confused with a Missed Abortion; 5) Non OB Causes: a) Vulvar, b) Vagina, c) Cervical Trauma, d) Cervical Polyp; e) Coitus Robustus; f) Trauma And/or Injury (Physical Examination and Clinical Diagnoses); 3) Prognosis (Prx) of FTB and Miscarriage with a Progesterone Level Assessment of Less than 6 ng/mL (16 nmol/L) can reliably Exclude a Viable Pregnancy, with a Negative Predicative Value of 99% (Sensitivity of 99%); 4) Physical Examination on the Clinical Scenario of FTB (Px) and Diagnosis (Dx): 1) Rule out Vulvar, Vaginal or Cervical Trauma (Bicycling during Pregnancy); 2) Speculum Examination (A Specific Amplification Device to Female Urogenitalia) is useful to Evaluate the Cervix, where an Open Os indicates Spontaneous Abortion/Miscarriage (Thrombus and Conception Products [Fetal Debris]); 3) Quantitative Serum Beta-Human Choriogonadotropin Hormone (B-hCG) Levels to compared with Past Levels and Future one Also understanding Levels should Double within 48 Hours and Comparison to Estimated Dates on LMP; 4) Complete Blood Counts (CBC) whenever Hemorrhage is Relevant and Ongoing; 5) Transvaginal Ultrasound (TVUS) to Visualize the Fetus (Cardiac Motion Assessment assures a Viable Fetus at 6-7 Weeks LMP); a) Ectopic Pregnancy can hereby be Excluded or Suspected (B-hCG and Fetus Absence is Diagnostic upon Fetus Localization) if Evidence of Intrauterine Pregnancy in wanting; 6) Blood Testing via Prothrombin Time and Partial Thromboplastin Time (Factors of Coagulation) and Blood Type with ABO and Rh Factor (D Antigen Status); 7) Treatment (Tx): 1) RhoGAM Alloimmunogeneicity Prophylaxis; 2) Fluid Resuscitation Therapy if Unstable; 8) Management (Mx): 1) Depending on the Diagnosis and Prophylaxis and wishes of the Subject (Surgery is Preferred with some while Medical Procedure can be influenced by Religious Dogma of Non Blood Transfusion Possibility amongst other Considerations (Misoprostol (Oxytocin Secondary) to Induce Evacuation and Methotrexate in Ectopic Pregnancy; 9) Complication (Cx): 1) Pregnancy Loss; 2) Dysmenorrhea (1-2 Sanitations Amenities Per Hour Usually); 3) Septic Abortion or Retained Products of Conception (POC) can have Hypovolemia and Termination of Pregnancy Thereby; 4) Endometritis, Surgical Intervention Complications/Endometriosis is Metastasis of Endometrium Tissue to Ectopic Locus; 5) Threaten Abortion can have Complications Peripartum, Antepartum ( Second Trimester Abruptio Placentae or Late SAB) or FTB and SAB in Later Pregnancy (Association of Past Medical History and Diathesis of Miscarriage [Rh Negative Females are Generally the Bulk of Complicated Gestations]); Goodness, my first Trophoblastic Disease Management. Not Really, Just Kidding. The Subject was Given Ultrarelevant (Rather than Systemically and Institutionalized Medicine) for Specificity and Sensitivity to the Diathesis and Environmental Factors Relevant in the Genitorurinary Tract, amongst other Considerations via Transfection of Genetic Product of the Significance of 9q34 (D-Antigen Gene), 6p21 (MHC-HLA Significence) and eugenized the Sex Chromosomes (Both Lineages with Vectored Modifing Viral Mechanisms). MD Paul W. Bolin, es geht sehr gut aber man muss lernen was gut soll gehabt gewessen nicht nur was sie ist. Heil!
Theany you for every thing , but I have a note , in 7:18 In case of complete abortion , the cervical os is closed not opened …..
(On Tuesday of April 4, 2023). On the Matter of First Trimester Bleeding and Miscarriage by MD Paul W. Bolin (CRASH! Medical Review Series) on Obstetrics/Gynecology (ObGyn): 1) Epidemiology of First Trimester Bleeding (FTB): 1) One Quarter of Pregnancies have FTB; b) Heavy Bleeding and Pain have an Association with Pregnancy Loss; c) Chromosomal Abnormality is usually the Aetiology of Pregnancy Loss (Trisomy, Monosomy, Uniparental Disomy, and the Like) which has a an Association to Maternal Age And/or Paternal Age; 2) Differential Diagnosis (DDx): 1) Threatened Abortion has the Cervical Os Closed (Visualization via Speculum) with FTB (Less than 20th Week Gestational Age and Positive Qualitative B-hCG Test), without Passage of Products of Conception or Absent Evidence of Fetal/Embryonic Demise (TVUS), which nevertheless can progress onto Miscarriage later on; 2) Miscarriage and/or Spontaneous Abortion (SAB) will have an Open Os but Transvaginal Ultrasound (TVUS) will show a Fetus absent of Cardiac Motion: a) Inevitable Abortion Type has Hemorrhage, an Open Cervical Os but No Passage of Fetal Tissue on TVUS, and/or no Detectable Motion within the Embryo Heart; b) Incomplete abortion has FTB, Open Cervical Os with Passage of Some But not all Fetal Debris; c) Complete Abortion will have an Close Cervical Os and TVUS will show all Fetal Tissue has Cleared. The Uterus will be Empty/Evacuated; d) Missed Abortion has No Hemorrhage with a Closed Cervical Os. The Fetus on TVUS is Deemed Dead (Visualization Yield no Cardiac Motion). Mx of all SABs Possible include RhoGam Vaccination (Prophylaxis For Alloimmunogeneicity) at 300 micrograms IM ; 3) Ectopic Pregnancy is a Pregnancy incompatible with Life, Qualitative B-hCG are Positive, TVUS shows no Fetus, and Management is Localization of Fetus (Tubal Ampulla and Phallopian Tube). Also, Cervical Os Status is Variable (Dilated or Constricted). SSx may be Amenorrhea, Vaginal Bleeding or FTB, Lower Abdomen Tenderness/Pain, Adnexal Tenderness And/or Mass, Some Cervical Motion Tenderness; and Tx via Salpingotomy Or Salpingectomy Surgery; Mx: 1) Expectant Conservative Mx when B-hCG is Less than 2,000 mIU/mL and Hemodynamically Stable; 2) Medical Mx via Methotrexate (Folate Antagonist) with B-hCG Less than 5,000 mIU/mL and Hemodynamically Stable; or 3) Surgical Mx via Salpingostomy/Salpingectomy with B-hCG greater than 5,000 mIU/mL, or Hemodynamically Unstable (IV Fluid Resuscitation Therapy), or Symptomatic Ongoing Rupture of Ectopic Mass, Signs of Intraparietal Hemorrhage, or Contraindications to MTX (Intrauterine Pregnancy [Teratogen and Birth Defects], Evidence of Immunosuppression, Moderate to Severe Anemia, Leukopenia, or Thrombocytopenia, Etcetera); All Subjects should be Follow up with Serial Ultrasounds and Quantitative B-hCG Levels until such are Undetectable; FTB warrants RhoGAM Prophylaxis due to the Possibility of Antigen Activation of the Maternal Immune System (Antigen D Immunoglobulin from Donation of Plasma Specimens Prepared Commercially and Controversially Used nonetheless); 4) Molar Pregnancy ([MP] Usually due to a Hydatidiform Mole) is Incompatible with Life usually due to Chromosomal Abnormalities (Trisomy, Polyploidy, Nondisjunction and the like) with FTB, N/V, Uterus Abnormality (28%) for Gestational Age (Close is Large; Partial is Small) with Hydropic Villi Morphology (Grape-like Profusive Pattern) and Hemorrhage within. B-hCG is abnormally High for Gestational Age (Greater than 100,000 mIU/mL); Types of MPs: 1) Complete Hydatidiform Mole with Uniparental Disomy with Sonography showing Prominent Villi and Snowstorm Appearance without a Visible Fetus. CXR to Look For Possible Metastases and Monitor (Follow Up) with Serial Quantitative B-hCG Levels (Progression to Gestational Trophoblastic Disease [GTD] of Neoplasia [Proliferation Disease Process] if no Normalization). Tx is Debridement and Curettage (D&C Surgery) and Suction; Hysterectomy can be done if Subject does not wish further Pregnancy (Nulliparous Decision); 2) Partial Hydatidiform Mole with Triploidy (69 Chromosomes out of 46 in Euploidy) and Sonography showing a Fetal Pole (Absent Cardiac Motion and No Viability Possible) and Often Confused with a Missed Abortion; 5) Non OB Causes: a) Vulvar, b) Vagina, c) Cervical Trauma, d) Cervical Polyp; e) Coitus Robustus; f) Trauma And/or Injury (Physical Examination and Clinical Diagnoses); 3) Prognosis (Prx) of FTB and Miscarriage with a Progesterone Level Assessment of Less than 6 ng/mL (16 nmol/L) can reliably Exclude a Viable Pregnancy, with a Negative Predicative Value of 99% (Sensitivity of 99%); 4) Physical Examination on the Clinical Scenario of FTB (Px) and Diagnosis (Dx): 1) Rule out Vulvar, Vaginal or Cervical Trauma (Bicycling during Pregnancy); 2) Speculum Examination (A Specific Amplification Device to Female Urogenitalia) is useful to Evaluate the Cervix, where an Open Os indicates Spontaneous Abortion/Miscarriage (Thrombus and Conception Products [Fetal Debris]); 3) Quantitative Serum Beta-Human Choriogonadotropin Hormone (B-hCG) Levels to compared with Past Levels and Future one Also understanding Levels should Double within 48 Hours and Comparison to Estimated Dates on LMP; 4) Complete Blood Counts (CBC) whenever Hemorrhage is Relevant and Ongoing; 5) Transvaginal Ultrasound (TVUS) to Visualize the Fetus (Cardiac Motion Assessment assures a Viable Fetus at 6-7 Weeks LMP); a) Ectopic Pregnancy can hereby be Excluded or Suspected (B-hCG and Fetus Absence is Diagnostic upon Fetus Localization) if Evidence of Intrauterine Pregnancy in wanting; 6) Blood Testing via Prothrombin Time and Partial Thromboplastin Time (Factors of Coagulation) and Blood Type with ABO and Rh Factor (D Antigen Status); 7) Treatment (Tx): 1) RhoGAM Alloimmunogeneicity Prophylaxis; 2) Fluid Resuscitation Therapy if Unstable; 8) Management (Mx): 1) Depending on the Diagnosis and Prophylaxis and wishes of the Subject (Surgery is Preferred with some while Medical Procedure can be influenced by Religious Dogma of Non Blood Transfusion Possibility amongst other Considerations (Misoprostol (Oxytocin Secondary) to Induce Evacuation and Methotrexate in Ectopic Pregnancy; 9) Complication (Cx): 1) Pregnancy Loss; 2) Dysmenorrhea (1-2 Sanitations Amenities Per Hour Usually); 3) Septic Abortion or Retained Products of Conception (POC) can have Hypovolemia and Termination of Pregnancy Thereby; 4) Endometritis, Surgical Intervention Complications/Endometriosis is Metastasis of Endometrium Tissue to Ectopic Locus; 5) Threaten Abortion can have Complications Peripartum, Antepartum ( Second Trimester Abruptio Placentae or Late SAB) or FTB and SAB in Later Pregnancy (Association of Past Medical History and Diathesis of Miscarriage [Rh Negative Females are Generally the Bulk of Complicated Gestations]); Goodness, my first Trophoblastic Disease Management. Not Really, Just Kidding. The Subject was Given Ultrarelevant (Rather than Systemically and Institutionalized Medicine) for Specificity and Sensitivity to the Diathesis and Environmental Factors Relevant in the Genitorurinary Tract, amongst other Considerations via Transfection of Genetic Product of the Significance of 9q34 (D-Antigen Gene), 6p21 (MHC-HLA Significence) and eugenized the Sex Chromosomes (Both Lineages with Vectored Modifing Viral Mechanisms). MD Paul W. Bolin, es geht sehr gut aber man muss lernen was gut soll gehabt gewessen nicht nur was sie ist. Heil!
Now it makes sense, thank you so much dr Pual ✨
1st trimesters use of duphastan ?