A 32-year-old gravida 3 para 2 presents for routine prenatal care. The patient is at 14 weeks estimated gestational age by last menstrual period, and ultrasonography at 8 weeks gestation was consistent with these dates. Fetal heart tones are not heard by handheld Doppler. Transvaginal ultrasonography reveals an intrauterine fetus without evidence of fetal cardiac activity. The patient has not had any bleeding or cramping, and otherwise feels fine. A pelvic examination reveals a closed cervix without any signs of bleeding or products of conception.
Which one of the following is the most likely cause of this presentation?
Correct Answer C: In this case, the patient has a missed abortion, which is defined as a dead fetus or embryo without passage of tissue and with a closed cervix. This condition often presents with failure to detect fetal heart tones or a lack of growth in uterine size.
→ By 14 weeks estimated gestational age, fetal heart tones should be detected by both handheld Doppler and ultrasonography.
→ An inevitable abortion presents with a dilated cervix, but no passage of fetal tissue.
→ A blighted ovum involves failure of the embryo to develop, despite the presence of a gestational sac and placental tissue.
A healthy 36-year-old female presents with vaginal bleeding 3 weeks after a missed menstrual period. A pelvic examination reveals a dilated cervix with products of conception visible in the vaginal vault.
Which one of the following is the most likely cause of this condition?
Correct Answer E:
Although heavy caffeine use, advanced maternal age, and a previous history of multiple elective abortions are all considered risk factors for spontaneous abortion, the most common cause, which accounts for nearly 50% of spontaneous abortions, is chromosomal abnormalities. Most chromosomal abnormalities are random events, such as maternal and paternal gametogenesis errors, dispermy, and nondisjunction. Sexual activity does not raise the risk of spontaneous abortion in women with uncomplicated pregnancies.
You are asked to see a young woman in the emergency department for a miscarriage. On exam, she has passed the conceptus, and no products of conception remain inside the uterus. The cervical os is closed and has minimal bleeding. Vital signs are stable. The patient is inquiring as to the reason for her miscarriage. Knowing that the most likely cause of this spontaneous abortion is due to aneuploidy, you can tell her that the most common chromosomal abnormality is:
Correct Answer C:
Overall, trisomy as a group accounts for 50% of all first trimester abortuses (of which trisomy 16 is the most common).
Monosomy X is the most frequent single anomaly found. Diploid of androgenetic origin is associated with gestational trophoblastic neoplasias such as complete and partial molar pregnancy.
→ An uncommon finding in abortuses.
→ Haploid of paternal origin will be a 23X or a 23Y.
→ Diploid of paternal origin is associated with complete molar pregnancy.
A 24-year-old female G1P0 is admitted to hospital at 34 weeks gestation. The patient describes passing a large volume of clear fluid per vagina for 36 hours. Examination reveals the following:
Lab investigations reveal:
Which of the following is the most likely diagnosis?
Correct Answer B:
Rupture of the membranes before onset of labor is considered premature; it sometimes results in infection. Diagnosis is clinical. If fetal lungs are immature and infection is absent, treatment is bed rest plus delay of delivery with Mg sulfate and other tocolytic drugs as needed. If fetal lungs are mature or if fetal compromise or infection is present, treatment is expedited delivery (eg, by inducing labor).
Chorioamnionitis is infection of the chorion and amnion, usually occurring near term. Chorioamnionitis may result from an infection that ascends through the genital tract. Risk factors include premature rupture of membranes and prolonged labor. Consequences of chorioamnionitis include premature rupture of membranes and premature labor, and increased risk of neonatal pneumonia, bacteremia, meningitis, and death.
Diagnosis is suggested by fever occurring late in pregnancy. Fetal heart rate monitoring is required. Fetal heart rate increases during fever but, in the absence of chorioamnionitis, returns to baseline as fever resolves. Fetal tachycardia out of proportion to or in the absence of fever suggests chorioamnionitis.
Which of the following clinical signs and symptoms of chorioamnionitis appears to be the most frequent?
Correct Answer D:
The time-honored clinical signs and symptoms of chorioamnionitis include the following:
Of these criteria, intrapartum maternal fever appears to be the most frequent.
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