Lecture 14- 1st trimester loss Flashcards
When do the majority of spontaneous abortions occur?
<12 weeks GA
Termination of a pregnancy before ____ weeks is considered what trimester loss.
20; First
What are the three most common abnormal uteri?
Septate
Asherman’s syndrome
Bicornalte uterus
What are key things you want to know with a suspected miscarriage?
If the cervix is closed vs/ open
Presence of POC, discharge, blood
Uterine size
With a threatened AB what will they present like.
Bleeding
closed cervix
uterine size consistent with GA
What will an inevitable AB look like?
Cervix dilated
ROM
bleeding and UCs
expel POC (products of conception)
What will a missed AB present like.
POC reatained
Uterus < GA
Dark brown discharge
No pain & IUP symptoms cease
What is considered a recurrent loss?
loss on > 2 consecutive pregnancies
What are reasons for 2nd trimester loss?
Cervical insufficiency (painless effacement and dilation)
What do you do for cervical insufficiency?
Cervical cerclage
how do you induce labor surgically?
Vacuum aspiration
What are some complications with surgically induced labor?
uterine perf, cervical laceration
What is cervical priming?
use seaweed like plant to prime the cervix.
After induction what do you want to monitor?
temp, pain , bleeding
hemorrhage, incomplete evacuation, infection
Under how many days since LMP can you do a medical induced labor?
<49 days
Where do the majority of ectopic pregnancies occur?
Fallopian tube
What does an ectopic pregnancy look like on US?
cyst w/ wide echogenic vascular outer ring
What is the “classic” signs and symptoms of ectopic?
amenorrhea followed by bleeding and abdominal pain on affected side
What are the ominous signs of ectopic pregnancy?
Shoulder pain worsened w/ inspiration
syncope, vertigo
You must r/o ectopic w/out confirmation of what in utero?
chorionic villi
About what level with serum beta quant. level stay at with ectopic pregnancy?
600-800
Can serum progesterone distinguish IUP from ectopic?
No
Serum progesterone level < what is negative for pregnancy.
5
Serum progesterone level greater than what is consistent with pregnancy.
20
What is procedure that removes an ectopic pregnancy?
laparoscopic linear salpingostomy
What is where the chorionic villi continue to grow and become swollen.
hydatidiform mole (aka molar pregnancy)
Is molar pregnancy benign?
Usually
What is the name for non-malignant, non-metastatic gestational trophoblastic neoplasia.
Hydatidiform mole
What is the karyotype with complete hydatidiform mole?
Complete - 45XX or 45XY
What is the karyotype with a partial molar pregnancy?
Triploid (Partial - 69XXX or 69XXY)
In a molar pregnancy what is abnormal with the uterine size?
Uterine size >GA
WHat is the treatment for a molar pregnancy?
Hospitalization
D&C
contraception for 1 year
Watch for uterine atony or pulmonary embolism
Monitor B-hCG for rise/decline/plateau to r/o persistant GTN
for a localized persistent GTN what do they do?
Single agent chemotherapy
What is a malignant transformation of GTN?
Choriocarcinoma
What are reasons for 1st trimester recurrent loss?
parent karyotypes, Asherman’s syndrome, antiphospholipid antibodies
What is post-abortal syndrome?
bleeding, dilated cervix, cramping, large, boggy uterus with hematometra
Mimics incomplete abortion
What should you do for septic abortion?
IV fluid, IV antibiotics, evacuate uterus
What are 3 outcomes of ectopic pregnancy without interventions?
Tubal abortion (POC expelled out of fimbriated end) Tubal rupture (intra-abdominal hemorrhage) Spontaneous resolution
What are risk factors for ectopic pregnancy?
tubal scarring 2ndary PID/salpingitis
Prior ectopic or tubal surgery
History of infertility
What are PE of ectopic pregnancy post rupture?
Marked pelvis and abdominal tenderness, CMT, pelvic fullness or mass
What are contraindications for Medical treatment (Methotrexate) for ectopic pregnancy?
Absolute: breastfeeding, liver disease, alcoholism, blood dyscrasias, active pulmonary disease, PUD, immunodeficiency, methotrexate sensitivity
Relative: >3.5cm, cardiac motion/fetus
What is the ideal candidate for methotrexate for ectopic pregnancy treatment?
<5000mlU/L and no fetal heart activity
What are neoplasms from spectrum of abnormal placental proliferation?
gestational trophoblastic neoplasia
What is the PE for a hydatidiform mole?
Uterine size> GA, absent FHT, vaginal bleeding, HTN
What will a complete hydatidiform mole look like on US?
no embryo/fetus, no amniotic fluid, thick and cystic placenta filled uterus; snowstorm appearance
What will a partial hydatidiform mole look like on US?
growth-restricted fetus, low amniotic fluid, thick cystic placenta
