12: Early Pregnancy Loss

Question 1

Discriminatory level

Answer 1

hCG levels 1500-2000 IU/L, gestational sac can be seen

Question 2

Rise in hCG of less than 53% in 48 hours?

Answer 2

Confirms abnormal IUP or ectopic

Question 3

Most common chromosomal abnormality leading to spontaneous abortion

Answer 3

Turner’s 45XO

Question 4

Most common class of chromosome abnormality leading to spontaneous abortion

Answer 4

Trisomies (Trisomy 16 most common)

Question 5

Threatened abortion

Answer 5

Vaginal bleeding, cervix closed. Treat with expected management

Question 6

Inevitable abortion

Answer 6

Vaginal bleeding, cervix partially dilated. Inevitable loss of pregnancy.

Question 7

Incomplete abortion

Answer 7

Vaginal bleeding, cramping, dilated cervix. Passage of some products of conception. Tx: D and C

Question 8

Complete abortion

Answer 8

Passage of all products of conception with closed cervix. No tx.

Question 9

Missed abortion

Answer 9

Fetus expired and remains in uterus. No xs. Expectant management, or cytotec, or D and C

Question 10

Septic abortion

Answer 10

Retained infected products of conception; IV abx (ampicillin, gentamycin, clindamycin), D and C

Question 11

Blighted ovum

Answer 11

AKA anembryonic gestation; fertilized egg develops placenta but no embryo, empty gestational sac

Question 12

Most common immunologic reason for recurrent abortions

Answer 12

Antiphospholipid syndrome - associated with recurrent fetal loss, preeclampsia, venous and arterial thromboembolism and stroke

Question 13

Leading cause of maternal death in first trimester

Answer 13

Ectopic pregnancy

Question 14

Most common site for ectopic pregnancy

Answer 14

Fallopian tube

Question 15

Risk factors for ectopic pregnancy

Answer 15

Gonorrhea, chlamydia, hx ectopic, hx tubal surgery, DES exposure, concurrent IUD, IVF, ART, smoking

Question 16

Classic triad of ectopic pregnancy

Answer 16

1. Prior missed menses
2. Vaginal bleeding
3. Lower abdominal pain

Question 17

Acutely ruptured ectopic pregnancy

Answer 17

Surg emergency, severe abd pain and dizziness
PE: distended, acute abdomen, hemodynamic instability
US: empty uterus with significant free fluid

Question 18

Relationship of hCG levels to ectopic or nonviable pregnancy

Answer 18

Rises less than 53% in 48 hours

Question 19

Medical management of ectopic pregnancy

Answer 19

With methotrexate if patients are hemodynamically stable, compliant, and ectopic is not ruptured

Question 20

Expectant management of ectopic pregnancy

Answer 20

If patient stable and symptoms are resolving spontaneously; hCG testing, counseling pt

Question 21

Rhesus isoimmunization

Answer 21

Immunologic disorder occurring in a pregnant RH-NEGATIVE woman carrying an RH-POSITIVE fetus

Question 22

RhoGAM

Answer 22

Prophylactic use to prevent maternal production of antibodies

Question 23

When to administer RhoGAM

Answer 23

At 28 weeks and within 72 hours after delivery of RhD+ infant

Question 24

Kleinhauer-Betke test

Answer 24

Identifies fetal RBCs in maternal blood, determines if additional RhoGAM dose necessary in high risk situations

Question 25

Fetal hydrops (presentation)

Answer 25

ascites, pleural effusion, pericardial effusion, scalp edema, polyhdramnios

Question 26

Most valuable tool for detecting fetal anemia

Answer 26

Doppler of peak systolic velocity in fetal MCA

Question 27

Severe fetal anemia

Answer 27

Hct below 30% or 2 standard deviations below mean Hct for gestational age

Question 28

Treatment of severe fetal anemia

Answer 28

Intravascular transfusion into umbilical vein of fresh group O Rh- packed RBCs