Lecture 14- 1st trimester loss

Question 1

When do the majority of spontaneous abortions occur?

Answer 1

<12 weeks GA

Question 2

Termination of a pregnancy before ____ weeks is considered what trimester loss.

Answer 2

20; First

Question 3

What are the three most common abnormal uteri?

Answer 3

Septate
Asherman’s syndrome
Bicornalte uterus

Question 4

What are key things you want to know with a suspected miscarriage?

Answer 4

If the cervix is closed vs/ open
Presence of POC, discharge, blood
Uterine size

Question 5

With a threatened AB what will they present like.

Answer 5

Bleeding
closed cervix
uterine size consistent with GA

Question 6

What will an inevitable AB look like?

Answer 6

Cervix dilated
ROM
bleeding and UCs
expel POC (products of conception)

Question 7

What will a missed AB present like.

Answer 7

POC reatained
Uterus < GA
Dark brown discharge
No pain & IUP symptoms cease

Question 8

What is considered a recurrent loss?

Answer 8

loss on > 2 consecutive pregnancies

Question 9

What are reasons for 2nd trimester loss?

Answer 9

Cervical insufficiency (painless effacement and dilation)

Question 10

What do you do for cervical insufficiency?

Answer 10

Cervical cerclage

Question 11

how do you induce labor surgically?

Answer 11

Vacuum aspiration

Question 12

What are some complications with surgically induced labor?

Answer 12

uterine perf, cervical laceration

Question 13

What is cervical priming?

Answer 13

use seaweed like plant to prime the cervix.

Question 14

After induction what do you want to monitor?

Answer 14

temp, pain , bleeding

hemorrhage, incomplete evacuation, infection

Question 15

Under how many days since LMP can you do a medical induced labor?

Answer 15

<49 days

Question 16

Where do the majority of ectopic pregnancies occur?

Answer 16

Fallopian tube

Question 17

What does an ectopic pregnancy look like on US?

Answer 17

cyst w/ wide echogenic vascular outer ring

Question 18

What is the “classic” signs and symptoms of ectopic?

Answer 18

amenorrhea followed by bleeding and abdominal pain on affected side

Question 19

What are the ominous signs of ectopic pregnancy?

Answer 19

Shoulder pain worsened w/ inspiration

syncope, vertigo

Question 20

You must r/o ectopic w/out confirmation of what in utero?

Answer 20

chorionic villi

Question 21

About what level with serum beta quant. level stay at with ectopic pregnancy?

Answer 21

600-800

Question 22

Can serum progesterone distinguish IUP from ectopic?

Answer 22

No

Question 23

Serum progesterone level < what is negative for pregnancy.

Answer 23

5

Question 24

Serum progesterone level greater than what is consistent with pregnancy.

Answer 24

20

Question 25

What is procedure that removes an ectopic pregnancy?

Answer 25

laparoscopic linear salpingostomy

Question 26

What is where the chorionic villi continue to grow and become swollen.

Answer 26

hydatidiform mole (aka molar pregnancy)

Question 27

Is molar pregnancy benign?

Answer 27

Usually

Question 28

What is the name for non-malignant, non-metastatic gestational trophoblastic neoplasia.

Answer 28

Hydatidiform mole

Question 29

What is the karyotype with complete hydatidiform mole?

Answer 29

Complete - 45XX or 45XY

Question 30

What is the karyotype with a partial molar pregnancy?

Answer 30

Triploid (Partial - 69XXX or 69XXY)

Question 31

In a molar pregnancy what is abnormal with the uterine size?

Answer 31

Uterine size >GA

Question 32

WHat is the treatment for a molar pregnancy?

Answer 32

Hospitalization D&C contraception for 1 year Watch for uterine atony or pulmonary embolism Monitor B-hCG for rise/decline/plateau to r/o persistant GTN

Question 33

for a localized persistent GTN what do they do?

Answer 33

Single agent chemotherapy

Question 34

What is a malignant transformation of GTN?

Answer 34

Choriocarcinoma

Question 35

What are reasons for 1st trimester recurrent loss?

Answer 35

parent karyotypes, Asherman's syndrome, antiphospholipid antibodies

Question 36

What is post-abortal syndrome?

Answer 36

bleeding, dilated cervix, cramping, large, boggy uterus with hematometra Mimics incomplete abortion

Question 37

What should you do for septic abortion?

Answer 37

IV fluid, IV antibiotics, evacuate uterus

Question 38

What are 3 outcomes of ectopic pregnancy without interventions?

Answer 38

``` Tubal abortion (POC expelled out of fimbriated end) Tubal rupture (intra-abdominal hemorrhage) Spontaneous resolution ```

Question 39

What are risk factors for ectopic pregnancy?

Answer 39

tubal scarring 2ndary PID/salpingitis Prior ectopic or tubal surgery History of infertility

Question 40

What are PE of ectopic pregnancy post rupture?

Answer 40

Marked pelvis and abdominal tenderness, CMT, pelvic fullness or mass

Question 41

What are contraindications for Medical treatment (Methotrexate) for ectopic pregnancy?

Answer 41

Absolute: breastfeeding, liver disease, alcoholism, blood dyscrasias, active pulmonary disease, PUD, immunodeficiency, methotrexate sensitivity Relative: >3.5cm, cardiac motion/fetus

Question 42

What is the ideal candidate for methotrexate for ectopic pregnancy treatment?

Answer 42

<5000mlU/L and no fetal heart activity

Question 43

What are neoplasms from spectrum of abnormal placental proliferation?

Answer 43

gestational trophoblastic neoplasia

Question 44

What is the PE for a hydatidiform mole?

Answer 44

Uterine size> GA, absent FHT, vaginal bleeding, HTN

Question 45

What will a complete hydatidiform mole look like on US?

Answer 45

no embryo/fetus, no amniotic fluid, thick and cystic placenta filled uterus; snowstorm appearance

Question 46

What will a partial hydatidiform mole look like on US?

Answer 46

growth-restricted fetus, low amniotic fluid, thick cystic placenta