Early Pregnancy Loss/ Spontaneous Abortion Flashcards by Kay Zee

Spontaneous abortion occurs most frequently in the _____ trimester

First

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When recurrent,

spontaneous abortion can be associated with ______

Infertility

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Spontaneous abortion can result in ______

Grief Reactions

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What are the 5 broad causes of early pregnancy loss/ spontaneous abortion?

1) Genetic factors (e.g., chromosomal abnormalities)
2) Reproductive tract abnormalities (e.g., uterine anomalies)
3) Prothrombotic factors (e.g., thrombophilia)
4) Endocrinologic factors (e.g., polycystic ovary syndrome)
5) Immunologic factors (e.g., antiphospholipid syndrome)

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What are critical investigations for early pregnancy loss/ spontaneous abortion

critical investigations, including
a)transvaginal ultrasound;
b)laboratory investigations when appropriate (e.g., maternal antibody screen, complete blood count, beta-hCG);
c)proper investigation regarding recurrent abortion (e.g., anti-phospholipid antibody screen, karyotype,
hystero-salpingogram);

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Construct an effective initial management plan for early pregnancy loss/ spontaneous abortion

a) emergent management in case of hemodynamic instability (e.g., ruptured ectopic pregnancy);
b) referral for surgical evacuation or medical management (e.g., incomplete or missed abortion), if necessary;
c) counseling (e.g., grief, fertility implications, contraception);
d) referral for specialized care, if indicated (e.g., serious hemorrhage, recurrent abortion).

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WHO defines abortion as any spontaneous or induced pregnancy termination
before how many weeks?

20 weeks

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Approximately, what % of first trimester abortions results from chromosomal anomalies?

15%

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What is the most common cause of early first trimester bleeds?

chromosomal abnormalities

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From 12 wk - 20 wk what is the most common cause of early loss?

antiphospholipid abnormalities (autoimmune)

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What is the most common chromosomal abnormality that causes abortion

autosomal trisomy

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What karotype abnormality is consistent with turners disease (r/t early fetal loss)

cystic hygroma

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Up to what percentage of women experience vaginal spotting/bleeding
during a first –trimester?

A-3%
B-5%
C-15%
D-25%
E- 43%

25%

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Of those pregnant women having first trimester bleeding, approximately what percentage will abort
A-3%
B-5%
C-15%
D-25%
E- 43%

43%

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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

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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- strep pyogenes
E- strep bovis
F - Clostridium (perfigens or sordelli)

Clostridium perfingens or clostridium sordellii

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What are the three sx of Toxic shock syndrome?

fever, hypotension, rash (palms and soles)

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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 of the above

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 weeks

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 Abortion

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. Same above patient , return 3 days later with 8/10 pelvic cramps and light vaginal bleeding, She is AVSS. HCT 40%, 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

T/F; is fetal and embryonic tissue present in a partial hydatiform mole?

Yes

T/F; is fetal and embryonic tissue present in a complete hydatiform mole?

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.

E- Three or more consecutive pregnancy losses at 20 weeks gestation or less.

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

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 20 weeks. C- Moderate levels of IGG anticardiolipin D- High levels of IGM anticardiolipin E- 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 ```

E- 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 ```

A- 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 ```

Psychological screening

Which of the following medication is used in every dosing scheme and have been studied widely for early medical abortion? ``` A- Misoprostol B- Methotrexate C- Mifepristone D- Ibuprofen E- Ulipristal ```

Misoprostol

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

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

Methotrexate- most common side effects

- transient liver dysfunction | Overall resolution rate with methotrexate is 90 percent

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 ```

C- Initial serum BHCG value is <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 ```

B 1500 - 2000

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 IUP

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

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

D & C Put on oral contraception for at least a year monitor betas Order CXR for mets of neoplasia

A 22 y.o. female presents to your clinic with lower abdominal pain and mild vaginal bleeding. Her last menstrual period was 8 weeks ago. She is sexually active and has had 2 prior episodes of PID. She has no fever and is hemodynamically stable. What are 5 differential diagnoses:- a) Ectopic pregnancy b) Spontaneous abortion c) Molar pregnancy d) PID e) Torsion of ovarian cyst f) Appendicitis g) Ruptured corpus luteum

a) Ectopic pregnancy b) Spontaneous abortion c) Molar pregnancy d) PID e) Torsion of ovarian cyst f) Appendicitis g) Ruptured corpus luteum

Physical exam reveals a female in no painful distress. Palpation of the abdomen reveals LLQ tenderness . Pelvic exam shows a bluish discoloration of the vulva, blood oozing from a closed cervical os, a slightly enlarged uterus and left adnexal tenderness What investigations would you do?

``` Qualitativeβ-HCG: urine, serum Quantitative β-HCG: serum Transvaginal US Type and crossmatch Blood group and Rh CBC with differential PT/INR; PTT Glucose, lytes, urea, Cr LFTs Gonococcal & Chlamydial cultures ```