1st trimester complications

Question 1

Oocyte is swept into lumen of the fallopian tube by the fimbria

Fertilization occurs in the_____ portion of the tube

After fertilization the blastocyst reaches the uterine cavity by day ____and implantation begins day ____ when embryo is at the blastocyst stage Implantation is complete by day 9-10

Answer 1

ampullary

4-5

5-7

Question 2

Detection of _____in maternal blood and urine provides the basis for endocrine tests of pregnancy.

Answer 2

βhCG ; sim alpha as: luteinizing hormone (LH), follicle-stimulating hormone (FSH), and thyroid-stimulating hormone (TSH)

Question 3

Promotes the maintenance of the progesterone secreting corpus luteum during the beginning of pregnancy

Answer 3

BhCG

Question 4

hCGs levels roughly double every ____in early pregnancy

Peak levels occurs at 10 weeks gestation at about _____

Answer 4

48 hours

100,000 mIU/mL

Question 5

Because of its similarity to____, hCG can be used to induce ovulation in the female ovary during fertility treatment as well as _stimulate testosterone pr_oduction in the male testes

Answer 5

LH

• hCG and LH bind to the same receptor (LHCGR)

Question 6

How does urine pregnacy test work

Answer 6

Employ a monoclonal antibody specific to the β subunit of hCG (human chorionic gonadotropin)

Employ a chromatographic immunoassay. Detection thresholds range from 20 to 100 mIU/ml depending on the brand.

At the time of the missed menses the hCG level is about 100 mIU/mL

Question 7

• Most sensitive and precise measure
• Negative if < 3-5 mIU/mL
• Roughly doubles every 48 hours in normal pregnancy (minimum rise is 53% in 48 hrs)

Answer 7

Quantitative serum hCG

Question 8

With transvaginal ultrasound should be able to visualize the pregnancy when a quantitative hCG level is 1500-2000 mIU/mL – referred to as

Answer 8

discriminatory zone of hCG

Question 9

Fetal loss before 20 weeks calculated from last menstrual period (LMP) or delivery of fetus <500 grams

Occurs in approximately 15% of clinically recognized pregnancies

80% occur in first trimester

Answer 9

Spontaneous Abortion/Miscarriage/Pregnancy Loss

Question 10

Bleeding or cramping with no passage of tissue, closed os, intrauterine pregnancy, fetal heart tones present (if age appropriate)

Answer 10

Threatened

Question 11

Bleeding, open os, without passage of products of conception, nonviable pregnancy

Answer 11

Inevitable abortion

Question 12

Partial passage of products of conception, open os, variable bleeding, nonviable pregnancy

Answer 12

Incomplete:

Question 13

Intrauterine demise < 20 weeks without any passage of fetal or placental tissue: Embryonic vs Anembryonic

Answer 13

Embryonic demise– embryonic pole visible on ultrasound, no cardiac activity

Anembryonic demise– gestational sac without corresponding embryo identified on ultrasound

Question 14

Products of conception completely passed, closed os, minimal bleeding, uterus well contracted

Answer 14

Complete abortion/miscarriage

Question 15

Stipulations for “Recurrent Pregnancy Loss”

Answer 15

• 3 or more spontaneous pregnancy losses before 20 weeks
• Occurs in less than 1% of couples attempting to have children
• After evaluation etiology unexplained in 50%
• Future live pregnancy rates can be as high as 70%

Question 16

Causes of recurrent pregnancy loss

Answer 16

• Anatomic
– Uterine anomalies, fibroids, intrauterine adhesions

• Endocrine
– Diabetes, thyroid dysfunction, PCOS

• Genetic
– Translocations or aneuploidy

• Immunologic
– Antiphospholipid syndrome, infection

• Environmental
– Smoking, toxins, medications

Question 17

16 yo girl with + pregnancy test:

Quantitative hCG 1400 mIU/ml and repeat level 2 days later is 1900 mIU/ml

Ultrasound shows no intrauterine pregnancy

A gestational sac with a yolk sac is seen in the right adnexa.

Answer 17

ectopic pregnancy

Question 18

Blastocyst implants in a location outside of the endometrial cavity

2% of all pregnancies and 98% are located in the fallopian tube and the remainder in a cervical, ovarian, interstitial, hysterotomy scar, or abdominal locationm, majority of tubal pregnancies are located in the ampullary region.

Answer 18

Ectopic pregnancy

Question 19

is defined as a co-existing intrauterine and extrauterine pregnancy and occurs in an estimated 1 in 30,000 pregnancies. Risk factors include in vitro fertilization and ovulation induction

Answer 19

A heterotopic pregnancy

Question 20

Risk for ectopic pregnancy

Answer 20

Pelvic inflammatory disease,

Gonorrhea or chlamydia

Previous tubal ligation, previous tubal pregnancy

Assisted reproductive technologies

Smoking

Pregnancy with IUD in situ

Question 21

Tx for ectopic pregnancy

Answer 21

• Surgical

– Laparoscopic salpingostomy or salpingectomy

– Laparotomy

• Medical

– Methotrexate

• Expectant : just happens but make sure hCG goes back down

Question 22

A 28 yo woman presents for prenatal care with her second pregnancy. She had a positive urine pregnancy test 2 weeks ago. She reports some light vaginal bleeding. She has noticed that her nausea is much worse than with her first pregnancy. Her exam shows minimal amount of blood in the vagina, closed cervix, 12 week size uterus, no adnexal masses. Quantitative serum hCG 640,00 mIU/ml

Answer 22

Gestational trophoblastic disease (GTD)

Question 23

• All forms of GTD are associated with

Answer 23

elevated levels of human chorionic gonadotropin.

Question 24

persistent or invasive GTD, choriocarcinoma, and placental site trophoblastic tumor (PSTT) disease.

Answer 24

Malignant forms of gestational

trophoblastic neoplasia

Question 25

Benign form of GTD

Answer 25

hydatiform mole

Question 26

Trophoblastic proliferation and hydropic grape like chorionic villi Classic snowstorm appearance on ultrasound

Answer 26

Complete molar pregnancy

Question 27

Pathosphysiology of complete molar pregnancy

Answer 27

Results from fertilization of an **enucleate egg.** Paternally derived diploid genotype – 46,XX or rarely 46,XY Without maternal DNA, no fetal structures are able to develop. \*\*Up to 15-20 % of complete moles result in persistent GTD or malignancy

Question 28

contains fetal tissue: fertilization of a haploid ovum **by two sperm** or by a single sperm that then duplicates Genotype 69,XXX, 69, XYY or 69, XXY (triploidy) Risk of persistent GTD or malignancy 1-2% or LOW

Answer 28

Partial molar pregnancy

Question 29

It is used to treat rapidly dividing trophoblastic tissue and is used in the treatment of ectopic pregnancy, hydatiform molar pregnancy, and choriocarcinoma.,

Answer 29

Methotrexate

Question 30

An anti-metabolite chemotherapeutic agent that binds to the enzyme **dihydrofolate reductase (DHFR),** Acts as a **competitive antagonist** to DHFR thereby interference in DNA synthesis and replication

Answer 30

Methotrexate

Question 31

hCG rapidly rises in early pregnancy roughly doubling every 48 hours with peak at 10 weeks gestation of about \_\_\_\_and then declines and plateaus for the remainder of pregnancy

Answer 31

100,000 mIU/ml

Question 32

Discriminatory zone of 1500-2000 mIU/ml is when an intrauterine pregnancy should be

Answer 32

visualized on transvaginal ultrasound

Question 33

hCG that fails to increase by minimum of 53% over 48 hours is seen with a

Answer 33

failing intrauterine pregnancy or an ectopic pregnancy