Case 1: A woman arrives at the clinic seeking confirmation that she is pregnant for the first
time. The following information is obtained: She is 37 years old with a body mass index (BMI) of
17.5. She admits to having used cocaine “several times” during the past year and drinks alcohol
occasionally. Her blood pressure (BP) is 108/70 mmHg, her pulse rate is 72beats/min, and her
respiratory rate is 16 cpm. The family history is positive for diabetes mellitus and cancer. Her
sister recently gave birth to an infant with neural tube defect (NTD).
1. What is high risk pregnancy?
A high-risk pregnancy is one of greater risk to the mother or her fetus than an
uncomplicated pregnancy. Pregnancy places additional physical and emotional
stress on a woman’s body. Health problems that occur before a woman becomes
pregnant or during pregnancy may also increase the likelihood for a high-risk
pregnancy.
2. Based on the given case, identify the factors that put the patient at risks and explain
how?
Her family history of NTD, low BMI, and substance abuse all are high risk factors
of pregnancy. Her BMI is low and may indicate poor nutritional status, which
would be a high risk. The woman's drug/alcohol use and family history put her in
a high-risk category.
3. Why there’s a need to Identify or detect women with high risk factors?
In a high-risk pregnancy, healthcare providers will want to keep a close watch on
the woman and the pregnancy to detect any potential problems as quickly as
possible so that treatment can start before the woman’s or fetus’s health is in
danger. This is particularly true of pregnancies that are high risk because
of preeclampsia and previous preterm labor or birth. In these situations,
treatment could mean additional days in the womb to allow for fetal development
to continue.
4. Enumerate diagnostic tests for high risk pregnancy (Invasive/ non –invasive)
Specialized or targeted ultrasound.
Prenatal cell-free DNA (cfDNA) screening
Invasive genetic screening (CVS or Amniocentesis)
Ultrasound for cervical length
Lab tests
Biophysical profile
Case 2: A healthy 29-year-old woman who has been trying to conceive presents with vaginal
spotting for the past 5 days and intermittent crampy abdominal pain in her left lower quadrant for
the past 3 days. Her last menstrual period was 6 weeks and 2 days before presentation. She
has had a spontaneous vaginal delivery and an anembryonic gestation treated by dilation and
curettage. How should this patient be evaluated and treated?
1. What is the case presented?
The case presented is ectopic pregnancy.
2. What are symptoms of the above case?
Vaginal bleeding
Nausea and vomiting with pain
Sharp abdominal cramps
Pain on one side of your body
Dizziness or weakness
Pain in your shoulder, neck, or rectum
3. What are possible causes of the given case?
An infection or inflammation of the fallopian tube can cause it to become partially
or entirely blocked.
Scar tissue from a previous infection or a surgical procedure on the tube may
also impede the egg’s movement.
Previous surgery in the pelvic area or on the tubes can cause adhesions.
Abnormal growths or a birth defect can result in an abnormality in the tube’s
shape.
4. What are the potential consequences if the case is not treated?
It is very dangerous if not treated. Fallopian tubes can break if stretched too
much by the growing pregnancy this is sometimes called a ruptured ectopic
pregnancy. This can cause internal bleeding, infection, and in some cases lead
to death.
5. How should this patient be treated?
Treatment is usually needed to remove the pregnancy before it grows too large. The
main treatment options are:
Expectant management – your condition is carefully monitored to see whether
treatment is necessary.
Medication – a medicine called methotrexate is used to stop the pregnancy
growing.
Surgery – laparoscopic surgery is used to remove the pregnancy, usually along
with the affected fallopian tube.
Case 3: Mrs. M, aged 24 years and 11 weeks pregnant, presented to the emergency
department (ED) with abdominal cramping and heavy vaginal bleeding and clots. Over the past
two days, she had experienced light spotting, which had increased in severity that morning. Mrs.
M reported no fever, chills, burning on urination, nausea, or vomiting. Her past obstetric history
was gravida 4 para 2 aborted 1. She was sexually active and receiving prenatal care from her
obstetrician/gynecologist. The patient was otherwise healthy and had no significant medical
problems.
1. Physical examination
Mrs. M’s BP was 124/84 mm Hg, heart rate 83 beats per minute without ectopy, respiration rate
18 breaths per minute, oxygen saturation 100% on room air, and temperature 98.3°F. Lungs
were clear on auscultation in all fields; S1 and S2 were normal with no murmurs, gallops, or rubs.
The patient’s abdomen was slightly distended, and mild tenderness was present over her lower
pelvic area. During pelvic examination, moderate active bleeding was noted in the vaginal vault
with the cervical os open. No cervical motion tenderness or adnexal tenderness was observed.
Blood clots or tissue were noted on a peri pad. The remainder of the patient’s physical
examination was unremarkable.
1. What's the difference between spontaneous abortion and stillbirth?
Spontaneous abortion refers to pregnancy loss at less than 20 weeks' gestation
in the absence of elective medical or surgical measures to terminate the
pregnancy. while a Stillbirth is the death or loss of a baby before or during
delivery. Both miscarriage and stillbirth describe pregnancy loss, but they differ
according to when the loss occurs, a stillbirth is loss of a baby after 20 weeks of
pregnancy.
2. What are the risk factors for spontaneous abortion and potential complications of
spontaneous abortion?
Various factors increase the risk of miscarriage, including:
Age. Women older than age 35 have a higher risk of miscarriage than do
younger women. At age 35, you have about a 20 percent risk. At age 40, the risk
is about 40 percent. And at age 45, it's about 80 percent.
Previous miscarriages. Women who have had two or more consecutive
miscarriages are at higher risk of miscarriage.
Chronic conditions. Women who have a chronic condition, such as
uncontrolled diabetes, have a higher risk of miscarriage.
Uterine or cervical problems. Certain uterine abnormalities or weak cervical
tissues (incompetent cervix) might increase the risk of miscarriage.
Smoking, alcohol and illicit drugs. Women who smoke during pregnancy have
a greater risk of miscarriage than do nonsmokers. Heavy alcohol use and illicit
drug use also increase the risk of miscarriage.
Weight. Being underweight or being overweight has been linked with an
increased risk of miscarriage.
Invasive prenatal tests. Some invasive prenatal genetic tests, such as chorionic
villus sampling and amniocentesis, carry a slight risk of miscarriage.
Potential complications
Besides acute hemorrhage, post-abortion complications can include septic
shock, perforated bladder or bowel, and a possible ectopic pregnancy- all lethal
conditions which if not promptly diagnosed can lead to high mortality.
3. What 2 criteria have to be met for it be considered no VIABLE?
When the fetus has no heartbeat and a crown-to-rump length of seven
millimeters or more.
When the gestational sac has no embryo but a mean diameter of 25 millimeters
or greater.
4. Besides chromosome abnormalities, what other things cause spontaneous abortions?
Other causes of miscarriage include:
Infection
Medical conditions in the mother, such as diabetes or thyroid disease
Hormone problems
Immune system responses
Physical problems in the mother
Uterine abnormalities
5. When a medical abortion can be utilized?
Medical abortion is a procedure that uses medication to end a pregnancy. It can
be done as soon as a pregnancy can be seen in an ultrasound. A medical
abortion doesn't require surgery or anesthesia and can be started either in a
medical office or at home with follow-up visits to your doctor. It's safer and most
effective during the first trimester of pregnancy.
