E2/L12 - Abortion, Ectopic Preg, Rh Immunization

Question 1

1st Trimester

Answer 1

1st day LMP (FDLMP) - 14 weeks

Question 2

2nd Trimester

Answer 2

14 - 28 wks

Question 3

3rd trim

Answer 3

28 - 42 wks

Question 4

Estimated Date of Confinement

Answer 4

40 weeks after FDLMP

Question 5

Abortion dates? Most common Chromosomal abnormality?Most common class of abortions?

Answer 5

<20 wks or <500 grams; 45 XO (Turners); Trisomy class (Trisomy 16)

Question 6

Preterm

Answer 6

20-37wks

Question 7

Full term

Answer 7

37-42 wks

Question 8

Postdates

Answer 8

> 42 wks

Question 9

hCG date first detected?

Answer 9

6-8 days

Question 10

hCG level at expected menstruation

Answer 10

100

Question 11

hCG detectable on urine pregnancy test?

Answer 11

> 25

Question 12

hCG level for gestational sac? (discriminatory level)

Answer 12

1500-2000

Question 13

hCG highest peak?

Answer 13

100,000 at 10wks

Question 14

hCG level and fetal pole on US?

Answer 14

5 wks (5200 hCG)

Question 15

lowest hCG increase in 48 hrs?

Answer 15

> 53% (If not it is abnormal IUP or ectopic)

Question 16

“Biochemical Pregnancy”

Answer 16

presence of hCG 7-10 days after ovulation but whom menstruation occurs wen expected

Question 17

Vaginal bleeding, but closed cervix

Answer 17

Threatened Abortion

Question 18

Vaginal bleed, but cervix partially dilated

Answer 18

Inevitable abortion

Question 19

Vaginal bleed, cramping, lower ab pain, dilated cervix, passage of some products but not all

Answer 19

Incomplete abortion

Question 20

Closed cervix, passage of ALL products, resolution of pain and bleeding, no tx needed

Answer 20

Complete abortion

Question 21

Fetus expired & remains in uterus; no symptoms, can have coagulation problems, tx w/ suction D&C

Answer 21

Missed Abortion

Question 22

Anembryonic gestation (fertilized egg develops a placenta but NO embryo); Gestational sac too large to not have embryo; tx w/ expectant management, misoprostol, or D&C

Answer 22

Blighted ovum

Question 23

3 consecutive SABs w/o identifiable causes

Answer 23

Recurrent Abortions

Question 24

General Maternal Factors leading to Recurrent Abortions

Answer 24

1) Infections: Mycoplasma, Listeria, Toxoplasma, Chlamydia
2) Smoking, EtOH
3) Medical Disorder
4) Maternal Age

Question 25

Local Maternal Factors for SAB

Answer 25

1) Uterine Abnormalities: DES, Fibroids, etc

2) Cervical Incompetence (Painless Dilation)

Question 26

Fetal Factors for Recurrent Abortions

Answer 26

1) Chromosomal

Question 27

Immunologic Factor for Recurrent Abortions

Answer 27

1) Antiphospholipid Ab Syndrome (also assoc w/ preeclampsia, thromboembolism, stroke); lupus anticoagulant, Anticardiolipin Ab, Anti-B2 glycoprotein 1 Abs; Tx w/ heparin

Question 28

Leading cause of maternal death in the 1st trimester

Answer 28

Ectopic Pregnancy (most common place = Fallopian Tubes in the Ampulla area)

Question 29

Triad of Ectopic Pregnancy

Answer 29

1) Prior missed menses
2) Vaginal bleeding
3) Lower abdominal pain

Question 30

Tx of Ectopic Pregnancy

Answer 30

1) Methotrexate (pt must be hemodynamically stable, and compliant): hCG should fall when checked on day 4 and 7
2) Laparotomy = unstable pt (cornual ectopic)
3) Laparoscopy = Stable
4) Salpingectomy = full removal
5) Salpingostomy = left open
6) Salpingotomy = sutured

Question 31

When to give RhoGAM

Answer 31

1) At 28 weeks and w/in 72 hrs after delivery

2) Any incidence of fetomaternal hemorrhage (External Cephalic Version, amniocentesis, CVS, MVA)

Question 32

Test for fetal RBC in maternal blood; determine level of RhoGAM to give

Answer 32

Kleinhauer-Betke Test

Question 33

Most valuable tool for detecting fetal anemia?

Answer 33

Fetal peak systolic velocity of Middle Cerebral Artery (MCA): perform every 1-2 wks from 18-35 wks

worrisome if >1.5

Question 34

Progesterone levels during pregnancy

Answer 34

<5 is BAD, >20 is good

Question 35

Hcb/Hct levels during pregnancy

Answer 35

decrease some during pregnancy but normal is 12-16 and 35-45%