5 - Complications of Early Pregnancy Flashcards
relationship between developmental age and gestational (menstrual) age
developmental is 2 wks less than menstrual
divisions btwn trimesters (# wks)
first - 0-12
second - 13-27
third - 28-40
terms to describe pregnancy loss based on #wks
abortion 0-20 wks
pre term labor 20-36 wks
threatened abortion
when there is bleeding but the fetus is still ok and has a heartbeat
missed abortion
when there is no bleeding/signs of trouble but the fetus is no longer viable and doesnt have a heartbeat
chance of recurrence w/ history of 1 spontaneous abortion
20%
MCC spontaneous abortion
chromosomal abnlmalities
MC group of chromosomal anomalies causes spontaneous abortion
autosomal trisomies
single most common trisomy in spontaneous abortions
16
single MC aneuploidy in spontaneous abortions
45,X (turner’s syndrome)
most cases of Turner syndrome (45,X) are due to what?
loss of paternal sex chromosome (not related to maternal age)
maternal dz that increase risk for spontaneous abortion
thyroid dz
HTN
diabetes (insulin dependent)
collagen vascular dz
early-natal exposures that inc risk for spontaneous abortion
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
medical management of spontaneous abortion
cytotec (misoprostol) to get any retained stuff out
which is more dangerous - tubal or cornual ectopic pregnancy and why?
cornual - has more space so won’t be symptomatic until later, has change for more devastating rupture
risk factors for ectopic pregnancy
previous pelvic infection
prev tubal surgery
prev ectopic pregnancy
IUDs
presentation of ectopic pregnancy
abd pain (worsening), amenorrhea, vaginal bleeding more severe will have dizziness, pregnancy sx, or have passed tissue
how to dx / follow possible ectopic pregnancy
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
medical mgmt of ectopic pregnancy
methotrexate
name for persistance of hydatidiform mole
gestational trophoblastic disease
complete vs partial mole (molar pregnancy)
complete - all junk, no fetus
partial - some (messed up) fetus with the junk
presentation of molar pregnancy
vaginal bleeding uterine size discrepant from date HTN hyperemesis thyroid dysfn theca lutein cysts of ovaries
what should uterine size be for gestational age (easy rule of thumb)
by 20 wks, fundus at umbilicus
after that, # wks = cm from pubic symphysis to fundus
who gets molar pregnancies?
asians
maternal age 40
