6. Early Pregnancy Loss, Ectopic, and Rh Isoimmunization Flashcards
Vaginal bleeding is the major symptom during early pregnancy.. HCG is detected in serum 6-8days post ovulation, less than 5 is negative, level of hcg DOUBLES ever 2 days (peaks at ten weeks = 100000), what value can one expect a gestation sac to be present?
1500-2000 mIU/L with transvaginal US (TVUS)
The fetal pole is seen at 5 weeks or hcg of 5200, if there is an abnormal rise in hCG of less than 53% in 48 hours an abnormal IUP or what can be expected?
Ectopic pregnancy
If an US reveals a live appropriately grown fetus at 8 weeks gestation with a POSITIVE cardiac activity the risk of fetal loss is decreased to?
2%
Spontaneous abortions SAB is when a fetus is lost before 20 weeks gestation/less than 500 grams, 80% occur in first trimester- MCC by what two chromosomal abnormalities?
45XO Turner Syndrome
Trisomy 16
What type of abortion has vaginal bleeding and a closed cervix, 25-50% result in loss of pregnancy, treatment is expected management?
Threatened Abortion
Inevitable abortion is vaginal bleedingand the cervix is partially dilated-loss is inevitable. What abortion has vaginal bleeding, cramping in lower abd with a dilated cervix, passage of some but not all of the products of conception- tx with suction D and C?
Incomplete Abortion
What abortion has passage of all products of conception (fetus and placenta) with a closed cervix, with resoltuion of pain, bleeding and pregnancy sx, no tx required?
Complete Abortion
What abortion occurs when the fetus has expired and remains in the uterus with no sx, coagulation problems develop- check fibrinogen levels until SAB occurs or do suction with D and C?
Missed Abortion
What spontaneous abortion is known as anembryonic gestation, a fertilized egg develops a placenta but no embryo, US reveals empty gestational sac, tx is expectant, medical management with misprostol or D and C?
Blighted Ovum
What spontaneous abortion is known as anembryonic gestation, a fertilized egg develops a placenta but no embryo, US reveals empty gestational sac, tx is expectant, medical management with misprostol or D and C (dilation and currettage)?
Blighted Ovum
Suction D and C is used to remove products of conception, surgical D and C is a more succussful primary therapy than medical or expectant management. What is defined as 3 successive SAB exluding ectopic and molar pregs, 1% of women, with no identifiable causes?
Reccurent Abortions
General maternal factors that influence recurent abortions includes infection, smoking/ ETOH, medical disorders *MC is antiphospholipid Ab syndrome and coag defects along with?
Maternal age (older)
Local maternal factors that may cause reccurent abortions can be uterine abnormalities along with what, which is usually seen with second trimester loss, painless dilation and delivery, with previous trauma or hx of conization, tx with cervical cerclage?
Cervical Incompetence (Incompetent Cervix)
Chromosomal factors may influence recurrent abortions, karyotyping is done to detect balance reciprocal or robertsonian translocations that could be?
passed to fetus
What is the MC immunologic factor causing recurrent abortion, associated with preecampsia, V/A thromboembolism and stroke, test: lupus anticoag, anticardiolipin abs, anti-B2 glycoprotein 1 abs, tx w prophylactic dose of heparin and low dose aspirin?
Antiphospholipid Syndrome
What is defined as gestation implanted outside of the uterus, 98% in the fallopian tube (ampillary), occuring in 1.5% of pregs in US, trophoblast impants into mucosa of fallopian tube and rapidly erode through the underlying blood vessels, rupture and hemorrhage common, *leading cause of maternal death in first trimester?
Ectopic Pregnancy
Risk factors for Ectopic Pregnancy include tubal infection w chlamydia, previous, DES* exposure, pregnancy with IUD, hx of IVF or ART and ?
SMOKING
There is a classic triad associated with Ectopic Pregnancy, which includes prior missed menses, vaginal bleeding and?
Lower abdominal pain
POSSIBLE Ectopic Pregnancy presents with abdominal pain, vaginal spotting or bleeding, follow serial B-hCG and TVUS ultrasound, uterus is soft and normal size, may not feel adnexal mass, on US can see thickened endometrial stripe (arias-stella reaction) but rarely can one see?
The ectopic pregnancy
++ adnexal tenderness/cervical motion tenderness = PROBABLE
An acutely ruptured ectopic pregnancy has sx of severe abdominal pain and dizziness, on PE see distended and acutely tender abdomen, usually has cervical motion tenderness, with signs of hemodynamic instability, it is a surgical?
EMERGENCY (US shows free fluid)
Dx tests for ectopic pregnancy inlcude quantitative hCG (normally can see double hCG in 48 hours), hCG inappropriately rises with ectopic pregs, usually less than 50% rise, on TVUS one can see IUP/EUP or nondiagnostic- will follow closelt with serial?
hCG and give strong ectopic precautions
Medical managment for Ectopic Pregnancy in patients who are stable and compliant.. methotrexate MTX, folic acid antagonist inhibits DNA synthesis and cell replication, giving IM, and followed by checking hCG on days 4 and 7, what should be seen?
hCG levels decrease (sometimes increases intially)
Up to 80% of ectopics with hCG levels less than what will not rupture and will resolve spontaneously?
1000
Laparotomy is the preferred apporach for patients who are hemodynamically UNSTABLE, what surgical managment is used for stable patients?
Laparoscopy
Salpingectomy is the removal of the ENTIRE fallopian tube recommended when significant damage to tube is noted. Salpingostomy- incision is made parallel to acis of tube over site of implantation and incision is left open to heal my secondary intention- better long term tubal function… what surgical intervention is the same as above except is sutured closed?
Salpingotomy
Rhesus isoimmunization is a DO that occurs in a pregnant Rh- woman carrying a Rh+ baby, the moms immune system makes antibodies which cross placenta (igG) and destroy fetal RBCs= hemolytic disease of newborn, Rh is made up of many antigens, which is most important?
RhD = Rh positive (lack D = Rh NEG**)
Highest incidence of RhD negative is Caucasians (15%) and african americans… prophylactic Rh immune globulin named what is given to prevent maternal production of the toxic antibodies?
RhoGAM
RhoGAM is given as a single dose and can prevent isoimmunization after exposure up to 30ml of RhD + whole blood or 15ml of fetal RBCs, administer at 28weeks and within how many hours of delivery of infant?
72hours
What test identifies fetal red blood cells in maternal blood and will determine if additional RhoGAM is neccessary?
Kleinhauer Betke Test
Maternal Rh-Abs titers are used as screening tool to estimate the severity of fetal hemolysis in Rh disease, titers less than 1:8 indicated the fetus is not in serious jepordy (recheck q 4 weeks), if the titer is greater than what, a detailed US to detect hydrops and doppler studies of middle cerebral a MCA?
Titers > 1:16
US imaging of fetal hydrops, one can see polyhydramnios, pleural effusion, pericardial effusion, skin or scalp edema and ?
Ascites
Perform doppler assessment of peak systolic velocity in the fetal MCA is MOST valuble for checking fetal anemia, perform q 1-2 weeks from 18-35 weeks, peak systolic velocity greater than what is predictive of mod/sev fetal anemia, might need transfusion?
> 1.5 MOM for gestational age
The following is what type of fetal anemia…
Hct below 30% for age, IU transfusions performed, using ffreshgroup O, Rh negative PRBC, survival rates after transfusions q 1-3 weeks is about 85%?
Severe fetal anemia
G1P1011 =
Gravidy: 1 number of times pregnant
Partiy:
1 Number full term births (37-42 weeks)
0 Number of Preterm births (20-36weeks, 6 days)
1 Number of Abortions (less than 20 weeks)
1 Number of Living children
MEOW
