2. Early PG loss, ectopic PG, Rh isoimmunization Flashcards
Which weeks constitute the 1st , 2nd, and 3rd trimesters?
- 1st = first day of last menstrual period (FDLMP) => 13 weeks + 6 days
- 2nd = 14 => 27 weeks + 6 days
- 3rd = 28 => 42 weeks
What weeks do the following occur?
- Estimated date of confinement (EDC)
- Abortion
- Preterm delivery
- Full term delivery
- Postdates
- Estimated date of confinement (EDC): due date = 40 weeks after FDLMP
- Abortion: < 20 weeks
- Preterm delivery: 20 => 36 weeks + 6 days
- Full term delivery: 37- 42 weeks
- Postdates: >42 weeks
What is the “discriminatory level” of hCG where a gestational sac be seen with transvaginal US (TVUS)?
1500-2000 mIU/L
***however, these are not always exact
What 2 things occur than can confirm a pregnancy?
- 1. Vaginal bleeding (occurs in 40% of W due to implantation bleeding)
- 2. hCG (detected 6-8 days after ovulation)
hCG: indicate the levels at the following stages
- Negative
- Amount reached when menstruation SHOULD be expected
- Amount a urine PG test detect
- How much do we see increase in pregnancy?
- Peak levels?
- Abnormal IUP or ectopic pregnancy
hCG
- Negative: <5
- Amount reached when period is expected: 100
- Amount a urine PG test can detect: 25
- How much do we see increase in PG? Doubles every 2 days
- Peaks at 10 weeks at 100,000
- Abnormal rise of less than 53% in 48 hours.
What is biochemical pregnancy?
Initial pregnancy test/hCG is (+) 7-10 days after ovulation, but does not progress into a clinical pregnancy because menstruation occurs.
Spontaneous abortions occur in 10-15% of clinically recognized cases.
When does the risk of fetal loss decrease to 2%?
If at 8 weeks, US shows a live, appropriately grown fetus with cardiac actvity.
What is an abortus?
an aborted fetus specifically : a fetus before 20 weeks, less than 500 grams.
80% of spontaneous abortions (SABs) occur during which trimester?
1st trimester
What are the most common cause of 1st trimester SAB’s?
Chromosome abnormalities
What is the most common single chromosomal abnormality and most common class of chromosomal abnormality responsible for 1st trimester SAB’s?
- 45 XO (Turner Syndrome) is most common single chromosomal abnormality
- Most common class is the Trisomy class, with trisomy 16 most common
SABs are defined by whether
- All of the products of conception have passed
- Dilation of the cervix.
What is a threatened abortion; how are they managed?
Threatened abortion: Cervix is closed, but vaginal bleeding is occuring.
- Treatment: Expectant management
SABs are defined by whether
- All of the products of conception have passed
- Dilation of the cervix.
What is a incomplete abortion; how are they managed?
Incomplete abortion: Cervix is dilated + passage of SOME products ( => vaginal bleeding is occuring) + cramping in lower abdomen.
- Treatment: Suction D&C
SABs are defined by whether
- All of the products of conception have passed
- Dilation of the cervix.
What is a inevitable abortion; how are they managed?
Inevitable abortion: Cervix is partially dilated + no passage of tissue + vaginal bleeding is occuring.
- Treatment: Loss is inevitable
SABs are defined by whether
- All of the products of conception have passed
- Dilation of the cervix.
What is a missed abortion; how are they managed?
Missed abortion: Fetus has expired and stays in uterus; typically no symptoms/bleeding.
- Coagulation problems may occur so check fibrinogen levels weekly until SAB occurs or perform suction D&C
- Treatment: Expected management vs. misoprostol vs. D&C
.
SABs are defined by whether
- All of the products of conception have passed
- Dilation of the cervix.
What is a septic abortion; how are they managed?
Septic abortion: Retain infected products of conception causes => fever, uterine and cervical motion tenderness + purulent discharge + hemorrhage and rarely renal failure
- Treatment: IV ABX (Ampicillin + Gentamycin + Clindamycin), follow with suction D&C.
What is anembryonic gestation (blighted ovum); what do we see on US, how is it managed?
- Fertilized egg develops a placenta, but no embryo.
- US shows empty gestational sac >25 mm (too big to not have embryo)
- Tx: expected management vs. misoprostol vs. D&C
How are induced or elective abortions most often performed in the 1st semester?
Suction D&C;
*More successful 1st therapy then medical or expectant managment.
Recurrent abortions occur in 1% of women and often have no cause.
Recurrent abortions are defined as what?
3 successive SAB, excluding ectopic and molar pregnancies.
What general maternal factors increase risk of recurrent abortions?
- Infection (Mycoplasma, Chlamydia, Listeria or Toxoplasma) is rare. Tx = ABX
- Smoking and alcohol (4x risk is smoke 20 ciggs/day and 7 drinks/week)
- Medical disorders: antiphospholipid syndrome *** (main), DB, hypothyroidism, SLE.
- Age of mom
How does the % rate of spontaneous abortion change from women <30 yo to women >40?
- W <30: 11.2%
- W >40: 56%
What is usually seen with 2nd trimester pregnancy loss, causing “painless dilation” and delivery?
Incompetent cervix
RF and treatment for incompetent cervix as a cause of recurrent SAB’s?
- RF:
- Utermine anomalies
- Previous trauma
- Hx of conization
- Treatment: cervical cerclage.
What is recommended for both parents whom are trying to get pregnant?
Karyotyping to detect balanced reciprocal and Robertsonian translocations that could be passed onto the fetus unbalanced. There is a 3% chance one is a asyx carrier.
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
Tests for what 3 serum markers can be done for antiphospholipid syndrome?
- - Lupus anticoagulant
- - Anticardiolipin antibodies (IgG and IgM)
- - Anti-B2-glycoprotein 1 antibodies (IgG and IgM)
