Pregnancy Loss

Question 1

early pregnancy loss

Answer 1

SAB at <20wks GA OR when fetus weighs 500g

Question 2

s/sx early pregnancy loss

Answer 2

• cramping
• bleeding
• passage of clots/products of conception (POC)
• weakness
• vomiting
• back pain

Question 3

What is management for early pregnancy loss?

Answer 3

• acetaminophen for pain
• f/u to assess for retained POC
• contraceptive needs
• be aware of s/sx infection or hemodynamic instability
• assess emotional aspects of experience
• RhoGAM w/in 48-72h of onset bleeding

Question 4

What is medical management of incomplete early SAB?

Answer 4

PO or vaginal misoprostol <12wks GA

Question 5

What is surgical management for incomplete early SAB?

Answer 5

Options:

• electric vacuum aspiration
• manual vacuum aspiration
• sharp curette

Question 6

What is RhoGAM management for pts that experience SAB?

Answer 6

<12wks GA: 50mu

>12wks GA: 300mu

Question 7

“late” AKA stillbirth AKA fetal demise

Answer 7

death prior to birth >20wks GA OR >400g birth weight

Question 8

What are risk factors of late fetal demise?

Answer 8

• AMA
• maternal obesity
• multiple gestation
• African-American
• cigarette smoking, cocaine, HTN

Question 9

How is f etal demise managed at 18-28wks GA?

Answer 9

IOL w/ misoprostol to deliver w/in 28h

Question 10

How is fetal demise managed after 28wks GA?

Answer 10

IOL w/ pitocin

Question 11

How can fetal demise be evaluated for cause?

Answer 11

• autopsy
• placental pathology
• fetal karyotype
• Kleihauer-Betke test on gestational carrier
• Coombs test
• parovirus B19 IgG and IgM
• toxicology screen
• lupus screen

Question 12

abortion

Answer 12

spontaneous or intentional pregnancy termination <20wks GA

Question 13

neonatal death

Answer 13

live birth followed by death w/in 28 days of life

Question 14

perinatal loss

Answer 14

loss of fetus/infant through spontaneous or elective abortion, stillbirth, or early neonatal death

Question 15

How is dx of perinatal loss confirmed?

Answer 15

• no auscultation of FHR

- no cardiac movement noted on U/S

Question 16

complete pregnancy

Answer 16

complete passage of POC

Question 17

s/sx complete pregnancy loss

Answer 17

• heavy cramping
• bleeding/passage of clots and/or tissue
• abrupt decrease in pain and bleeding follows
• cervix closed, small uterus
• +/- blood in vaginal vault

Question 18

incomplete pregnancy loss

Answer 18

partial passage of products of conception

Question 19

s/sx incomplete pregnancy loss

Answer 19

• +/- intense cramping
• +/- heavy bleeding
• cervix open or closed

Question 20

s/sx delayed pregnancy loss

Answer 20

• cervix closed
• uterus may be small or appropriate for GA
• amenorrhea only s/sx when FHR not heard at appropriate time

Question 21

septic pregnancy loss

Answer 21

loss accompanied by uterine infection and possible sepsis

very rare

Question 22

recurrent pregnancy loss

Answer 22

3 or more consecutive pregnancy losses prior to 20wks GA

Question 23

How should pts w/ recurrent pregnancy loss be managed?

Answer 23

refer to genetic counselor, reproductive endocrinologist