Early pregnancy outcomes

Question 1

What are some metabolic effects of hPL and hPGL

Answer 1

increase maternal lipolysis

free up glucose, amino acids, ketones for fetal use

Question 2

The placenta lacks ______ so it cannot synthesize estrogen from cholesterol

Answer 2

17 hydroxylase

Question 3

______ is an estrogen that is produced only in the placenta, and is a weak estrogen

Answer 3

estriol

Question 4

Up to 7 weeks gestation, the ____ is the primary source of progesterone

Answer 4

corpus luteum

Question 5

At 10 weeks gestation, the _____ becomes the primary producer of progesterone

Answer 5

placenta

Question 6

Describe the role of LH and hCG in progesterone production

Answer 6

initially LH stimulates the CL to make progesterone
hCG stimulates progesterone production from the CL from implantation at day 8 to week 8
the placenta produces estrogen for the remainder of pregnancy

Question 7

hCG is produced in what cell type?

Answer 7

synctiotrophoblast

Question 8

hCG is structurally very similar to ____ but has a longer half life

Answer 8

LH

Question 9

B-hCG doubles every ______ days in normal pregnancy

Answer 9

2-3 days

Question 10

What is the relevance of the discriminatory zone of hCG levels?

Answer 10

β hCG level more than 1000-1500 signifies the “discriminatory zone” = ultrasound is expected to show a viable pregnancy

Question 11

List causes of higher than expected hCG levels

Answer 11

molar pregnancy
multiple gestation
hyperemesis gravidarum

Question 12

List causes of lower than expected hCG levels

Answer 12

SAB

ectcopic pregnancy

Question 13

What is the most common cause of spontaneous abortion?

Answer 13

chromosomal abnormalities

Question 14

What are symptoms of spontaneous abortion?

Answer 14

pelvic pain, bleeding, cramping

Question 15

How can spontaneous abortion be diagnosed?

Answer 15

serial hCG levels, should double every 2-3 days

pelvic ultrasound- should see gestational sac after 5 weeks or when hCG>1500

Question 16

What is the appropriate treatment for a missed, inevitable or incomplete SAB?

Answer 16

medical management with misoprostol or surgical management with D&C

Question 17

Recurrent pregnancy loss is diagnosed after __________ misscarriages

Answer 17

3 consecutive

Question 18

What factors may contribute to recurrent pregnancy loss?

Answer 18

 Anatomic factors: uterine anomalies, fibroids/polyps, intrauterine adhesions, cervical
insufficiency (often present as a late second trimester loss)
 Endocrine factors: thyroid dysfunction, diabetes, PCOS, hyperprolactinemia, decreased
ovarian reserve, “luteal phase defect”
 Environmental factors/stress
 Genetic factors: translocations or aneuploidy of parental chromosomes
 Immunologic factors: Antiphospholipid syndrome, infection, other proposed conditions
 Thrombophilias

Question 19

What are risk factors for ectopci pregnancy?

Answer 19

tubal damage from PID, tubal surgery
current IUD use
IVF
smoking

Question 20

How is ectopic pregnancy diagnosed?

Answer 20

pain, bleeding at 6-8 weeks gestation

hCG>1500 but no intrauterine pregnancy seen on ultrasound

Question 21

How is ectopic pregnancy treated?

Answer 21

medial management with methotrexate, surgical management if serious

Question 22

Compare complete vs incomplete molar pregnancy

Answer 22

• complete: 46XX or 46 XY, hydropic villi, snowstorm appearance on ultrasound, no fetal tissue
• incomplete: 69 chromosomes, some fetal tissue present

Question 23

How is molar pregnancy treated?

Answer 23

Surgical evacuation, hysterectomy indicated if perforation

close follow up of B hCG