The alpha subunit of hCG resembles that of which 3 other hormones?
LH, FSH, TH
What is the function of hCG in pregnancy?
In a normal pregnancy, how long should it take observed hCG values to double?
What is the expected hCG level around the time of the first missed menses?
What hCG level should be achieved by 10 weeks gestation?
hCG promotes the maintenence of the progesterone-secreting corpus luteum during the beginning of pregnancy
What pharmacological usage of hCG is a consequence of the structural similarity between hCG and LH?
Thinking along the same lines, what other pharmacological use might hCG have?
Stimulate testosterone production in the male testes
What level of hCG is considered a negative finding on a quantitative serum hCG test?
What is the discriminatory zone of hCG?
The discriminatory zone: 1500-2000 mIU/mL. A transvaginal ultrasound should be able to detect pregnancy at this point.
What is a spontaneous abortion/miscarraige/loss?
What is the proper terminology to use when discussing with a patient?
Fetal loss before 20 weeks and/or delivery of a fetus <500 grams
"pregnancy loss" -> other terminology like 'miscarraige' or 'abortion' carry heavy emotional connotations
Name the mode of abortion/miscarraige
- Bleeding with open os without passage of the products of conception. Nonviable pregnancy.
- Partial passage of products of conception, open os, variable bleeding. Nonviable pregnancy.
- Bleeding or cramping with no passage of tissue and closed os. Fetal heart tones are present (if age appropriate).
What is a missed abortion?
Compare embryonic demise to anembryonic demise
Missed abortion: intrauterine demise at <20 weeks without passage of any fetal or placental tissue.
Embryonic demise: embryonic pole is visible, no cardiac activity
Anembryonic demise: gestational sac is present without identifiable embryo
What is a complete abortion?
- Products of conception completely passed
- Closed os
- minimal bleeding
- uterus well-contracted
Define recurrent pregnancy loss
What is the most common etiology?
What is the chance of a woman with this diagnosis experiencing a live pregnancy in the future?
History of 3 or more spontaneous abortions before 20 weeks
50% are idiopathic
Though most recurrent pregnancy losses are idiopathic, name some other potential causes
- Anatomic (uterine anomalies, fibroids, adhesions)
- Endocrine (diabetes, thyroid dysfunction, PCOS)
- Genetic (translocations, aneupoidy)
- Immunologic (antiphospholipid syndrome, infection)
- Environmental (smoking, toxins, medications)
Where are most ectopic pregnancies located?
What is a heterotopic pregnancy?
98% are located in the fallopian tube. Most of these occur in the ampulla.
Co-existing intrauterine and extrauterine pregnancies
Name several risk factors for ectopic pregnancy
- Gonorrhea, chlamydia
- Previous tubal ligation or previous tubal pregnancy
- assisted reproductive technologies
- IUD in situ
What is the key intervention for treatment of ectopic pregnancy?
What is the key medical management strategy for ectopic pregnancy?
Your patient has an absurdly high hCG level (e.g. 900,000)
Is the fetus actually a Super Saiyan? No really, what's going on here?
Gestational trophoblastic disease (GTD)
A group of rare diagnoses that all arise from abnormal proliferation of trophoblastic tissue
What is the genetic difference(s) between complete and partial molar pregnancies?
Which has a higher incidence of persistent GTD and/or malignancy?
Complete: 46XX or 46XY
Partial: 69XXX, 69XYY, 69XXY
Complete (15-20%) > Partial (1-2%)
Describe the classic ultrasound findings in a complete molar pregnancy
US: "Snowstorm appearance"
Grossly: "grape-like" chorionic villi
Does a complete molar pregnancy contain fetal tissue?
Does a partial molar pregnancy contain fetal tissue?
No - 2 sets of paternal genes
Yes - 1 maternal and 2 paternal sets of genes
What is the key drug used in the treatment of hydatiform molar pregnancy?
hCG that fails to rise by a minimum of 53% over 48 hours is concerning for what?
Failing intrauterine pregnancy or ectopic pregnancy