Obstetrics and Gynecology Board Review Pearls of Wisdom

604 Obstetrics and Gynecology Board Review •••

❍ Patients experiencing spontaneous, recurrent abortion would benefit from what established testing?

Category Recommended Tests Other Tests

Genetic Karyotype, both parents

Anatomic HSG or sonohysterogram or

hysteroscopy

MRI as indicated

Immunologic Lupus anticoagulant

Anticardiolipin antibody

Thrombophilias Factor V Leiden

Prothrombin gene mutation

Activated protein C resistance

Homocysteine

MTHFRa

Protein C

Protein S

Antithrombin III

Endocrine TSH, fasting blood glucose, HbA1c

Prolactin

Infectious Gonorrhea and Chlamydia cultures Listeria and TORCH titers if indicated

Environmental History

aMethylenetetrahydrofolate reductase.

❍ When is the appropriate time to do such a workup?
After three SABs or in women above 35 after two SABs.

❍ What is the risk of ectopic pregnancy in those experiencing repetitive SAB?
A fourfold increased risk.

❍ What is the miscarriage rate if embryonic cardiac activity is seen sonograpically at 6 weeks’ gestation and at
8 weeks’ gestation?
6% to 8% and 2% to 3%.

❍ What is the occurrence of threatened miscarriage and what percentage results in abortion?
Threatened miscarriage occurs in 30% to 40% of human gestations leading to abortion in half of these.

❍ How many weeks after fetal death with retained products of conception may consumptive coagulopathy
with hypofibrinogenemia occur?
5 weeks.