Loss of pregnancy prior to 20 weeksa
bAsymptomatic bacteriuria in pregnancy needs to be treated promptly. Without treatment, it is likely to cause clinical UTI (urinary tract infection), acute pyelonephritis, and various feto-maternal complications (e.g., preterm labor, low birth weight). (!)
Background: Aneuploidy occurs due to abnormal cell division (most commonly due to meiotic nondisjunction). This results in daughter cells having wrong number of chromosomes. The commonly encountered non-sex chromosomal aneuploidies are Down (trisomy 21), Edward (trisomy 18) and Patau syndrome (trisomy 13). Edward and Patau are universally fatal.
Etiology: The (MCC) spontaneous abortion in the first trimester is chromosomal abnormalities. During the second trimester, etiologies of abortion include infection/teratogen exposure, incompetent cervix, trauma, etc.
Edward low HEAP = Edward syndrome has low HEAP = Hcg, Estriol, AFP and PAPP-A is low Trisomy 13 (Patau syndrome) not included here as the quadruple screening results can be variable. But. PAPP-A is typically low and nuchal translucency is increased.
This is equivalent to intrauterine fetal death.e
Dead fetus in uterod
Manage as inevitable or incomplete abortiond
dIn some cases, there might be an empty gestational sac with no fetal tissue development inside the sac. This condition is known as empty gestational sac (blighted ovum), which presents in a similar manner to missed abortion and is managed the same way. It likely occurs due to spontaneous fetal regression.
Presentation: Abdominal pain, lower abdominal tenderness ± vaginal bleeding ± hx of amenorrhea. Ruptured ectopic pregnancy can present with hemodynamic instability due to bleeding and hypovolemic shock.
dIn stable patients with unruptured ectopic pregnancy, treatment may be surgical (laparoscopy) or medical (methotrexate or similar agent). If medically managed, closely follow β-hCG levels. If β-hCG is not trending down, a second round of methotrexate dose can be given. If still not responding, NSIM is laparoscopy.
All of the above can present with bleeding during labor. Placenta previa can have abdominal pain and bleeding, but is usually mild to moderate. Severe pain points toward abruptio placenta or rupture, but these can also present with mild to moderate pain. So, an important differentiating factor is US (ultrasound).
Normal delivery does not have vaginal bleeding; however, there may be the passage of a small amount of blood or blood-tinged mucus through the vagina near the end of pregnancy (which is called the bloody show).
Rh(D) is an antigen found in RBCs. Most people are Rh(D) +ve, but some people can be Rh(D) negative. When an Rh(D)-negative person is exposed to Rh(D) +ve RBCs, this will stimulate production of anti-Rh(D) antibodies. Exposure to Rh(D) antigen occurs with incompatible blood donation (which rarely occurs), or when the Rh(D)-negative female is pregnant with an Rh(D) +ve fetus and there is fetomaternal hemorrhage.
Immunoglobulin G (IgG) antibodies against Rh(D) produced as a result of exposure to Rh(D) +ve antigen is called Rh(D) sensitization (alloimmunization). These IgG antibodies can cross the placenta and cause hemolytic disease of the fetus and newborn.