5 - Complications of Early Pregnancy

Question 1

relationship between developmental age and gestational (menstrual) age

Answer 1

developmental is 2 wks less than menstrual

Question 2

divisions btwn trimesters (# wks)

Answer 2

first - 0-12
second - 13-27
third - 28-40

Question 3

terms to describe pregnancy loss based on #wks

Answer 3

abortion 0-20 wks

pre term labor 20-36 wks

Question 4

threatened abortion

Answer 4

when there is bleeding but the fetus is still ok and has a heartbeat

Question 5

missed abortion

Answer 5

when there is no bleeding/signs of trouble but the fetus is no longer viable and doesnt have a heartbeat

Question 6

chance of recurrence w/ history of 1 spontaneous abortion

Answer 6

20%

Question 7

MCC spontaneous abortion

Answer 7

chromosomal abnlmalities

Question 8

MC group of chromosomal anomalies causes spontaneous abortion

Answer 8

autosomal trisomies

Question 9

single most common trisomy in spontaneous abortions

Answer 9

16

Question 10

single MC aneuploidy in spontaneous abortions

Answer 10

45,X (turner’s syndrome)

Question 11

most cases of Turner syndrome (45,X) are due to what?

Answer 11

loss of paternal sex chromosome (not related to maternal age)

Question 12

maternal dz that increase risk for spontaneous abortion

Answer 12

thyroid dz
HTN
diabetes (insulin dependent)
collagen vascular dz

Question 13

early-natal exposures that inc risk for spontaneous abortion

Answer 13

radiation - big inc if lots of radiation, little stuff is no big deal
smoking - inc if moderate or higher use

alcohol and caffiene - no big deal if moderate
trauma - super small risk

Question 14

medical management of spontaneous abortion

Answer 14

cytotec (misoprostol) to get any retained stuff out

Question 15

which is more dangerous - tubal or cornual ectopic pregnancy and why?

Answer 15

cornual - has more space so won’t be symptomatic until later, has change for more devastating rupture

Question 16

risk factors for ectopic pregnancy

Answer 16

previous pelvic infection
prev tubal surgery
prev ectopic pregnancy
IUDs

Question 17

presentation of ectopic pregnancy

Answer 17

abd pain (worsening), amenorrhea, vaginal bleeding
more severe will have dizziness, pregnancy sx, or have passed tissue

Question 18

how to dx / follow possible ectopic pregnancy

Answer 18

get HCG level. if its > 1500-2000 or so, should be able to see an intrauterine pregnancy. if you can’t see it, need to go hunting for ectopic

if HCG < threshold, follow the HCG every 48 hrs. If it doubles every 48 hrs as expected, should be fine. If it goes up less than expected or is plateauing, probably ectopic

Question 19

medical mgmt of ectopic pregnancy

Answer 19

methotrexate

Question 20

name for persistance of hydatidiform mole

Answer 20

gestational trophoblastic disease

Question 21

complete vs partial mole (molar pregnancy)

Answer 21

complete - all junk, no fetus

partial - some (messed up) fetus with the junk

Question 22

presentation of molar pregnancy

Answer 22

vaginal bleeding
uterine size discrepant from date
HTN
hyperemesis
thyroid dysfn
theca lutein cysts of ovaries

Question 23

what should uterine size be for gestational age (easy rule of thumb)

Answer 23

by 20 wks, fundus at umbilicus

after that, # wks = cm from pubic symphysis to fundus

Question 24

who gets molar pregnancies?

Answer 24

asians

maternal age 40