BC Pregnancy Loss/ Spontaneous Abortion Flashcards
WHO defines abortion as any spontaneous or induced pregnancy termination
before how many weeks?
A- 20 weeks B- 12 weeks C- 18 weeks D- 37 weeks E- 24 weeks
20 wk
Majority of early pregnancy losses are clinically silent.
Highly sensitive maternal serum B-HCG assays indicate approximately what %
of pregnancies is lost after implantation?
A- 10% B- 0.5 % C- 80% D- 30% E- 60%
30%
Approximately, what % of first trimester abortions results from chromosomal anomalies?
A- 10% B- 15 % C- 35% D- 55% E- 75%
55%
Up to what percentage of women experience vaginal spotting/bleeding
during a first –trimester bleeding?
A-3% B-5% C-15% D-25% E- 43%
25%
Up to what percentage of women experience vaginal spotting/bleeding
during a first –trimester bleeding? 25%
Of the above, approximately what percentage will abort A-3% B-5% C-15% D-25% E- 43%
43%
25 year old multigravida with a previous confirmed early pregnancy presents with vaginal bleeding and pelvic pain.
Which of the following tests can help ascertain if the fetus is viable or if it is located in the uterus?
A- serum progesterone levels B- serial quantitative B-HCG C- Transvaginal ultrasound D- All of the above E- B and C only
All of the above
Septic abortion deaths following medical abortion , are more notably caused
by toxic shock syndrome from which of the following bacterial infections?
A- Staph. aureus B- Neisseria gonorrhoeae C- Chlamydia trachomatis D- clostridium sodellii E- strep. agalactiae
Clostridium Sodelli
A proven , effective therapy for threatened abortion includes which of the following?
A- Daily AM acetomenophen B- Daily AM Ibuprofen C- Increased fluid intake D- Bed rest E- none of the above
None
A 32 year old woman with 4 previous recurrent second trimester pregnancy losses, presented at 8 weeks gestation
You decided that she is a good candidate for cervical cerclage?
When is it best placed?
A- 16 to 24 weeks B- 12 to 14 weeks C- 8 to 10 weeks D- 20 to 24 weeks E- 24 to 28 weeks
12 - 14 wk
25 year old Miss F primigravida presents with vaginal spotting.
Her LNMP is 6 weeks ago. Transvaginal US reveals a fetal pole and fetal heart rate. Which of the following is your diagnosis?
A- Incomplete abortion B- Threatened abortion C- Missed Abortion D- Ectopic pregnancy E- none of the above
Threatened
25 year old Miss F primigravida presents with vaginal spotting.
Her LNMP is 6 weeks ago. Transvaginal US reveals a fetal pole and fetal heart rate. Which of the following is your diagnosis? Threatened Abortion
Return 3 days later with 8/10 pelvic cramps and light vaginal bleeding, She is AVSS. repeat US showed no fetal pole or heart beat,
Appropriate management include ?
A- Await spontaneous miscarriage B- perform emergent cerclage placement C- Administer IM methotrexate D- None of the above E- All of the above
Await Spontaneous Miscarriage
Miss F our last patient, return to the ER , a few hours later and passes , the tissue shown below. She is now asymptomatic after passing tissue. (clots/fetal parts)
Complete abortion
In women experiencing a first trimester SA, without dangerous hemorrhage or
infection, expectant management results in spontaneous resolution of the pregnancy in what percentage?
A- 80% B- 100% C- 10% D- 40% E- 25%
80%
Recurrent spontaneous abortion/miscarriage is defined by which of the following?
A- Two pregnancy losses in 10 years at 20 weeks gestation or less
B- Two consecutive pregnancy losses at 20 weeks gestation or less
C- Three or more consecutive pregnancy losses with fetal weights greater than 500g
D- Three or more consecutive pregnancy losses with fetal weight less than 500g
E- Three or more consecutive pregnancy losses at 20 weeks gestation or less.
Three or more consecutive Pregnancy Losses at 20wk Gestation or less
Which of the following causes are more likely to result in recurrent second trimester losses?
A- Genetic B- Autoimmune or anatomic C- Infectious D- endocrine E - All of the above
Autoimmune or anatomic
Acquired defects that may lead to recurrent SA, include which of the following?
A- Asherman syndrome B- Leiomyoma C- Cervical incompetence D- all of the above E- none of the above
All of the above
What estimated percentage of immunological factors causing recurrent SA?
A- 15 % B- 40% C- 0.1% D- 2% E- 35%
15%
Antiphospholipid antibodies clinical and laboratory diagnostic criteria include?
A- Lupus anticoagulant presence.
B- 3 or more consecutive abortions before 10 weeks.
C- Moderate levels of IGG anticardiolipin
D- High levels of IGM anticardiolipin
E- one or more unexplained deaths of a morphologically normal fetus at or beyond 10 weeks
F- one or more episodes of arterial,venous,or small vessel thrombosis in any
tissue or organ
G- all of the above
All of the above
Early pregnancy loss is most common in women with which of the following ?
A- Type 2 DM- well controlled B- Gestational HTN C- HIV D- PCOS-Stein Leventhal synd. E- SLE with antiphospholipid antibodies
SLE with antiphospholipid antibodies
What is the preferred treatment regimen for antiphospholipid syndrome that will increase live birth rates?
A- low dose ASA plus unfractionated heparin daily B- low dose ASA alone C- unfractionated heparin daily D- 2000 units of vitamin D daily E- low dose warfarin
Low dose ASA plus unfractionated heparin daily
Initial evaluation of couples with recurrent pregnancy loss DOES NOT include which one of the following ?
A- psychological screening B- uterine cavity evaluation C- antiphospholipid antibody syndrome testing D- Parental Karyotyping E- TSH
Psychologic Screening
Which of the following medication is used in widely for early medical abortion?
A- Misoprostol B- Methotrexate C- Mifepristone D- Ibuprofen E- Ulipristal
Misoprostol
What is the most common cause of fetal loss in the early gestation period?
a) Ectopic implantation
b) Prematurity
c) Chromosomal abnormalities
d) Infection
e) Poor placental circulation
Chromosomal AbN
A patient presents to clinic c/o abdominal pain and nausea. She states, a home pregnancy test taken one week ago was positive. Transvaginal ultrasound fails to reveal the presence of an intrauterine pregnancy. Her serum β-hCG level is 1500 mIU/ml. Four days later, repeat β-hCG levels increase to 1800 mIU/ml. What is the most likely diagnosis?
a) Ectopic pregnancy
b) Spontaneous abortion
c) Multiple gestation
d) Incomplete abortion
e) None of the above
Ectopic Pregnancy
The use of methotrexate to treat ectopic pregnancy is contraindicated in which of the following?
A- renal dysfunction B- Intrauterine pregnancy C- Hemodynamic instability D- Liver dysfunction E- all of the above
All of the above
A predictor of success for the use of single dose methotrexate includes
Which of the following?
A- Fetal cardiac activity B- ectopic mass greater than 3.5 cm C- Initial serum BHCG value is <5000 mlu/ml D- concomitant use of folinic acid E- known renal failure
Initial serum bhcgvalue <5000 mlu/ml
What is the lower limit serum B-HCG concentration at which transvaginal
Ultrasound can reliably visualize pregnancy?
A- 500 and 1000 mlu/ml B- 1500 and 2000 mlu/ml C- 2500 and 3000 mlu/ml D- 3500 and 5000 mlu/ml E- 5500 and 6000 mlu/ml
1500 - 2000
Without intervention , an ectopic tubal pregnancy can lead to which of the following ?
A- Spontaneous resolution B- Tubal rupture C- expulsion of the POC through the fimbriated end of the tube D- all of the above E- B and C only
all of the above
In the differential diagnosis of ectopic pregnancy, ultrasound is used primarily to?
a) Identify bleeding in cul-de-sac
b) Identify intrauterine gestational sac
c) Identify adnexal mass
d) Measure size of uterus
e) Estimate gestational age
Identify intrauterine gestational sac
A previously healthy 21 yo south east Asian woman presents to the ER c/o of increasing vaginal bleeding for the past 2 days. Last menstrual period was 8 wks ago. Home pregnancy tests was positive . She is 165 cm tall and weighs 68 kg. Bimanual exam shows a soft uterus consistent in size with a 10 wk gestation. serum B-hCG is 554,367 mlU/mL.
Transvaginal ultrsonography shows an enlarged uterus with no fetus. The endometrial cavity is filled with scattered hyperechoic material and both ovaries have small 2 to 3cm, simple cysts.
Which of the following is the most appropriate next step in management?
a) Suction and curettage
b) Hysterectomy
c) Administration of misoprostol
d) Chronic villus sampling
e) Administration of methotrexate
suction and curettage
Three things of note in Bleeding <20wk
- Ectopic 2. Abortion 3. Molar Pregnancy
What Ix do you do with early preg loss/ spontaneous abortion?
Maternal Antibody/ Beta Hcg (also CBC)
What causes ++ high bhcg levels?
molar pregnancy
What cells make bhcg?
trophoblastic cells
What is the most common type of abortion?
Threatened
What organism causes septic abortion?
clostridium sodelli
If an embryo is present in material of hydatidiform mole is it complete or partial?
Partial
What are the two types of hydatidiform mole?
Complete/Partial
Where is the origin or hydatidiform mole? (Maternal or Paternal?
Paternal
What is the imunochemistry in a complete mole? (P57 + or -ve)
P57 Negative (COMPLETE NEG)
Is a complete or partial mole more common?
Complete
What is the immunochemistry in a partial mole? (P57 -ve or +)
P57 Positive Partial (PPP)
What is the best management for molar pregnancy?
D&C
What do you do after D&C of molar pregnancy?
1 year of contraception
What is the complication you worry about in molar pregnancies?
Choriocarcinoma
What do you monitor in molar pregnancy (after removed)
B Hcg (should be negative eventually)
Where do you look for Mets in choriocarcinoma?
lungs (need CXR)
What kind of leiomyomas tend to cause the most problems?
Submucosal
what is the most common SE of methotrexate?
transient liver dysfunction
when can you not use MTX?
if serum HCG is over >5000
what population is molar pregnancy popular in?
Asians
35yo 8weeks amenorrhea with PV bleeding. Cx closed, uterus 14wk size. Ddx (top 3)? Workup
Ddx 1) molar preg 2) abortion 3) ectopic)
Workup 1) betahcg 2) type&screen 3) CBC 4) Ptt/INR 5) pelvic US
When do you order thrombophilia workup after pregnancy loss?
ONLY in late fetal loss (nine weeks) and recurrent cases
What do you order for women with recurrent pregnancy loss?
Anticardiolipin antibody, lupus anticoagulant, uterine assessment (hysterosalpinography or sonohysterographY), thyroid function, karyotype for both partners
