Early pregnancy outcomes Flashcards
What are some metabolic effects of hPL and hPGL
increase maternal lipolysis
free up glucose, amino acids, ketones for fetal use
The placenta lacks ______ so it cannot synthesize estrogen from cholesterol
17 hydroxylase
______ is an estrogen that is produced only in the placenta, and is a weak estrogen
estriol
Up to 7 weeks gestation, the ____ is the primary source of progesterone
corpus luteum
At 10 weeks gestation, the _____ becomes the primary producer of progesterone
placenta
Describe the role of LH and hCG in progesterone production
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
hCG is produced in what cell type?
synctiotrophoblast
hCG is structurally very similar to ____ but has a longer half life
LH
B-hCG doubles every ______ days in normal pregnancy
2-3 days
What is the relevance of the discriminatory zone of hCG levels?
β hCG level more than 1000-1500 signifies the “discriminatory zone” = ultrasound is expected to show a viable pregnancy
List causes of higher than expected hCG levels
molar pregnancy
multiple gestation
hyperemesis gravidarum
List causes of lower than expected hCG levels
SAB
ectcopic pregnancy
What is the most common cause of spontaneous abortion?
chromosomal abnormalities
What are symptoms of spontaneous abortion?
pelvic pain, bleeding, cramping
How can spontaneous abortion be diagnosed?
serial hCG levels, should double every 2-3 days
pelvic ultrasound- should see gestational sac after 5 weeks or when hCG>1500
What is the appropriate treatment for a missed, inevitable or incomplete SAB?
medical management with misoprostol or surgical management with D&C
Recurrent pregnancy loss is diagnosed after __________ misscarriages
3 consecutive
What factors may contribute to recurrent pregnancy loss?
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
What are risk factors for ectopci pregnancy?
tubal damage from PID, tubal surgery
current IUD use
IVF
smoking
How is ectopic pregnancy diagnosed?
pain, bleeding at 6-8 weeks gestation
hCG>1500 but no intrauterine pregnancy seen on ultrasound
How is ectopic pregnancy treated?
medial management with methotrexate, surgical management if serious
Compare complete vs incomplete molar pregnancy
- complete: 46XX or 46 XY, hydropic villi, snowstorm appearance on ultrasound, no fetal tissue
- incomplete: 69 chromosomes, some fetal tissue present
How is molar pregnancy treated?
Surgical evacuation, hysterectomy indicated if perforation
close follow up of B hCG
