pregnancy loss and ectopic pregnancy

Question 1

spontaneous abortion

Answer 1

pregnancy that ends spontaneously before the fetus reaches a viable gestational age (22wks)

Question 2

risks for spontaneous abortions

Answer 2

age >35 or young. 
previous sAb.
smoking
BMI 25
maternal disease
trauma
alcohol
NSAIDS
caffeine
fever >100

Question 3

sAb etiology

Answer 3

abnormal chromosomes, aneuploides (abnormal # chromosomes, autosomal trisomies, monosomy X, polyploides, anembryonic (no plantation), dystrophic, unidentifiable. congenital anomalies, teratogens (maternal DM with poor glycemic control, drugs, environment)

Question 4

sAb characteristics

Answer 4

vaginal bleeding
pelvic pain/cramping
cervical os (open or closed)
products of conception-passed or retained
uterus-appropriate size, consistency, tenderness

Question 5

threatened abortion

Answer 5

vaginal bleeding through a closed cervical os, pregnancy may still be vaible.

Question 6

sxs threatened abortion

Answer 6

vaginal bleeding, painless or mild suprapubic pain, closed cervical os, products of conception not usually visualized, uterine size appropriate for gestational age.

Question 7

reassuring factors for threatened abortion

Answer 7

serum hcg up to 15 weeks

detectable cardiac activity

Question 8

inevitable abortion

Answer 8

sAb is imminent. vag bleeding, pelvic cramping, cervical os OPEN, gestational products may or may not be visible, uterus may still be appropriately sized. Expectant mgmt.

Question 9

Complete abortion

Answer 9

sAb in which the entire contents of uterus are expelled. Common

Question 10

incomplete abortion

Answer 10

sAb with retained products. common after 12 wks
heavy bleeding, severe cramps, cervical os OPEN, retained products, uterus small for gestational age, not well contracted. Surgical mgmt

Question 11

missed abortion

Answer 11

retention of a failed intrauterine pg. sxs of pg abated (nausea, breast tenderness). mild vaginal bleeding, spotting, cervical os CLOSED, POF not visible, uterus small. surgical mgmt

Question 12

septic abortion

Answer 12

spotaneous abortion complicated by uterine infection. staph aures, gram negative bacilli, or some gram + cocci.

Question 13

risks for septic abortion

Answer 13

invasive procedures, foreign bodies, incomplete or illegal induced abortion

Question 14

sAb eval

Answer 14

LMP
signs of sAb
signs of sepsis
consider ddx-physiologic- due to implantation, ectopic pg, cervical, vaginal, or uterine pathology

Question 15

indication for surgical mgmt

Answer 15

retained products
septic abortion
prevent complications
unstable

Question 16

recurrent pregnancy loss (RPL)

Answer 16

3 or more losses before 20 wks. possible causes- uterine anomalies, chromosomal, endocrine, immunologic, heme

Question 17

medical abortion

Answer 17

less than 9 wks gestation.
methotrexate-progesterone inhibitor, induces contractions, vascular destruction, necrosis, and detach of POC. Misoprostol-pg directly stimulates myometrium, softens uterus and uterine contractions. surgery if not successful

Question 18

ectopic pg location

Answer 18

MC=fallopian tube, then ovary, abdominal cavity, and cervix

Question 19

risks for ectopic pg

Answer 19

pelvic infections, previous ec. pg, age >35, h/o abdominal or pelvic surgeries, IUD, exposure to DES

Question 20

ectopic pg symptoms

Answer 20

range from asymptomatic to acute abdomen/hypovolemic shock. 
abdominal pain
abnormal bleeding
pg sxs
dizziness
amenorrhea

Question 21

physical findings of ectopic pg.

Answer 21

abdominal tenderness, peritoneal signs, adnexal tenderness, CMT, uterus normal size.

Question 22

eval ectopic pg

Answer 22

UPT, quant hCG (hits 1500 and then doesn’t double), transvag US, CBC

Question 23

hCG > 1500-2000 IU/L

Answer 23

if not visualized follow hCG. if decreases nonviable pg, follow to 0. if increases ectopic is dx

Question 24

hCG

Answer 24

normal rise-doubles every 48 hours, transvag sonogram when 1500 IU/L. slow rise-abnormal pg. decreases-nonviable pg, follow to 0

Question 25

ectopic pg mgmt

Answer 25

small declining hCG, close follow up. risk: rupture and secere hemorrhage. methotrexate, surgical mgmt preferred.