Early Pregnancy Loss, Ectopic Pregnancy, Rh Isoimmunization (Moulton)

Question 1

Up to 40% of women will have some vaginal bleeding during early pregnancy known as ___ bleeding.

Answer 1

Implantation

Question 2

At hCG levels of 1500- 2000 mIU/L a __1__ will be seen.

__2__ is seen around 5 weeks or at hCG levels of 5200 mIU/L.

Answer 2

1) Gestational sac

2) Fetal pole

Question 3

If abnormal rise in hCG of less than 53% in 48 hrs, this confirms an ____?

Answer 3

Ectopic pregnancy

Question 4

__1__ pregnancy refers to the presence of hCG 7-10 days after ovulation but in whom menstruation occurs when expected.

Majority of this type of pregnancy will result in __2__.

Answer 4

1) Biochemical

2) Miscarriage

Question 5

Spontaneous abortions are characterized by the fetus being lost before __1__ weeks gestation and less than __2__ grams.

80% of SAB’s occur in the __3__ trimester.

Answer 5

1) 20 weeks
2) 500 grams
3) First

Question 6

__1__ abnormalities are most common cause of first trimester SAB’s.

__2__ is the most common type of this abnormality.

Trisomy class is the most common class of this occurring with trisomy __3__ being the most common.

Answer 6

1) Chromosome
2) 45 XO (Turner syndrome)
3) Trisomy 16

Question 7

__1__ is a type of SAB characterized by vaginal bleeding and a closed cervix which leads to 25-50% eventually results in loss of pregnancy.

__2__ is a type of SAB characterized by vaginal bleeding and the cervix is partially dilated.

__3__ is a type of SAB characterized by vaginal bleeding, cramping with lower abdominal pain, and the cervix is dilated leading to passage of some but not all of the products of conception?

__4__ is a type of SAB characterized by passage of all products of conception (fetus and placenta) with a closed cervix.

__5__ is a type of SAB characterized by fetus has expired and remains in the uterus which may result in coagulation problems.

__6__ is a type of SAB characterized by motion tenderness, purulent discharge, hemorrhage, and rarely renal failure along with retained infected products of conception.

__7__ is a type of SAB characterized by gestational sac too large to not have embryo.

Answer 7

1) Threatened abortion
2) Inevitable abortion
3) Incomplete abortion
4) Complete Abortion
5) Missed abortion
6) Septic Abortion
7) Anembryonic Gestation (Blighted ovum)

Question 8

With majority of the SAB types, what should you proceed with?

Answer 8

Suction Dilation and curettage

Question 9

Anembryonic Gestation (Blighted ovum) is when the fertilized egg develops a?

Answer 9

Placenta but no embryo

Question 10

What results in the mother’s immune system to produce antibodies to the fetal Rh antigen, which can cross the placenta and destroy fetal red blood cells resulting in serious hemolytic disease in the fetus/newborn?

Answer 10

Rhesus isoimmunization

Question 11

Rhesus isoimmunization occurs in a pregnant, Rh __1__ women carrying an Rh __2__ fetus.

Answer 11

1) Negative

2) Positive

Question 12

The Rh complex is made up of a number of antigens, women who carry which antigen are RH positive?

Answer 12

Rh D antigen

Question 13

Initial response to Rh antigen is the production of __1__ antibodies for a short period of time, followed by __2__ antibodies that freely cross the placenta & enter the fetal circulation.

If the fetus has Rh antigen, then the antibodies will bind to the fetal __3__ antigenic sites and cause hemolysis.

Severe hemolysis may lead to profound anemia resulting in __4__.

Answer 13

1) IgM
2) IgG
3) Red blood cells
4) Hydrops fetalis

Question 14

Prophylactic ____ is used to prevent maternal production of antibodies to Rh.

Answer 14

Rh immune globulin (RhoGAM)

Question 15

Cesarean section, placenta previa or abruption and manual extraction of placenta can all cause ____ which can then lead to isoimmunization.

Answer 15

Fetomaternal hemorrhage

Question 16

Who should be administered with RhoGAM?

When should it be given?

Answer 16

1) Rh-negative woman

2) At 28 weeks and also within 72 hours after delivery of a Rh D positive infant

Question 17

The Kleinhauer-Betke test can be used to identify fetomaternal hemorrhage by looking for __1__ in maternal blood.

Will determine if additional __2__ is necessary.

Answer 17

1) Fetal RBCs

2) RhoGAM

Question 18

If a Rh negative women whose anti-D antibody titers are positive (Rh D sensitized) and the father of the baby is Rh-D negative, what should be done?

Why?

Answer 18

1) No further workup or treatment is necessary

2) The fetus will be Rh negative

Question 19

If a Rh negative women whose anti-D antibody titers are positive (Rh D sensitized) and the father of the baby is Rh-D positive which results in homozygosity for D antigen, how will it be passed?

If this scenario results in heterozygosity for D antigen?

Answer 19

1) All fetuses will be Rh positive and could be affected

2) 50% of the children will be Rh negative and 50% Rh positive

Question 20

If a maternal Rh-Antibody titer is less than 1:8 this usually indicates that?

If titers are more than 1:16 this indicates?

Answer 20

1) The fetus is not in serious jeopardy

2) Detailed US to detect hydrops

Question 21

What US findings point towards fetal hydrops?

Answer 21

1) Ascites
2) Pleural effusion
3) Pericardial effusion
4) Skin or scalp edema
5) Polyhydramnios

Question 22

Doppler assessment of peak systolic velocity in the fetal ____ in cm/sec is the most valuable tool for detecting fetal anemia.

Answer 22

Middle cerebral artery

Question 23

Hematocrit below 30% or 2 standard deviations below the mean Hct for the gestational age is suggestive of?

Answer 23

Severe fetal anemia

Question 24

In the management of isoimmunization, intrauterine transfusions usually performed between 18-35 weeks using fresh group ___ packed red blood cells.

Answer 24

O, Rh negative