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21 Cards in this Set
- Front
- Back
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First Trimester loss is usually _______ in origion
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Fetal
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MCC of First Trimester Fetal Losses
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Aneuploidy - Abnormal karyotype (too many too little chromosomes
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MCC OVERALL aneuploidy
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Turners syndrome (45 X0)
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MCC TRISOMY
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Trisomy 21 (Downs)
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Second Trimester loss is usually _________ in origion
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Maternal - Uterine (painful) or Cervical (Short < 2.5cm -Painless)
Normal Cervical length = 4 cm |
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THREATENED ABORTION
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Spontaneous Abortion
Minimal bleeding/No cervical dilation Observe |
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MISSED ABORTION
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Spontaneous Abortion
No bleeding/No cervical dilation Dead fetus - D&C |
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INEVITABLE ABORTION
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Spontaneous Abortion
Heavy bleeding/Cervical dilation No passage POC - Emergency D&C |
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INCOMPLETE ABORTION
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Spontaneous Abortion
Heavy bleeding/Cervical Dilation Partial passage POC/Emergency D&C |
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COMPLETED ABORTION
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Spontaneous Abortion
Minimal bleeding/Cervical Dilation Complete passage POC/Observe Check Serial BhCG for Ectopic |
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SEPTIC ABORTION
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Spontaneous Abortion
Hx of nonsterile abortion attempt Admit for IV multiple agent antibiotifcs |
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Detecting Fetal Demise:
Early pregnancy ________ Late pregnancy____________ Confirm by_________ |
Lack of fundal growth (3 cm discrepancy)
Lack of fetal movements U/S cardiac activity |
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7 Causes of Fetal Demise
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1 Idiopathic MCC
2 Placental 3 Cord 4 Death (Aneuploidy) 5 Antiphospholipid Syndrome 6 Trauma 7 DM - outgrows blood supply |
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Management of Fetal Demise
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Rule out DIC
Pyschological readiness Route of Termination (+/- Autopsy) |
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Benign GTD - Hydatidiform mole
2 types |
Complete/Incomplete
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GTD - Incomplete
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Normal egg
69 XXY - Tripoloidy Fetus Seen but Non-Viable Slightly elevated BhCG Size = Date |
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GTD - Complete
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Empty Egg -anuclear ovum
46 XX Diploidy - Paternal orgion Fetus Absent High BhCG 50% Large for dates Snowstorm appearance on u/s LEAD TO CHORIOCARCINOMA |
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Malignant GTD = Choriocarcinoma
Good vs Poor prognosis |
GOOD - pelvis/lung/ >95% cure/Single chemotherapy/1yr f/u w/BhCG levels
POOR - Brain/Liver 65% cure/Multiple Chemotherapy/ 5yr f/u |
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Ectopic Pregnancy
Findings |
Ruptured or Unruptured
amenorrhea, bleeding, abdominal pain +BhCG, U/s shows nothing in uterus when BhCG above discriminatory zone >1500 |
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Ectopic Pregnancy
Management |
UNRUPTURED
<5,000 BhCG (Early)= Methotrexate >5,000 BhCG (Late)= Surgical RUPTURED! = Surgical |
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Ectopic Pregnancy
Follow up |
1. Rho Gam if pt -
2. Serial BhCG titers especially if methotrexate given |
