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Block I: Reproduction & Sexuality > Clinical: Pregnancy Loss > Flashcards

Clinical: Pregnancy Loss Flashcards

1
Q

Define miscarriage

A
  • Loss of intra-uterine pregnancy before 24 completed weeks
  • Loss of fetus/mbryo <500 g and less than 22 completed gestational weeks
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2
Q

Typical presentation of spontaneous abortion

A

Vaginal bleeding and uterine cramps or back pain

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3
Q

5 potential ultrasound findings for spontaneous abortion

A
  • Anembryonic pregnancy
  • Abortion in progress
  • Missed abortion
  • Retained products of conception
  • Abnormally shaped gestational sac
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4
Q

US for anembryonic pregnancy

A

Large (>18 mm) gestational sac without embryo

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5
Q

US for abortion in progress

A

Low-lying gestational sac (thick arrow), decidual reactoi nand hemorrhage (mixed hyper- and hypo-echoic material between arrowheads)

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6
Q

7 causes of sporadic miscarriage

A
  • Chromosomal abnormalities
  • Fetal malformations
  • Placental abnormalities
  • Infection
  • Fetal sex
  • Mulitple pregnancy
  • Maternal health
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7
Q

4 chromosomal abnormalities associated with multiple fetal abnormalities (risk for sporadic miscarriage)

A
  • Trisomies
  • Monosomy X (45X0)
  • Polyploidy (69XXY, 69XXX)
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8
Q

8 infections that may cause sporadic miscarriage

A
  • Listeria
  • Toxoplasmosis
  • Malaria
  • Rubella
  • CMV
  • HIV
  • B19 parvo (late)
  • Syphilis (late)
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9
Q

7 steps of the pathophysiology of sporadic miscarriage

A
  1. Fetal demise or abnormal placental invasion
  2. Reduced trophoblastic invasion
  3. Blood flow enters the intervillous space and dislodges the conceptus
  4. Further intrauterine bleeding
  5. Local prostagladin release
  6. Pain
  7. Uterine contraction/expulsion of the conceptus
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10
Q

3 presentations of miscarriage

A
  • Bleeding (threatened miscarriage)
  • Complete miscarriage
  • Arrested pregnancy
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11
Q

Define complete miscarriage

A

Cervix opens and conceptus/products expelled

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12
Q

3 conditions associated with incomplete miscarriage

A
  • Massive hemorrhage
  • Cervical shock syndrome
  • Urgent evacuation of the uterus
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13
Q

3 treatments for sporadic miscarriage

A
  • Expectant management
  • Cytotec (misoprostol)
  • Suction curettage
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14
Q

2 risks of suction curettage

A
  • Infection
  • Uterine damage
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15
Q

Define recurrent miscarriage

A

Three (or more) consecutive miscarriage

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16
Q

Define primary recurrent miscarriage

A

No previous llive births

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17
Q

Define secondary recurrent miscarriage

A

At least one successful pregnancy

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18
Q

6 reproductive problems that recurrent miscarriage is associated with

A
  • Infertility
  • Late miscarriage
  • Stillbirth/NND
  • Ectopic pregnancy
  • Fetal abnormality TOP
  • Prematurity/IUGR
19
Q

7 etiologies of recurrent miscarriage

A
  • Genetic
  • Anatomical
  • Infective
  • Endocrine
  • Immune
  • Thrombophilic
  • Unexplained
20
Q

5 examples of genetic causes of recurrent miscarriage

A
  • Prental chromosomal abnormalities (peripheral blood karyotype of both parents)
  • Recurrent fetal aneuploidy (fetal cytogenetic analysis)
  • Balanced or reciprocal translocations
  • Robertsonian translocation
  • Pericentric inversions
21
Q

2 anatomical causes of recurrent miscarriage

A
  • Uterine anomalies
  • Fibroids
22
Q

8 uterine anomalies

A
  • Arcuate
  • Subseptate
  • Septate
  • Unicollis bicornuate
  • Bicolis bicornuate
  • Didelphus
  • Unicornuate
  • Hypoplastic
23
Q

Treatment for arcuate and didelphys uterine anomalies

A

None

24
Q

Treatment for septate and subseptate uterine anomalies

A

Resect septum

25
Q

Treatment for bicornuate uterus

A

Consider metroplasty usually as last resort

26
Q

Treatment for fibroids causing recurrent miscarriage

A

Myomectomy (only if no other cause identified)

27
Q

3 infective causes of recurrent miscarriage

A
  • Syphilis
  • Malaria
  • Bacterial vaginosis (trichomonas vaginalis)
28
Q

4 endocrine causes of recurrent miscarriage

A
  • Systemic endocrine disease
    • Diabetes (esp NIDDM)
    • Thyroid disease
  • Luteal phase deficiency
  • PCOS (hypersecretion of LH, hyperinsulinemia)
29
Q

3 immune causes of recurrent miscarriage

A
  • Autoimmune disease
  • Antiphospholipid syndrome (PAPS, aPL, APS, APAs)
  • Allo-immune factors
30
Q

3 auto-immune diseases associated with recurrent miscarriage

A
  • SLE
  • Antithyroid antibodies (anti-thyroglobulin and anti-thyroid peroxidase)
  • Anti-nuclear antibodies
31
Q

2 antiphospholipid antibodies

A

LA and aCL

32
Q

Diagnosis of antiphospholipid syndrome

A

dRVVT (for LA) and ELISA (for aCL). Need at least two tests at least 6 weeks apart

33
Q

3 treatments of antiphospholipid syndrome

A

SC heparin and LDA until 34 weeks

Potential IVIG for thrombocytopenia

34
Q

7 thrombophilic causes of recurrent miscarriage

A
  • APS (acquired thrombophilic state)
  • Hyperhomocysteinemia (dietary or MTHFR mutation)
  • Activated protein C resistane (factor V leiden)
  • Protein S deficiency
  • Protein C deficiency
  • AT III deficiency
  • Prothrombin G20210A mutation
35
Q

Effect of hyperhomocystenemia

A

Impairs endothelial function and promotes thrombosis

36
Q

Cause of acquired hyperhomocystenemia

A

Deficiencies of Vit B6, (B9) and B12

37
Q

Cause of inherited hyperhomocystenemia

A

MTHFR mutation

NOTE: individuals homozygoud for MTHFR mutation are NOT at increased risk of RM by most recent meta-analysis

38
Q

Treatment for acquired hyperhomocysteinemia

A

Folate and B12 supplementatoin

39
Q

Effect of activated Protein C resistance

A

Factor V resistant to cleavage by activated Protein C

40
Q

Cause of inherited activated Protein C resistance

A

Factor V Leiden mutation (hetero- or homo-)

41
Q

Test for activated protein C resistance

A

Test for APCR and FVL

42
Q

Treatment for activated protein C resistance

A

LDA and heparin?

43
Q

Effect of prothrombin G20210A mutation

A

Increased factor II (prothrombin)

44
Q

3 thrombophilic causes that are not directly related to recurrent miscarriage, but which should be treated due to risk of thrombosis anyway

A
  • Inherited hyperhomocystenemia
  • Protein C deficiency
  • Anti-thrombin III deficiency

Block I: Reproduction & Sexuality (23 decks)

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