Early Pregnancy Loss, Ectopic pregnancies and RH Isoimmunizations Flashcards
1-3 trimesters
- 1- FDLMP- 13 (+6) wks
- 2- 14 wks- 27 (+6) wks
- 3- 28 wks- 42 wks
abortion, preterm delivery, full term delivery
- abortion- < 20 wks
- preterm- 20-36 +6 wks
- fullterm- 37-42 wks
vaginal bleeding
- pregnancy (40%)
- HCG!!
HCG
- first detected 6-8 days after ovulation
- level dbls every 2 days (peaks at 10 wks at 100,000)
- gestational sac can be seen at 1500-2000 with TVUS!!!!
discriminatory level
-HCG levels of 1500-2000 will see a gestational sac!!
if abnormal rise in HCG < 53% in 48 hrs
-abnormal IUP or ectopic pregnancy
Spontaneous abortions
< 20 wks, less than 500 gm
- 80% occur in 1st trimester
- most common cause- chromosome abnormalities- 45XO most common; trisomy is most common class (trisomy 16)
types of SAB defined by
- any or all of products of conception have passed
- cervix is dilated or not
Threatened abortion
- vaginal bleeding and closed cervix
- 25-50% result in loss of pregnancy
- tx- expected management
Inevitable abortion
- vaginal bleeding and cervix is partially dilated
- loss is inevitable
Incomplete abortion
- vaginal bleeding, cramping lower abd pain, dilated cervix
- passage of some products of contraception
- tx- suction D&C
Complete abortion
- passage of all products of contraception, closed cervix
- no tx
Missed abortion
fetus has expired and remains in uterus
Septic Abortion
- fever, uterine and cervical motion tenderness, purulent discharge, hemorrhage, rarely renal failure
- retained infected products of contraception
- start IV abx
- suction D&C
Blighted Ovum
(anembryonic gestation)
-empty gestational sac- no embr
Suction D&C- used for
-remove products of conception
Recurrent abortions
3 successive SAB
- general maternal factors
- local maternal factors
- fetal factors
- chromosomal factors- most common!!!
- immunologic factors
Recurrent abortions- general maternal factors
- infection
- smoking and ETOH
- medical- antiphospholipid ab syndrome
- maternal age
Recurrent abortions- local maternal factors
- uterine abnormalities
- cervical incompetence- painless dilation!!
Recurrent abortions- fetal factors
-chromosomal- 45XO (turner) and most common class is trisomy (16)
Recurrent abortions- immunologic factors
-antiphospholipid syndrome!!
ectopic pregnancy
- fallopian tube (98%)
- leading cause of maternal death in first trimester
ectopic pregnancy- risk factors
- tubal infection
- prev ectopic
- tubal reconstructive surgery
- DES
- IUD
- IVF or ART
- cig smoking
ectopic pregnancy- classic triad
- prior missed menses
- vaginal bleeding
- lower abd pain
Possible ectopic pregnancy
- most common
- abd pain, vaginal spotting/bleeding
- follow serial B-HCG and TVUS!!
Probable ectopic pregnancy
- abd pain, vaginal spotting/bleeding
- adnexal tenderness!!
- US- may see ectopic
Acutely Ruptured ectopic pregnancy
- surgical emergency
- severe abd pain, dizziness (hemorrhage)
- acutely ender abd
- hemodynamic instability!!
- US- empty uterus, free fluid
ectopic pregnancy- dx tests
- HCG inappropriately rises (<53%)
- discriminatory zone- HCG of 1500-2000- should see intrauterine gest sac
- TVUS (when in discriminatory zone)
ectopic pregnancy- medical mangement
when hemodynamically stable w/ an unruptured ectopic
- Methotrexate!!
- recheck HCG
ectopic pregnancy- expectant management
- if stable, and sx’s are spontaneously resolving
- follow HCG
ectopic pregnancy- surgical management
- laparotomy- if hemodynamically unstable!!
- laparoscopy- if stable
- salpingectomy, salpingostomy, salpingotomy
Rhesus isoimmunization
- Rh-neg women carring an Rh-positive fetus!!!
- mother’s ab’s cross placenta, attach to fetal Rh antigen- cause hemolysis
- 15% of caucasions are Rh D negative!
Rh sensitization
-prod of IgM ab’s- then IgG ab’s which cross placenta
Fetomaternal hemorrhage resulting in isoimmunization
- fetal blood enters into maternal circulation
- routine uncomplicated vaginal deliveries- most common
prevention of Rh isoimmunization
RhoGAM (anti-D Ig)
- dec RhD to maternal immune system
- administer in a Rh-neg women at 28 wks and within 72 hrs after delivery of a Rh D positive infant
Fetal hydrops- US
- ascites
- pleural effusion
- pericardial effusion
- skin or scalp edema
- polyhydramnios
detect fetal anemia
- doppler assessment of fetal MCA
- perform q 1-2 wks from 18-35 wks
severe fetal anemia
- HCT < 30%
- intrauterine infusions!- group O Rh-neg packed RBCs
