Early Pregnancy Loss, Ectopic Pregnancy, and Rh Isoimmunization (Moulton)

Question 1

first trimester timing

Answer 1

first day of last menstrual period to 13 weeks + 6 days

Question 2

second trimester timing

Answer 2

14 weeks to 27 weeks + 6 days

Question 3

Third trimester timing

Answer 3

28 weeks to 42 weeks

Question 4

What is estimated date of confinement

Answer 4

the due date (40 weeks after the first day of the last menstrual period)

Question 5

abortion timing definition

Answer 5

< 20 weeks

Question 6

preterm delivery timing definition

Answer 6

20 to 36 weeks + 6 days

Question 7

full term delivery timing definition

Answer 7

37-42 weeks

Question 8

postdates definition

Answer 8

> 42 weeks

Question 9

first test on a woman presenting with vaginal bleeding

Answer 9

pregnancy test

Question 10

when is hcg first detected in serum

Answer 10

6-8 days after ovulation

Question 11

is a titer <5 mIU/L positive?

Answer 11

no

Question 12

What level of HCG can a urine pregnancy test detect?

Answer 12

25 m IU/L

Question 13

How does the level of hCG increase?

Answer 13

hCG levels should double every 2 days (peaks at 10 weeks at 100,000 IU/L)

Question 14

At what level of hCG can gestational sac be seen?

Answer 14

at 1500-2000 mIU/L with transvaginal U.S.

Question 15

What is the discriminatory level of hCG?

Answer 15

1500-2000 mIU/L –> will see gestational sac

Question 16

At what level of hCG and at what time is a fetal pole seen?

Answer 16

5200 mIU/L or around 5 weeks

Question 17

Lab findings suggestive of abnormal IUP or ectopic pregnancy

Answer 17

abnormal rise in hCG (< 53% in 48 hours)

Question 18

biochemical pregnancy

Answer 18

the presence of hCG 7-10 days after ovulation but in whom menstruation occurs when expected

Question 19

abortus

Answer 19

fetus lost before 20 weeks gestation, less than 500 grams

Question 20

most common cause of first trimester SAB’s

Answer 20

chromosome abnormalities

Question 21

most common chromosomal abnormality

Answer 21

45 XO (Turner’s syndrome)

Question 22

most common class of chromosomal abnormalities

Answer 22

trisomy class

Question 23

most common trisomy leading to abortion

Answer 23

trisomy 16

Question 24

threatened abortion

Answer 24

• vaginal bleeding and closed cervix
• 25-50% result in loss of pregnancy
• treatment is expected management

Question 25

inevitable abortion

Answer 25

• vaginal bleeding and the cervix is partially dilated

- loss is inevitable

Question 26

incomplete abortion

Answer 26

• vaginal bleeding, cramping lower abdominal pain with dilated cervix
• passage of some but not all the products of conception
• treatment is usually suction D&C

Question 27

complete abortion

Answer 27

• passage of all products of conception with a closed cervix
• with resolution of pain, bleeding, and pregnancy symptoms
• no treatment needed

Question 28

missed abortion

Answer 28

• fetus has expired and remains in the uterus

- usually no symptoms

Question 29

management of missed abortion

Answer 29

• coagulation problems may develop, check fibrinogen levels weekly until SAB occurs or proceed with suction D&C
• expectant management vs. misoprostol (cytotec) vs D&C

Question 30

septic abortion

Answer 30

• fever, uterine and cervical motion tenderness, purulent discharge, hemorrhage, and rarely renal failure
• retained infected products of conception

Question 31

management of septic abortion

Answer 31

• start IV antibiotics (Ampicillin, Gentamycin, Clindamycin)

- proceed with suction D&C

Question 32

blighted ovum

Answer 32

• anaembryonic gestation
• fertilized egg develops a placenta but no embryo
• gestational sac too large to not have embryo (>25mm)

Question 33

induced or elective abortion procedure

Answer 33

suction D&C is most common in first trimester

Question 34

management of blighted ovum

Answer 34

• expectant management
• medical management (misoprostol/cytotec)
• D&C

Question 35

suction D&C

Answer 35

• uses suction to remove products of conception

- surgical D&C is a more successful primary therapy then medical or expectant management