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Questions and Answers

What is the age range for a preterm infant?

  • 40 weeks and above
  • 24-37 weeks (correct)
  • 37-40 weeks
  • 20-24 weeks

    • What is the term for pregnancy losses before 20 weeks?

  • Abortus (correct)
  • Pregnancy loss
  • Miscarriage
  • Abortion

    • How is the estimated date of confinement (EDC) calculated?

  • LMP - 2 weeks, + 7 days
  • LMP + 2 weeks, + 7 days
  • LMP + 3 months, - 7 days
  • LMP - 3 months, + 7 days (correct)

    • What is the term for a woman whose parity is 5 or more?

    <p>Grand multipara</p> Signup and view all the answers

    What is the age in weeks and days from fertilization (conceptional age)?

    <p>Developmental age</p> Signup and view all the answers

    When can fetal heart tones be auscultated via stethoscope?

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

    What is the term for a pregnancy that involves more than one fetus?

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

    When can a gestational sac be seen on transvaginal ultrasound?

    <p>5 weeks</p> Signup and view all the answers

    What percentage of cases are associated with gestational choriocarcinoma?

    <p>2% to 5%</p> Signup and view all the answers

    What type of trophoblastic tumor is very rare?

    <p>Placental site trophoblastic tumor (PSTT)</p> Signup and view all the answers

    What is the term for the sensation of the fetus moving, felt by the mother?

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

    When can fetal movement be seen on ultrasound?

    <p>6 weeks</p> Signup and view all the answers

    What percentage of cases are associated with persistent GTD and invasive moles?

    <p>10% to 15%</p> Signup and view all the answers

    Which of the following is not a type of gestational trophoblastic disease?

    <p>Placenta previa</p> Signup and view all the answers

    What is the most common type of gestational trophoblastic disease?

    <p>There is no information about the most common type</p> Signup and view all the answers

    What is the range of cases associated with gestational trophoblastic disease?

    <p>2% to 15%</p> Signup and view all the answers

    What is the main purpose of the 100g OGTT test?

    <p>To diagnose Gestational Diabetes Mellitus (GDM)</p> Signup and view all the answers

    Which of the following is a component of the Biophysical Profile (BPP)?

    <p>Non-stress test (NST)</p> Signup and view all the answers

    At what gestational age is the screening test for MSAFP typically performed?

    <p>Between 15-18 weeks</p> Signup and view all the answers

    What is the primary indication for performing a fetal anatomy survey ultrasound?

    <p>To detect fetal anomalies</p> Signup and view all the answers

    What is the main reason for performing RPR/VDRL testing at 36 weeks of gestation?

    <p>To screen for syphilis</p> Signup and view all the answers

    Which of the following is a risk factor for developing GDM?

    <p>All of the above</p> Signup and view all the answers

    What is the main purpose of performing Leopold maneuvers?

    <p>To determine fetal presentation</p> Signup and view all the answers

    Which of the following is a common symptom of preeclampsia?

    <p>Severe headache</p> Signup and view all the answers

    What is the primary reason for performing a glucose loading test (GLT) at 24-28 weeks of gestation?

    <p>To diagnose GDM</p> Signup and view all the answers

    Which of the following is a complication of pregnancy that can cause contractions?

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

    This is an example statement that is true

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

    What is the treatment of choice for Placental Site Trophoblastic Tumors (PSTT)?

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

    What is the most common symptom of Placental Site Trophoblastic Tumors (PSTT)?

    <p>Persistent irregular vaginal bleeding</p> Signup and view all the answers

    What is the rate of development of Gestational Choriocarcinoma after a complete molar pregnancy?

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

    What is the characteristic of Gestational Choriocarcinoma?

    <p>Sheets of anaplastic cytotrophoblasts and syncytiotrophoblasts</p> Signup and view all the answers

    What is the diagnosis for Gestational Choriocarcinoma?

    <p>Elevated hCG levels</p> Signup and view all the answers

    What is the treatment for low-risk Gestational Trophoblastic Disease (GTD)?

    <p>Single-agent chemotherapy</p> Signup and view all the answers

    What is the cure rate for low-risk Gestational Trophoblastic Disease (GTD)?

    <p>95-100%</p> Signup and view all the answers

    What is the characteristic of Placental Site Trophoblastic Tumors (PSTT)?

    <p>Absence of villi, intermediate trophoblasts, and (+) hPL</p> Signup and view all the answers

    What is the incidence of Gestational Choriocarcinoma?

    <p>1 in 20,000 to 40,000</p> Signup and view all the answers

    What is the diagnosis for Placental Site Trophoblastic Tumors (PSTT)?

    <p>Elevated hPL levels</p> Signup and view all the answers

    Study Notes

    Pregnancy

    • A pregnancy can be classified into different types:
      • Preterm: born between 24-37 weeks
      • Abortus: pregnancy losses before 20 weeks
      • Multifetal pregnancy: counts as 1 for TPA, but number of children alive counts separately for L
    • A woman's parity is the number of times she has been pregnant, and a grand multipara is a woman whose parity is ≥ 5

    Dating the Pregnancy

    • Developmental age (DA) is the number of weeks and days since fertilization (conceptional/embryonic age)
    • Gestational age (GA) is the age in weeks and days from the last menstrual period (LMP), which is +2 weeks from DA
    • Estimated date of confinement (EDC) / estimated date of delivery (EDD) can be computed via Naegele's rule
    • Ultrasound can be used to date the pregnancy, with a margin of error of 7-8% from GA
    • Auscultation of fetal heart tones can be detected by 20 weeks via stethoscope, or 10 weeks via Doppler ultrasound
    • Quickening usually occurs between 16-20 weeks

    Diagnosis

    • Ultrasound can detect a gestational sac at 5 weeks on transvaginal ultrasound, or at a beta-hCG of 1,500-2,000 mIU/mL
    • Fetal heart motion can be seen at 6 weeks or at a beta-hCG of 5,000-6,000 mIU/mL

    Fetal Well-being

    • Hematocrit (Hct) becomes close to its nadir during the third trimester
    • Glucose loading test (GLT) is used to screen for gestational diabetes mellitus (GDM)
    • RPR/VDRL is used to screen for syphilis at 36 weeks
    • Group B streptococcus (GBS) culture is used to detect GBS infection, which can be prevented with IV penicillin during labor
    • Biophysical profile (BPP) and non-stress test (NST) are used to assess fetal well-being

    Prenatal Care

    • Routine problems of pregnancy include back pain, constipation, contractions, dehydration, edema, GERD, hemorrhoids, pica, round ligament pain, urinary frequency, and varicose veins
    • High-risk groups include African Americans, Southeast Asians, individuals with a family history of genetic disorders, and those with pregestational diabetes or hypertension
    • Specific tests are used for each high-risk group, such as sickle cell prep for African Americans and Hgb electrophoresis for Southeast Asians
    • Routine prenatal visits include assessment of blood pressure, weight, and urine dipstick, as well as detection of protein, glucose, and leukocyte esterase

    Gestational Trophoblastic Diseases

    • Persistent gestational trophoblastic disease (GTD) and invasive moles occur in 10-15% of pregnancies
    • Gestational choriocarcinoma occurs in 2-5% of pregnancies
    • Placental site trophoblastic tumors (PSTTs) are very rare### Persistent Postmolar GTD and Invasive Moles
    • Composed primarily of cytotrophoblast
    • Notable due to the presence of an embryo
    • 1 in 15,000 pregnancies
    • Often misdiagnosed as spontaneous or missed abortions
    • Hydropic chorionic villi and trophoblast proliferation into the myometrium
    • Much lower malignant potential than complete moles
    • Rarely metastasize and are capable of spontaneous regression

    Clinical Presentation

    • Delayed menses and positive urine pregnancy test (PT)
    • Vaginal bleeding from miscarriage or incomplete abortion in late first trimester or early second trimester (90%)
    • Physical examination typically normal due to slightly elevated hCG, positive fetal heart sounds, and uterine size small for gestational age
    • Ultrasound (UTZ): fetus with cardiac activity, congenital malformations, and/or intrauterine growth restriction (IUGR)
    • "Swiss-cheese" appearance

    Diagnosis

    • Plateau or rise in hCG levels, excessive uterine size, and large theca lutein cysts
    • UTZ: invasion of an intrauterine mass into the myometrium
    • Doppler: high vascular flow
    • Definitive diagnosis: histopathological examination of uterine tissue

    Management

    • Avoid repeat D&C
    • Single-agent chemotherapy (MTX or dactinomycin)
    • If with metastases: single agent for low risk, multiagent for high risk
    • Similar follow-up and surveillance with GTD

    Placental Site Trophoblastic Tumors (PSTT)

    • Extremely rare tumors from invasion of the myometrium and vasculature from intermediate cytotrophoblasts of the placental implantation site
    • Absence of villi, intermediate trophoblasts, and positive human placental lactogen (hPL)
    • Rarely metastasize

    Diagnosis

    • Most common symptom of PSTT: persistent irregular vaginal bleeding
    • Labs: positive hPL
    • UTZ: uterine mass, less hemorrhage than seen in gestational choriocarcinomas

    Treatment

    • Generally not sensitive to chemotherapy
    • Hysterectomy is the treatment of choice for PSTT
    • Multiagent chemotherapy to prevent recurrence

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