Early Pregnancy Complications Quiz
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Questions and Answers

What should vaginal bleeding and abdominal pain be considered until proven otherwise?

Ectopic

If a patient presents with early pregnancy bleeding, what should exam include?

Genitalia exam (pelvic exam, quantity & source of bleeding)

What is the first thing that should be assessed for in early pregnancy bleeding?

Hemodynamic stability and infection (present = referral)

What quantity of early pregnancy bleeding is considered worrisome?

<blockquote> <p>2 pads/hr for 2 consecutive hours</p> </blockquote> Signup and view all the answers

What are cervical polyps more common in?

<p>Parous individuals</p> Signup and view all the answers

What is a result of separation of the chorion from the uterine lining which results in a collection of blood between the uterine wall and chorionic membrane?

<p>Subchorionic hemorrhage</p> Signup and view all the answers

What is the presentation for subchorionic hemorrhage?

<p>Painless spotting or bleeding</p> Signup and view all the answers

What will be seen adjacent to the gestational sac for subchorionic hemorrhage?

<p>Hypoechoic area</p> Signup and view all the answers

When does subchorionic hemorrhage typically resolve by?

<p>20 weeks via reabsorption</p> Signup and view all the answers

With subchorionic hemorrhage, the risk of loss is dependent on the size, what size is associated with greater risk?

<p>50% or greater</p> Signup and view all the answers

What results from blastocyst implants and causes HCG levels to rise, but spontaneously aborts before an ultra sound can even detect a fetal heart beat?

<p>Chemical pregnancy</p> Signup and view all the answers

What is the death of an embryo before 10 weeks gestation, before viability is reached often diagnosed on u/s when the embryo is expected to have a heartbeat?

<p>Embryonic demise</p> Signup and view all the answers

What results from all POC passing, the cervix will be closed, the uterus will be small - associated w. heavy cramping and bleeding, passage of clots/tissue, followed by abrupt decrease in sxs?

<p>Complete abortion</p> Signup and view all the answers

What results at > 20 weeks gestation with cervical dilation &/or rupture of membranes w. vaginal bleeding and lower abomdinal/back pain but NO passage of tissue?

<p>Inevitable abortion</p> Signup and view all the answers

What will the embryo size be on u/s for an inevitable abortion?

<p>An embryo measuring 5 millimeters or larger without a heartbeat on ultrasound indicates an inevitable abortion.</p> Signup and view all the answers

What results from the passage of some fetal or placental tissue at < 20 weeks EGA, tissue is still visible in the uterus w.o evidence of viability?

<p>An incomplete abortion involves the passage of some fetal or placental tissue, while tissue remains in the uterus. Ultrasound will show a lack of fetal viability.</p> Signup and view all the answers

What type of abortion is often found at a routine visit, the cervix will be closed but there will be retained POC in the uterus w.o FHTs?

<p>Missed abortion</p> Signup and view all the answers

What type of abortion is defined by painless vaginal bleeding w.o cervical dilation or effacement?

<p>Threatened abortion</p> Signup and view all the answers

What results from the development of a gestational sac w.o development of an embryo?

<p>Aembryonic pregnancy (blighted ovum or biochemical pregnancy)</p> Signup and view all the answers

What results from loss accompanied by infection and sepsis (rare)?

<p>Septic abortion</p> Signup and view all the answers

What is the criteria for recurrent abortion?

<p>2 or more clinical pregnancy losses (do not have to be consecutive)</p> Signup and view all the answers

Who should a patient be referred to if they meet the criteria for recurrent abortion?

<p>Endocrinology</p> Signup and view all the answers

What are potential pathogenesis for spontaneous abortion?

<p>Anatomic defects (A), Endocrine factors (B), Exposure to toxic substances (C), Infection (D), Unknown (E), Abnormal karyotype (50%) (F)</p> Signup and view all the answers

For spontaneous abortion, when an embryo dies or has failure to develop, where does hemorrhage occur?

<p>Decidua basalis</p> Signup and view all the answers

After hemorrhage occurs in teh decidua basalis, what occurs at the implantation site in a spontaneous abortion?

<p>Necrosis</p> Signup and view all the answers

In a spontaneous abortion, what occurs at the site of implantation after necrosis?

<p>Leukocyte infiltration</p> Signup and view all the answers

In a spontaneous abortion, after leukocyte infiltration, what becomes edematous?

<p>Chorionic villi</p> Signup and view all the answers

In a spontaneous abortion, what results in hormones?

<p>Estrogen and progesterone drop</p> Signup and view all the answers

What results in vaginal bleeding in a spontaneous abortion?

<p>Decidual sloughing</p> Signup and view all the answers

In a spontaneous abortion, what does uterine irritability result in?

<p>Uterine contractions</p> Signup and view all the answers

What is the classic sign for a spontaneous abortion?

<p>Bright red vaginal bleeding (like period)</p> Signup and view all the answers

What is the primary goal when triaging bleeding in early pregnancy?

<p>Prevent/assess for life threatening blood loss</p> Signup and view all the answers

For spontaneous abortion management, what has the greatest risk for retained POC?

<p>Expectant management</p> Signup and view all the answers

What circumstances do not allow for medical management of a spontaneous abortion?

<p>Bleeding disorders (A), Infection (B), Hemorrhage (C)</p> Signup and view all the answers

What medications are used for medical management of a spontaneous abortion?

<p>Misoprostol 800 mcg vaginal Mifepristone 200mg 24 hours prior to misoprostol and 800 mcg after</p> Signup and view all the answers

How soon should an u/s occur after medical management for a spontaneous abortion?

<p>7-14 days</p> Signup and view all the answers

What management for a spontaneous abortion has the lowest risk for retained POC?

<p>Surgical management</p> Signup and view all the answers

What circumstances warrant immediate surgical management for a spontaneous abortion?

<p>Hemorrhage (A), Infection (B), Hemodynamic instability (C)</p> Signup and view all the answers

What is the antibiotic prophylaxis for surgical management of a spontaneous abortion?

<p>200 mg doxy 1 hour pre procedure</p> Signup and view all the answers

What EGA can MVA/MUA be used for spontaneous abortion management?

<p>&lt; 10 weeks</p> Signup and view all the answers

What EGA will dilation and evacuation be used for the surgical management of a spontaneous abortion?

<blockquote> <p>14 weeks</p> </blockquote> Signup and view all the answers

What is severe pain supicious for after management of a spontaneous abortion?

<p>Retained POC</p> Signup and view all the answers

When should a patient expect menses to return after a spontaneous abortion?

<p>4-6 weeks (hormone levels ordered if not occurred at this point)</p> Signup and view all the answers

When can a patient return to fertility/try to get pregnancy again after a spontaneous abortion?

<p>Anytime (no limit)</p> Signup and view all the answers

What are findings that are diagnostic of pregnancy failure?

<p>No heartbeat at 2 weeks or more after scan w. gestational sac w.o yolk sac (A), CRL 7mm or greater, no heartbeat (B), Sac 25 mm or greater, no embryo (C), No heartbeat 11 days or more after scan w. gestational sac and yolk sac (D)</p> Signup and view all the answers

What lab evaluation should occur in recurrent pregnancy loss?

<p>Coagulation (A), Autoimmune disorders (B), Endocrine (C)</p> Signup and view all the answers

What is recurrent pregnancy loss often a result of?

<p>50% d.t aneuploidy</p> Signup and view all the answers

What is the only circumstance where anticoagulation should be used for recurrent pregnacy loss?

<p>Antiphospholipid antibodies present</p> Signup and view all the answers

When is hemorrhage higher w. a spontaneous abortion?

<p>Expectant or medical management</p> Signup and view all the answers

When is infection a high risk with a spontaneous abortion?

<p>Retained POC or genital tract infection</p> Signup and view all the answers

What does retained POC after a spontaneous abortion require?

<p>Surgical treatment</p> Signup and view all the answers

If a patient has sepsis or a septic abortion post spontaneous abortion, what will it present like?

<p>Endometritis</p> Signup and view all the answers

What is the most common site for an ectopic pregnancy?

<p>Ampulla</p> Signup and view all the answers

What are risk factors for ectopic pregnancy?

<p>Previous tubal or pelvic surgery (A), ART (B), Smoking (dose related) (C), Unknown (D), PID (E), Contraceptive failure (F)</p> Signup and view all the answers

What is the result of hCG production and uptake being decreased in an ectopic pregnancy?

<p>Minimal pregnancy symptoms</p> Signup and view all the answers

How do pain and bleeding occur in an ectopic pregnancy?

<p>Pain then bleeding</p> Signup and view all the answers

What will be the characteristic of pain and bleeding if an ectopic pregnancy ruptures?

<p>Pain ceases and blood loss continues</p> Signup and view all the answers

What additional symptoms may occur with an ectopic pregnancy aside from bleeding?

<p>Hemodynamic instability (A), Delayed menses (B), Palpable mass (C), Abdominal pain/tenderness (D), Absence of common pregnancy signs (E)</p> Signup and view all the answers

What lab should be obtained to assesss for hemodynamic status in an ectopic pregnancy?

<p>CBC or hmg/hct</p> Signup and view all the answers

Regarding hCG, what is a concern for ectopic pregnancy or loss?

<p>No doubling of hcg q48 hours</p> Signup and view all the answers

What pharm management will be used for an ectopic pregnancy, causes cellular death of trophoblastic tissue and decreases size of ectopic w.o surgery?

<p>Methotrexate</p> Signup and view all the answers

What surgical management will be used for an ectopic pregnancy at later EGA?

<p>Salpingectomy or laparotomy</p> Signup and view all the answers

How long should hCG be followed after methotrexate therapy in an ectopic pregnancy?

<p>Non pregnancy level: &lt; 5</p> Signup and view all the answers

What should be avoided until resolution of an ectopic pregnancy is confirmed?

<p>Exercise (A), Intercourse (B), Excessive pelvic exams (C)</p> Signup and view all the answers

How long should pregnancy be delayed for an ectopic pregnancy?

<p>1-3 months post methotrexate tx</p> Signup and view all the answers

What does gestational trophoblastic disease arise from?

<p>Fetal tissue</p> Signup and view all the answers

What type of hydatidiform mole has all chorionic villi hyperplastic, edematous and avascular with no embryo, fetus or gestational sac development?

<p>Complete mole (46xx, all paternal origin)</p> Signup and view all the answers

What type of hydatidiform mole has molar changes only in a portion of the chorionic villi, a fetus or embryo will be present?

<p>Partial mole (69xxx or 69 xxy)</p> Signup and view all the answers

What are symptoms assoicated w. a hydatidiform mole?

<p>Ovarian enlargement: multiple theca lutein cysts (A), First trimester bleeding (B), Variable uterine size (small or large) (C)</p> Signup and view all the answers

How will typical pregnancy symptoms present for a hydatidiform mole?

<p>Increased</p> Signup and view all the answers

What will be the characteristics of vessicles passed with a hydatidiform mole?

<p>Grapelike structures</p> Signup and view all the answers

What will be the characteristic of hCG in the presence of a hydatidiform mole?

<p>Persistently high or rising quicker than expected</p> Signup and view all the answers

What is the most accurate diagnostic tool for a hydatidiform mole?

<p>U/S</p> Signup and view all the answers

What will be seen on u/s for a hydatidiform mole?

<p>Grape like lesions Snowstorm appearance</p> Signup and view all the answers

What will referral be for in a patient with a hydatidiform mole?

<p>D&amp;C or hysterectomy</p> Signup and view all the answers

How will hCG be monitored post surgically for a hydatidiform mole?

<p>Weekly until undetectable Then q1-3 months</p> Signup and view all the answers

What circumstances should an IUD be avoided after a hydatidiform mole?

<p>Persistently elevated hCG</p> Signup and view all the answers

How long should pregnancy be avoided for after the treatment of a hydatidiform mole?

<p>Until monitoring is complete (pregnancy = effects hCG trends/levels)</p> Signup and view all the answers

Flashcards

ectopic

What should vaginal bleeding and abdominal pain be considered until proven otherwise?

genitalia exam

What should exam include if a patient presents with early pregnancy bleeding?

hemodynamic stability

What is the first thing that should be assessed for in early pregnancy bleeding?

2 pads/hr for 2 hours

What quantity of early pregnancy bleeding is considered worrisome?

Signup and view all the flashcards

parous indiv

What are cervical polyps more common in?

Signup and view all the flashcards

subchorionic hemorrhage

What results from separation of the chorion from the uterine lining?

Signup and view all the flashcards

painless spotting

What is the presentation for subchorionic hemorrhage?

Signup and view all the flashcards

hypoechoic area

What will be seen adjacent to the gestational sac for subchorionic hemorrhage?

Signup and view all the flashcards

20 weeks

When does subchorionic hemorrhage typically resolve by?

Signup and view all the flashcards

chemical pregnancy

What results from blastocyst implants but aborts early?

Signup and view all the flashcards

embryonic demise

What is the death of an embryo before 10 weeks?

Signup and view all the flashcards

complete abortion

What results from all POC passing, cervix closed, smaller uterus?

Signup and view all the flashcards

inevitable abortion

What results with cervical dilation and no passage of tissue?

Signup and view all the flashcards

missed abortion

What type of abortion has closed cervix with retained POC?

Signup and view all the flashcards

threatened abortion

What type of abortion has painless vaginal bleeding without dilation?

Signup and view all the flashcards

septic abortion

What results from loss of pregnancy accompanied by infection?

Signup and view all the flashcards

recurrent abortion

What is the criteria for having 2 or more clinical pregnancy losses?

Signup and view all the flashcards

endocrinology

Who to refer to if criteria for recurrent abortion is met?

Signup and view all the flashcards

abnormal karyotype

What accounts for 50% of causes for spontaneous abortion?

Signup and view all the flashcards

deciduas basalis

Where does hemorrhage occur when an embryo dies?

Signup and view all the flashcards

necrosis

What occurs at the implantation site after hemorrhage in a spontaneous abortion?

Signup and view all the flashcards

Study Notes

Early Pregnancy Bleeding

  • Ectopic Pregnancy: Vaginal bleeding and abdominal pain should be considered ectopic until proven otherwise.
  • Initial Assessment: Evaluate hemodynamic stability and signs of infection in patients with early pregnancy bleeding; referral is warranted if present.
  • Excessive Bleeding: Bleeding exceeding 2 pads per hour for two consecutive hours is worrisome.
  • Pelvic Exam: Includes genital exam (pelvic exam) to assess the quantity and source of bleeding.
  • Cervical Polyps: More common in parous individuals; characterized by dark or bright red bleeding.

Types of Spontaneous Abortion

  • Chemical Pregnancy: Blastocyst implantation, rising hCG levels followed by spontaneous abortion before fetal heartbeat detected by ultrasound.
  • Embryonic Demise: Embryo death before 10 weeks gestation, identified by ultrasound lacking a heartbeat.
  • Complete Abortion: All products of conception (POC) have passed; cervix is closed; uterus is small; heavy cramping and bleeding with abrupt decrease.
  • Inevitable Abortion: Cervical dilation and/or rupture of membranes; vaginal bleeding and lower abdominal/back pain, but no tissue expulsion.
  • Incomplete Abortion: Passage of some POC before 20 weeks; tissue remains in the uterus; fetal viability absent.
  • Missed Abortion: Cervix closed; retained POC in uterus; no fetal heart tones (FHTs) detected; often found during a routine visit.
  • Threatened Abortion: Painless vaginal bleeding; no cervical dilation or effacement.
  • Anembryonic Pregnancy (Blighted Ovum): Gestational sac forms without embryo development.
  • Septic Abortion: Loss of pregnancy accompanied by infection and sepsis (rare).
  • Recurrent Abortion: Two or more clinical pregnancy losses.
  • Referrals: Patients with recurrent loss should be referred to endocrinology specialists.

Spontaneous Abortion Pathogenesis

  • Pathogenesis: Potential causes include abnormal karyotypes (50%), infection, anatomic defects, endocrine factors, exposure to toxic substances, and unknown factors.
  • Hemorrhage/Necrosis: Hemorrhage occurs in the decidua basalis; the implantation site undergoes necrosis.
  • Leukocyte Infiltration: Leukocyte infiltration follows necrosis.
  • Chorionic Villus Edema: Chorionic villi become edematous.
  • Hormonal Changes: Estrogen and progesterone levels drop.
  • Decidual Sloughing: Results in vaginal bleeding.
  • Uterine Contractions: Uterine irritability leads to contractions.
  • Classic Sign: Bright red vaginal bleeding (like a period).

Spontaneous Abortion Management

  • Primary Goal: Prevent/assess for life-threatening blood loss.
  • Management Options: Expectant, Medical, or Surgical management.
  • Expectant: Highest risk for retained POC.
  • Medical: Contraindicated for infection, hemorrhage, or bleeding disorders.
  • Medical Management: Misoprostol (800 mcg vaginal) or mifepristone (200mg 24 hours prior to misoprostol) followed by 800 mcg misoprostol.
  • Follow-up: Ultrasound within 7-14 days after medical management.
  • Surgical Management: Lowest risk for retained POC.
  • Surgical Indications: Hemorrhage, hemodynamic instability, or infection.
  • Antibiotic Prophylaxis: 200 mg Doxycycline 1 hour prior.
  • Management Considerations: MVA/MUA (<10 weeks) and D&E (>14 weeks) for surgical management.
  • Complication: Retained POC; severe pain.
  • Post-Abortion Recovery: Menses return in 4-6 weeks (hormone levels ordered if not occurred at this point).
  • Fertility Return: Patients can return to fertility/try to get pregnant anytime.
  • Pregnancy Failure Diagnosis: Ultrasound findings indicating pregnancy failure (e.g., CRL 7mm+, no heartbeat).

Ectopic Pregnancy

  • Site: Most common site is the ampulla.
  • Risk Factors: Pelvic inflammatory disease (PID), smoking (dose-related), prior tubal/pelvic surgery, contraceptive failure, assisted reproductive technology (ART), and unknown factors.
  • Symptoms: Minimal pregnancy symptoms initially; then pain followed by bleeding; a rupture causes pain to cease, continued bleeding. Additional symptoms may include abdominal pain/tenderness, delayed menses, absence of common pregnancy signs, palpable mass, and hemodynamic instability.
    • Lab Assessment: Complete Blood Count (CBC) to assess for hemodynamic status.
  • hCG Concerns: Absence of hCG doubling every 48 hours.
  • Pharmaceutical Management: Methotrexate to cause cellular death of trophoblastic tissue; decreases ectopic size without surgery.
  • Surgical Management: Laparoscopy or laparotomy.
  • Post-Treatment: Monitor hCG until no longer detectable (non-pregnancy level); avoid intercourse, excessive exercise, excessive pelvic exams.
  • Post-Treatment Return to Fertility: 1-3 months post-methotrexate treatment; pregnancy delayed for this period.

Gestational Trophoblastic Disease (Hydatidiform Mole)

  • Types: Complete Mole (46,XX, all paternal origin) and Partial Mole (69,XXX or 69,XXY).
  • Symptoms: First-trimester bleeding, variable uterine size (small or large), ovarian enlargement (multiple theca lutein cysts), and exaggerated pregnancy symptoms.
  • Ultrasound Findings: Grape-like structures; snowstorm appearance.
  • Diagnosis: Ultrasound.
  • Referral: D&C or hysterectomy.
  • Monitoring: Weekly hCG until undetectable; then every 1-3 months.
  • Pregnancy Avoidance: Avoid pregnancy until monitoring is complete.

General Considerations

  • High Risk for Hemorrhage: Expectant or medical management.
  • High Risk for Infection: Retained POC or genital tract infection.
  • Retained POC: Surgical treatment required.
  • Endometritis: Presentation in sepsis or septic abortion.
  • Lab Evaluation in Recurrent Pregnancy Loss: Endocrine, coagulation, and autoimmune disorders testing.
  • Recurrent Pregnancy Loss Etiology: 50% due to aneuploidy.
  • Anticoagulation: Only indicated in recurrent pregnancy loss with antiphospholipid antibodies.

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Description

Test your knowledge on early pregnancy complications, including ectopic pregnancy and types of spontaneous abortion. This quiz covers essential assessments and common causes of early pregnancy bleeding, allowing you to refresh your understanding of critical concepts in obstetrics.

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