12: Early Pregnancy Loss Flashcards
Discriminatory level
hCG levels 1500-2000 IU/L, gestational sac can be seen
Rise in hCG of less than 53% in 48 hours?
Confirms abnormal IUP or ectopic
Most common chromosomal abnormality leading to spontaneous abortion
Turner’s 45XO
Most common class of chromosome abnormality leading to spontaneous abortion
Trisomies (Trisomy 16 most common)
Threatened abortion
Vaginal bleeding, cervix closed. Treat with expected management
Inevitable abortion
Vaginal bleeding, cervix partially dilated. Inevitable loss of pregnancy.
Incomplete abortion
Vaginal bleeding, cramping, dilated cervix. Passage of some products of conception. Tx: D and C
Complete abortion
Passage of all products of conception with closed cervix. No tx.
Missed abortion
Fetus expired and remains in uterus. No xs. Expectant management, or cytotec, or D and C
Septic abortion
Retained infected products of conception; IV abx (ampicillin, gentamycin, clindamycin), D and C
Blighted ovum
AKA anembryonic gestation; fertilized egg develops placenta but no embryo, empty gestational sac
Most common immunologic reason for recurrent abortions
Antiphospholipid syndrome - associated with recurrent fetal loss, preeclampsia, venous and arterial thromboembolism and stroke
Leading cause of maternal death in first trimester
Ectopic pregnancy
Most common site for ectopic pregnancy
Fallopian tube
Risk factors for ectopic pregnancy
Gonorrhea, chlamydia, hx ectopic, hx tubal surgery, DES exposure, concurrent IUD, IVF, ART, smoking
Classic triad of ectopic pregnancy
- Prior missed menses
- Vaginal bleeding
- Lower abdominal pain
Acutely ruptured ectopic pregnancy
Surg emergency, severe abd pain and dizziness
PE: distended, acute abdomen, hemodynamic instability
US: empty uterus with significant free fluid
Relationship of hCG levels to ectopic or nonviable pregnancy
Rises less than 53% in 48 hours
Medical management of ectopic pregnancy
With methotrexate if patients are hemodynamically stable, compliant, and ectopic is not ruptured
Expectant management of ectopic pregnancy
If patient stable and symptoms are resolving spontaneously; hCG testing, counseling pt
Rhesus isoimmunization
Immunologic disorder occurring in a pregnant RH-NEGATIVE woman carrying an RH-POSITIVE fetus
RhoGAM
Prophylactic use to prevent maternal production of antibodies
When to administer RhoGAM
At 28 weeks and within 72 hours after delivery of RhD+ infant
Kleinhauer-Betke test
Identifies fetal RBCs in maternal blood, determines if additional RhoGAM dose necessary in high risk situations
Fetal hydrops (presentation)
ascites, pleural effusion, pericardial effusion, scalp edema, polyhdramnios
Most valuable tool for detecting fetal anemia
Doppler of peak systolic velocity in fetal MCA
Severe fetal anemia
Hct below 30% or 2 standard deviations below mean Hct for gestational age
Treatment of severe fetal anemia
Intravascular transfusion into umbilical vein of fresh group O Rh- packed RBCs
