Lecture 10: Early Pregnancy Loss, Ectopic, and Rh Isoimmunization Flashcards
(57 cards)
Which weeks constitute the first, second, and third trimesters?
- First = first day of last menstrual period - 13 + 6 weeks
- Second = 14 weeks - 27 + 6 weeks
- Third = 28 weeks - 42 weeks
A full term delivery is between which weeks of gestation?
37-42 weeks
What is the “discriminatory level” of hCG where a gestational sac be seen with transvaginal ultrasound (TVUS)?
1500-2000 mIU/L
Which abnormal rise of hCG in 48 hours confirms a nonviable IUP or ectopic pregnancy?
Abnormal rise in hCG of <53% in 48 hrs
80% of spontaneous abortions occur during which trimester?
First
What are the most common cause of first trimester SAB’s?
Chromosomal abnormalities
What is the most common chromosomal abnormality and most common class of chromosomal abnormality responsible for first trimester SAB’s?
- 45 XO (Turner Syndrome) is most common chromosomal abnormality
- Most common class is the Trisomy class, with trisomy 16 most common
What constitutes a threatened abortion; how are they managed?
- Vaginal bleeding + closed cervix
- Treatment is expectant management
What constitutes an inevitable abortion; how are they managed?
- Vaginal bleeding + the cervix is partially dilated
- Loss is inevitable
What constitutes an incomplete abortion; how are they managed?
- Vaginal bleeding, cramping lower abdominal pain w/ dilated cervix
- Passage of some but not all products of conception
- Treatment is usually suction D&C
What constitutes a complete abortion; how are they managed?
- Passage of all products of conception (fetus + placenta) with a closed cervix
- With resolution of pain, bleeding, and sx’s of pregnancy
- No tx needed
What constitutes a missed abortion; how are they managed?
- Fetus has expired and remains in uterus; typically no symptoms
- Coagulation problems may develop, check fibrinogen levels weekly until SAB occurs or proceed w/ suction D&C
- Expected management vs. misoprostol vs. D&C
What constitutes a septic abortion; how are they managed?
- Fever, uterine and cervical motion tenderness + purulent discharge + hemorrhage and rarely renal failure
- Retained infected products of conception
- Start IV antibiotics (Ampicillin + Gentamycin + Clindamycin)
- Proceed w/ suction D&C
What is anembryonic gestation (blighted ovum); how is it managed?
- Fertilized egg develops a placenta, but no embryo
- U/S reveals gestational sac too large to not have embryo (>25 mm)
- Tx: expected management vs. misoprostol vs. D&C
How are induced or elective abortions most often carried out in the first semester?
Suction D&C
Recurrent abortions are defined as what?
- Defined as 3 successive SAB
- Excluding (ectopic and molar pregnancies)
How many cigarettes a day and alcoholic beverages a week are associted with a 4-fold increased risk for SAB?
- 20-cigs a day
- 7 alcoholic drinks/week
What are some underlying medical disorders which are associated with recurrent abortions?
- Diabetes
- Hypothyroidism
- SLE
- Antiphospholipid Ab syndrome
How does the % rate of spontaneous abortion change from women <30 yo to women >40?
- Women <30 = 11.2%
- Women >40 = 56%
Which cause of second trimester pregnancy loss is associated with “painless dilation” and delivery?
Incompetent cervix
What is the treatment for incompetent cervix as a cause of recurrent SAB’s?
Cervical cerclage
What is the purpose of karyotyping both parents whom are trying to get pregnant?
To detect balanced reciprocal and Robertsonian translocations that could be passed onto the fetus unbalanced
What is the most common immunologic abnormality contributing to recurrent and SAB’s?
Antiphospholipid Syndrome
What is the treatment of antiphospholipid syndrome for patient trying to conceive?
Prophylactic dose of heparin and low dose aspirin
