Pregnancy loss

Question 1

Lab tests of abnormal pregnancy

Answer 1

• hCG: in nl pregnancy the level doubles every 48 hrs (at least increases by 50% every 48 hrs)
• Rate of increase slows with increasing gestation
• Abnormal pregnancy: rate of hCG rise is slow, or plateau, or decreasing
• Progesterone: nl pregnancy progesterone is usually >20, <20 consistent (but not indicative) of abnormal pregnancy
• Transvaginal ultrasound: preferred method of ultrasound eval during first trimester (yolk sac is indicator that pregnancy is in uterus)

Question 2

Spontaneous abortion (sab, miscarriage)

Answer 2

• Involuntary termination of pregnancy prior to 20 wks of gestation (dated from last menstrual period) or fetal weight <500g
• Sab is most common complication of early pregnancy
• Dx via ultrasound, or hCG levels if prior to 5 wks gestation or if ultrasound is non-Dx

Question 3

Ectopic (non-viable) pregnancies 1

Answer 3

• 95% in fallopian tube
• Prior to 5 wks EGA (estimated gestational age): abnormal hCG rise (1500, or visualization of YS/embryo outside uterus (negative US does not exclude ectopic)
• Should do serum hCG test in all women w/ suspected ectopic
• Cannot differentiate ectopic from abnormal intrauterine pregnancy

Question 4

Ectopic (non-viable) pregnancies 2

Answer 4

• Clinical manifestations (usually late, 6-8 wks EGA): abd pain, vaginal bleeding, Hx of missed period, adnexal mass
• Complication is ruptured ectopic: free fluid in cup de sac, hypotension
• Rx: observation (those who are stable w/ low hCG that is declining), methotrexate, surgical (uterine curettage, laparoscopy)