Early pregnancy loss occurs within the first _____ weeks of gestation
13
Symptoms of a miscarriage?
Uterus cramps
Cervix dilate
Products of conceptions are expelled with vaginal bleeding
What is a chemical pregnancy?
pregnancy that occurs before six weeks and can be shown as a positive urine HCG test, where the sperm fertilized the egg but NO GESTATIONAL SAC
Never a confirmed pregnancy during office visits
What is an anembryonic pregnancy?
“blighted ovum”; gestational sac only, no embryo formed
What is threatened abortion?
vaginal bleeding, closed cervical os, unknown future of pregnancy
What is missed abortion?
In utero death of embryo, NO bleeding, closed cervix, commonly women will not feel pregnant anymore
What is inevitable abortion?
Profuse vaginal bleeding, membranes show gross rupturing, cervix has become DILATED and abortion is almost certain
Complete abortion is when _______ have been expelled, cervix is ______
All products of conception
Closed
Nothing in uterus
What is incomplete abortion?
some tissues remain within the uterus
Which type of spontaneous abortion has dilated cervix?
Inevitable abortion, while all the other have closed cervix
In ________ type(s) of spontaneous abortion, there is vaginal bleeding
Threatened abortion
Inevitable abortion (profuse bleeding)
Which type of pregnancy has only a gestational sac formed, and which does not even have a gestational sac formation?
Gestational sac only – anembryonic pregnancy
No gestational sac – chemical pregnancy
_____% of CLINICALLY recognized pregnancies is lost, and of those, _____% of them occur within the first trimester
10
80
____% of unrecognized or subclinical pregnancies (like chemical pregnancies) result in loss of pregnancy, and this typically would have patients reporting ________(length and quantity) menstrual period
26
Slightly longer but not necessarily heavier
Pre-implantation loss occurs in _____% of fertilized oocytes
50
Half (50%) of the cases of early pregnancy loss are due to _______
Fetal chromosomal abnormalities (most frequently seen in advanced maternal age)
Expectant management of miscarriage is only an option for ____ trimester
1st
What is the drug that is used for medical abortion?
Misoprostol (PGE1) 800 mcg vaginally or sublingually
Causes uterus to contract
What is contraindication for misoprostol use?
Infections, hemorrhage, severe anemia or bleeding disorder
What is the advantage of misoprostol use?
Misoprostol reduces the need for uterine curettage up to 60% and shortens the time to completion compared with placebo
If a patient tells you she doesn’t want to deal with the bleeding at home and just want to tbe done with the pregnancy, what is the management option for her?
Surgical, for immediate completion of the process
When is surgical management of abortion indicated, other than when she specifically asks for it?
Indicated with hemorrhage, hemodynamic instability or signs of infections (necrotic tissue) and pt with severe anemia, bleeding disorder or CV disease (they cant be on misoprostol)
T/F: hormonal contraception can be started immediately after an early pregnancy loss
True, and there are no C/I to placement of an IUD immediately after surgical treatment of early pregnancy loss as long as septic abortion is not suspected
When would you give Rh immune globulin to women who just had an abortion?
Rh negative and unsensitized women should receive 50 mg immediately after surgical management or within 72 hours of the diagnosis of early pregnancy loss
What type of workup is needed after early pregnancy loss?
no workup generally is recommended until after the second consecutive clinical early pregnancy loss
T/F: regular exercise followed by bed rest and avoiding hot tub is an effective proven intervention to prevent early pregnancy loss
False; there are no effective interventions to prevent, no food, vitamins, etc
How is recurrent pregnancy loss defined?
3 or more CONSECUTIVE losses of CLINICALLY recognized pregnancies prior to 20 weeks of gestation
What is primary recurrent pregnancy loss?
repeated losses with no pregnancy carried to viability
What is secondary recurrent pregnancy loss?
Has had at least one live birth over 20 weeks but now having back to back to back losses
Etiologies that mostly contribute to recurrent pregnancy loss
Immunologic 25%
Anatomic 22%
Endocrine 20%
Unknown 40%
Most common aneuploidy and trisomy that could cause pregnancy losses are:
XO (turner syndrome)
Trisomy 16
DES exposure in utero would result in ______ uterus and could be a ______etiology of pregnancy loss
T-shaped
Structural
Congenital structural problems that could lead to pregnancy loss:
Septate uterus
Mullerian abnormalities
DES exposure in utero
Acquired structural problems that could lead to pregnancy loss:
Asherman syndrome – trauma after D&C
Leiomyoma (fibroids)
Endometrial polyps
A wedge of fibrous tissue dividing the uterine cavity is a ____ uterus
Septate
What condition results in Adhesions crossing the lining of the uterus s/p trauma or D&C ?
Asherman syndrome
An incomplete uniting of the uterus is ______ uterus
Bicornuate
What is DES and what was the use for it?
a synthetic form of estrogen (Diethylstillbestrol)
Help prevent miscarriage
Mom who uses DES has higher rates of ____, while their daughters can have ________, a rare cancer, as well as deformities of the uterus, vagina or cervix, mos common being a ____ uterus and a _____ Cervix
Breast
Clear cell adenocarcinoma
T-Shaped
Cockscomb cervix
T-Shaped uterus and cockscomb cervix, think:
DES daughters
T/F: Mom who used DES will have daughter with fertility problem as well as structural abnormalities, while their sons would be unaffected because they don’t have gynecological parts
False; sons would have increased risk of epididymal cysts
What is antiphospholipid antibody syndrome?
Condition that causes impaired trophoblastic invasion at the decidua and spiral arteries and impair placental hormone production
Loss occurs due to uteroplacental insufficiency
T/F: if no etiology discovered, the chance of successful pregnancy without treatment in recurrent pregnancy loss is approximately 75% in the next pregnancy
True
What would you give patient with Antiphospholipid antibody syndrome in order to help with successful subsequent pregnancy?
Heparin – for blood thinning and oxygenation of tissue, better implantation of placenta
Still birth is defined as ____ weeks or greater of gestation or weight greater than or equal to _____ grams
20
350
T/F: estimate rate of stillbirth is higher if mom had previous growth-restricted infant, vs previous stillbirths
True; h/o growth-restricted infant has 12-30/1000 chance of having a stillbirth, vs h/o stillbirth is 9-10/1000 chance
G3P1 Woman brought in by ambulance after a MVA reports abrupt pain and uterine contraction along with active bleeding, what could happen to the mom?
This is likely placental abruption given trauma and prior history of abortions. In abruption, contractions can result in maternal shock and death (DIC)
Preterm rupture of membranes is rupture of membrane before onset of ____ and before ___ weeks of gestation
Labor
37
AT 10 weeks, hCG level is at ______, and late in pregnancy in plateaus at ______
100,000
10,000
Half life of hCG is ____ hours
24-36
_____ is an antiprogestin that is combined use with misoprostol, for termination of pregnancies up to ____ days of gestation
Mifepristone
70
Most effective emergency contraception is ____
Copper IUD, insert within 5 days of a misstep and lower your chance of pregnancy by 99.9%
Which emergency contraception has a one pill formula?
Ella (Rx only)
Works up to 5 days after unprotected sex
Which emergency contraception does not decrease in effectiveness during the 5 days post-sex?
Ella, this means that you can take Ella 5 days after sex and it’d be just as effective as taking it one day after
_____ is levonorgesteral given within 72 hours of intercourse and repeated 12 hours later
