OB-Miscarriage & management
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What occurrs with free B-hCG?
- -Promotes growth & invasion in non-gestational pregnancies
- -poor prognosis
What is the importance of H-hCG?
- -Essential for cell to burrow into endometrium
- -Usually gone by 6 weeks in pregnancy
- **if persistent--> gestational trophoblastic neoplasia (molar)
What is the importance of intact hCG of both alpha & beta?
-Promotes progesterone production by CL & spiral artery angiogenesis
How long does a positive pregnancy test show up (with the line)?
- 14 weeks
- -it's sensitive to hCG ~25mlu/ml
What is the average hCG level at 4 weeks?
100 at 28-30days
What is the normal rise of hCG during pregnancy?
Doubles q 36-48hrs x 10 weeks
**PEAKS ~ 70days
At about how many days does the hCG decrease to 5-20?
@ 120 days
What should you consider with a rapid rise in hCG?
When is the normal peak of hCG?
7-10weeks (@ 100,000 via urine hCG)
If a patient is bleeding and the hCG is not 0... what should you do?
Monitor hCG q 2 days to figure out the rise and pattern
What is an inevitable abortion?
-dilated cervix, but POC not expelled
What is a missed abortion?
-known fetal demise, but still in uterus
What is a threatened abortion?
-Pregnancy complicated by bleeding <20 weeks gestation (viable baby)
About how many pregnancies end in miscarriage?
What are some maternal risk factors for miscarriage?
- -substance use (tobacco, ETOH)
- -anesthetic gas exposure
- -chronic maternal disease (DM)
- -Rapid repeat pregnancy
- -IUD use
- -Maternal infection
- -mult previous elective abortions
- -previous SAB
- -uterine anomaoly (bicornate uterus)
When bleeding presents in the 1st trimester, list 6 DD.
- 1. Cervical/vaginal abnormality (polyp, trauma, cancer)
- 2. ectopic/molar
- 3. idiopathic bleed
- 4. vaginal/cervical infection
- 5. SAB
- 6. subchorionic bleed
What are the steps in the 1st TM workup for vaginal bleeding?
- -Quant hCG
- -wet prep, GC
- -CBC, ABO
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