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Bloc I - Reproduction > Sept14 A2-Pregnancy loss > Flashcards

Sept14 A2-Pregnancy loss Flashcards

1
Q

most ommon complication of pregnancy

A

miscarriage

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2
Q

miscarriage def

A
  1. loss if intrauterine pregnancy <24 wks
    OR
  2. loss of fetus <500g AND less than 22 wks
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3
Q

greatest risk of miscarriage is when in a pregnancy

A

T1.

close to 0% chance after week 15

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4
Q

(imp?) most common way people present with a spontaneous miscarriage

A

These two things:

  1. vaginal bleeding
  2. uterine cramps or back pain
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5
Q

hcg in a spontaneous miscarriage

A

falling OR not doubling every 48 hrs

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6
Q

types of spontaneous miscarriages

A
  • anembryonic pregnancy (oeuf clair, no yolk sac, no structures, not always bleeding or sx)
  • arrested pregnancy (missed abortion) (visible pregnancy, no heart beat)
  • inevitable miscarriage (def = sac low in cervix. sac in uterus, clots and bleeding around yolk sac)
  • incomplete abortion, miscarriage (bleeding, cramps, see tissue or fetus, no sac visible) MOST COMMON
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7
Q

most common presentation of sporadic miscarriage

A

incomplete abortion/miscarriage (bleeding, cramps)

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8
Q

effect of age on sporadic miscarriage risk

A

increases with age. starting at age 35, becomes very imp (25% and over)

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9
Q

(imp?) most common cause of sporadic miscarriage

A

chromosomal abnormalities (trisomies, monosomies, Turner, polyploidy, aneuploidie)

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10
Q

other causes of sporadic miscarriage

A
  • fetal malformation
  • placental abnormality
  • infection
  • maternal health disease
  • intra-uterine anomalies
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11
Q

possible infectious causes of sporadic miscarriage

A

TORCH (toxo, rubella, CMV, HIV) + listeria + malaria

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12
Q

maternal health problems related to miscarriage

A
  • smoking
  • diabetes, hypoT, obesity
  • radio and chemo
  • cocaine
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13
Q

intra-uterine abnoramlities assoc with miscarriage

A
  • Muellerian septum (uterine septum) = MOST COMMON
  • polyps
  • fibroids
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14
Q

charact of pathophgy of miscarriage

A
  • abnormal placental invasion
  • reduced trophoblastic invasion
  • blood flow enters the intervillous space and dislodges the conceptus
  • further intrauterine bleeding
  • local PG release
  • pain
  • uterine contraction nad expulsion of conceptus
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15
Q

possible presentations for a miscarriage

A
  1. bleeding (= threatened miscarriage). do HCG and US. 50% will survive and reach livebirth
  2. complete miscarriage (present with cervix open and conceptus and products expelled). blood test. no hcg
  3. US diagnoses an arrested pregnancy (no fetal HR) + bleeding or bit of spotting
  4. bleeding, pain (incomplete miscarriage). do an US.
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16
Q

incomplete miscarriage: notable on PE

A
  • massive hemorrhage
  • cervical shock syndrome (something passes through cervix everytime it is dilated) with possible vagal syndrome (fainting when something in cervix)
17
Q

tx of incomplete miscarriage

A
  • expectant (nothing)
  • misoprostol (cytotec) = PG E1 analogue (cause uterine contractions to expel)
  • suction curettage (risk of infection, risk of uterine damage)
18
Q

what if do nothing for an incomplete miscarriage

A

risk of infection = risk of uterine damage, problem for next pregnancy

19
Q

what is cervical cerclage

A
  • surgery done to tie the cervix at start of pregnancy and undone at 36 weeks for delivery
  • is for pts with hx of 2-3 pregnancy losses at 2O WEEKS, T2
20
Q

still birth other name

A

intra-uterine fetal death (IUFD)

21
Q

def of IUFD

A

dead fetus or nwborn weighting >500g or >20 wks

22
Q

gold std for IUFD dx

A

US

23
Q

signs of IUFD

A
  • no fetal heart
  • no signs and sx of pregnancy
  • loss of fetal movement
  • no uterine growth
24
Q

most common causes of IUFD

A
  • are fetal causes (before placental and maternal and unexplained)
  • mainly chromosomal or anatomic malformations
25
Q

fetal causes of IUFD

A
  • chromosomal anomalies
  • birth defects
  • non immune hydrops (baby swells and heart beat stops from failure)
  • infections (TORCH)
26
Q

placental causes of IUFD

A
  • abruption (placenta detaches from uterine wall)
  • cord accidents
  • placental insuffieicny
  • intrapartum asphyxia
  • placenta pervia (abnormal location of placenta like within uterus)
  • chorioamnionitis
27
Q

main maternal causes of IUFD

A
  • trauma (fall on belly, etc. bc risk of detachment of the placenta)
  • thrombophuilia (increased risk of clotting)
  • DM
  • anemia
  • etc
28
Q

placental evaluation in a still born infant: how can help

A
  • clots in placenta
  • meconium = stained
  • thickened placenta = infection
29
Q

(imp?) main risk associated with a IUFD for the mother

A

risk of bleeding

30
Q

recurrent miscarriage (RM) (also called RPL for recurrent pregnancy loss) def

A

3+ consecutive miscarriages

31
Q

chance of normal pregnancy after having 3 miscarriages

A

70-80%

32
Q

most common causes of RPL

A
  • unexplained is the most common
  • genetic (most common is balanced or reciprocal translocation in parents)
  • anatomical (most comm is septate/bicornuate uterus)
  • endocrine (most comm is hypoT. tx with TSH)
  • immune (most common is antiphospholipid syndrome (tx with subcu heparin + aspirin)
  • hypercoagulability
33
Q

most common site of ectopic pregnancy

A

Fallopian tube (ampulla)

34
Q

(imp?) classic triad for ectopic pregnancy

A
  • amenorrhea
  • ipsilateral abd pain
  • vaginal bleeding
  • in ruptured ectopic pregnancy, have hemorrhagic shock*
35
Q

dx of ectopic pregnancy

A
  • rule out other causes of abd pain (kidney infection, bladder, appendicitis
  • serial beta hcg (plateau or slow rise)
  • transvaginal US: empty uterus, adnexal mass, heartbeat outside uterus)
36
Q

tx of ectopic pregnancy

A
  • expectant (tubal abortion, hcg getting lower)
  • medical (methotrexate injection)
  • surgical (laparoscopic salpingostomy (cut tube) or salpingectomy (remove tube)

Bloc I - Reproduction (57 decks)

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