foetus, early pregnancy problems and miscarriage

Question 1

what period of pregnancy is crucial for organogenesis?

Answer 1

6-12 weeks

Question 2

what is a miscarriage?

Answer 2

Spontaneous loss of pregnancy before the foetus reaches viability.

(all pregnancy losses from the time of conception until 24 weeks of gestation)

Question 3

what amount of pregnancies end in miscarriage?

Answer 3

1 in 5 pregnancies will end in a loss before 12 weeks

Question 4

what is a biochemical pregnancy?

Answer 4

when you have hormones (hCG) but not signs of pregnancy

Biochemical loss - when there was evidence of pregnancy but they go away, it happens before clinical signs of pregnancy.

Question 5

what are the types of miscarriage?

related to time

Answer 5

biochemical, early pregnancy loss and late pregnancy loss.

Question 6

what are the risk factors for miscarriage?

Answer 6

• Gestational age: <6weeks -25%,6-12weeks-12-20%,12 weeks 1-2%
• Chromosomal abnormality: 50% of miscarriage
• Maternal and paternal age
• Previous miscarriage
• Pre-pregnancy weight
• Alcohol intake
• Smoking, Excessive Caffeine

Question 7

what are the types of miscarriage?

Answer 7

Threatened miscarriage 
Inevitable miscarriage 
Incomplete miscarriage 
Complete miscarriage 
Septic miscarriage
 Anembryonic miscarriage(Blighted ovum)
Missed miscarriage (Silent or delayed)

Question 8

what is a threatened miscarriage ?

Answer 8

when the woman has a little bit of bleeding but the baby is find

could be due to a little bit of separation from the womb

Question 9

what is an inevitable misscariage?

Answer 9

inevitable - the miscarriage has already started and you can’t stop it

Question 10

what is septic miscarriage?

Answer 10

when there is an associated infection

Question 11

what is incomplete miscarriage

Answer 11

incomplete miscarriage when there is products of pregnancy left in the womb.

Question 12

what is a missed miscarriage (/silent or delayed)

Answer 12

when you have seen the heart beat but it is no longer there

Question 13

what are the ultrasound criteria for diagnosis of miscarriage?

Answer 13

Crown-rump length of at least 7 mm and no heartbeat.
Mean gestational sac diameter of at least 25 mm and no embryo.
Absence of embryo with heartbeat at least 2 weeks after an ultrasound scan
that showed a gestational sac without a yolk sac.
Absence of embryo with heartbeat at least 11 days after an ultrasound scan
that showed a gestational sac with a yolk sac.

Question 14

when can you first see the heart beat?

Answer 14

6 weeks

Question 15

what happens if you can’t see heart by 7 weeks?

Answer 15

baby has probably miscarried.

Question 16

what are the stages of miscarriage?

Answer 16

1. USS shows early an embryonic or fetal death
2. vaginal bleeding occurs
3. open cervical OS (inevitable miscarriage)
4. miscarriage (products of conception are expelled and cramps and bleeding soon subside)

Question 17

what is an ectopic pregnancy?

Answer 17

A pregnancy located outside of the uterine cavity, usually in the fallopian tube. Incidence is 11.1/1000 pregnancies

Question 18

what is the most common site for ectopic pregnancy?

Answer 18

the ampullary region of the fallopian tube

Question 19

what are the sites that ectopic pregnancies can occur?

Answer 19

ypes: Tubal (Ampullary, cornual), ovarian, cervical, abdominal, cervical

Question 20

what is a heterotopic pregnancy?

Answer 20

one in the fallopian tube and one in the womb

Question 21

what are the common symptoms of ectopic pregnancy?

Answer 21

• abdominal or pelvic pain
• amenorrhoea or missed period
• vaginal bleeding with or without clots .

Question 22

what are less common symptoms of ectopic pregnancy?

Answer 22

dizziness, fainting or syncope
 shoulder tip pain
 urinary symptoms
 passage of tissue
 rectal pressure or pain on defecation.

Question 23

what are the signs of ectopic pregnancy?

Answer 23

Common signs:
pelvic tenderness
adnexal tenderness
abdominal tenderness

Other signs:
cervical motion tenderness
rebound tenderness or peritoneal signs  pallor
abdominal distension
enlarged uterus
tachycardia or hypotension
shock or collapse orthostatic hypotension.

Question 24

why does a pseudo sac occur in ectopic pregnancy?

Answer 24

because of rising oestrogen - secretions appear like a pseudo sac

you can tell if it is a proper pregnancy if it has a yolk sac inside it.

Question 25

what is recurrent miscarriage ?

Answer 25

Loss of three or more consecutive pregnancies
It affects 1% of couples trying to conceive
1-2% of second trimester pregnancies miscarry before 24 weeks

Question 26

what are risk factors for recurrent miscarriage?

Answer 26

• Environmental : Maternal age, previous miscarriages, advanced paternal age, obesity, alcohol ,smoking , excessive caffeine.
• Antiphospholipid antibody: 15% of women with recurrent miscarriages (inhibits trophoblast function and complement activation)
• Genetic factors : balanced translocation, chromosomal abnormalities
• Anatomical factors: Uterine malformations, Cervical weakness
• Endocrine: Uncontrolled Diabetes, Thyroid dysfunction, PCOS.
• Immune factors: Uterine natural killer cells
• Infection
• Thrombophilia

Question 27

what are the investigations of recurrent miscarriage?

Answer 27

Referral to specialist clinic
Antiphospholipid tests
Cytogenetic analysis
Pelvic ultrasound to assess uterine anatomy Thrombophilia tests

Question 28

what is gestational trophoblastic disease?

Answer 28

molar pregnancies

Hydatidiform mole

Question 29

what are the types of hydatidiform mole?

Answer 29

• benign - 80%
• invasive mole - 10-15%
  choriocarcinoma - malignant 2-3% of hydatidiform moles

Question 30

what are complete and partial hydatidiform moles?

Answer 30

normal conception (2 sets of genes, 1 paternal, 1 maternal normal fetus)

complete mole (2 sets of paternal genes, no maternal genes, nofetus)

partial mole (3 sets of genes, 1 maternal, 2 paternal, no viable fetus)

Question 31

risk factors for molar pregnancies?

Answer 31

Epidemiology Incidence in UK is 1 in 714 live births
Higher incidence in Asian women Extremes of age increases risk
Previous molar pregnancy
Diets low in protein, folic acid, and carotene
Defects in the egg, abnormalities of uterus etc
Women with Blood Group A

Question 32

what is the clinical diagnosis of hydaitidiform mole?

Answer 32

Vaginal bleeding after amenorrhea

Hyperemesis gravidarum, hyperthyroidism Passing of grape like vesicles

Question 33

what is the radiological diagnosis of molar pregnancy?

Answer 33

Complete Mole : Absent gestational sac & a complex echogenic intrauterine mass with cystic spaces(snow storm)
Partial Mole: May resemble a normal conception Ovaries may develop Theca lutein cysts

Question 34

when does the blastocyst reach the uterus?

Answer 34

5th day after fertilisation

Question 35

what happens in the embryo at 4 weeks?

Answer 35

Rapid growth occurs and the embryo’s main features begin to take form. This process is called differentiation, which produces the varied cell types (such as blood cells, kidney cells, and nerve cells)

A notochord forms in the center of the embryonic disk.
Gastrulation commences.
A neural groove (future spinal cord) forms over the notochord with a brain bulge at one end. Neuromeres appear.
Somites, the divisions of the future vertebra, form.
Primitive heart tube is forming. Vasculature begins to develop in embryonic disc.

Question 36

what is the embryo susceptible to?

Answer 36

During this critical period (most of the first trimester), the developing embryo is also susceptible to toxic exposures, such as:
Alcohol, certain drugs, and other toxins that cause birth defects, such as fetal alcohol syndrome
Infection (such as rubella or cytomegalovirus)
Radiation from x-rays or radiation therapy
Nutritional deficiencies such as lack of folate which contributes to spina bifida

Question 37

what happens at 6 weeks of embryo development

Answer 37

The embryo measures 4 mm (1/8 inch) in length and begins to curve into a C shape.
The heart bulges, further develops, and begins to beat in a regular rhythm. Septum primum appears.
Pharyngeal arches, grooves which will form structures of the face and neck, form.
The neural tube closes.
The ears begin to form as otic pits.
Arm buds and a tail are visible.
Lung bud, the first traits of the lung appear.
Hepatic plate, the first traits of the liver appear.[8]
Buccopharyngeal membrane ruptures. This is the future mouth.
Cystic diverticulum, which will become the gallbladder, and dorsal pancreatic bud, which will become the pancreas appear.
Urorectal septum begins to form. Thus, the rectal and urinary passageways become separated.
Anterior and posterior horns differentiate in the spinal cord.
Spleen appears.
Ureteric buds appear.

Question 38

embryo at 7 weeks?

Answer 38

The embryo measures 8mm (0.315 inch) in length and weighs about 1 gram.
Optic vesicles and optic cups form the start of the developing eye.
Nasal pits form.
The brain divides into 5 vesicles, including the early telencephalon.
Leg buds form and hands form as flat paddles on the arms.
Rudimentary blood moves through primitive vessels connecting to the yolk sac and chorionic membranes.
The metanephros, precursor of the definitive kidney, starts to develop.
The initial stomach differentiation begins

Question 39

embryo from 10th week of gestation?

Answer 39

From the 10th week of gestation (8th week of development), the developing organism is called a fetus.
All major structures are already formed in the fetus, but they continue to grow and develop.
Since the precursors of all the major organs are created by this time, the fetal period is described both by organ and by a list of changes by weeks of gestational age.
Because the precursors of the organs are now formed, the fetus is not as sensitive to damage from environmental exposure as the embryo was. Instead, toxic exposure often causes physiological abnormalities or minor congenital malformation.

Embryo measures 30–80mm (1.2–3.2inches) in length.
Ventral and dorsal pancreatic buds fuse during the 8th week
Intestines rotate.
Facial features continue to develop.
The eyelids are more developed.
The external features of the ear begin to take their final shape.
The head comprises nearly half of the fetus’ size.
The face is well formed.
The eyelids close and will not reopen until about the 28th week.
Tooth buds, which will form the baby teeth, appear.
The limbs are long and thin.
The fetus can make a fist with its fingers.
Genitals appear well differentiated.
Red blood cells are produced in the liver
Heartbeat can be detected by ultrasound.
The fetus reaches a length of about 15cm (6inches).
A fine hair called lanugo develops on the head.
Fetal skin is almost transparent.
More muscle tissue and bones have developed, and the bones become harder.
The fetus makes active movements.
Sucking motions are made with the mouth.
Meconium is made in the intestinal tract.
The liver and pancreas produce fluid secretions.

Question 40

fetus at 18 weeks?

Answer 40

The fetus reaches a length of 20 cm (8 inches).
Lanugo covers the entire body.
Eyebrows and eyelashes appear.
Nails appear on fingers and toes.
The fetus is more active with increased muscle development.
“Quickening” usually occurs (the mother and others can feel the fetus moving).
The fetal heartbeat can be heard with a stethoscope.