Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (277 page)

   
Hematology:
WBC may be increased. It usually returns to normal in 24 hours, and persistent increase may indicate recurrent bleeding. Fifty percent of patients have normal WBC; 75% of the patients have WBC <15,000/μL. Persistent WBC >20,000/μL may indicate PID. Anemia depends on degree of blood loss; it often precedes the tubal pregnancy in impoverished populations. Progressive anemia may indicate continuing bleeding into the peritoneal cavity. Absorption of blood from peritoneal hematoma may cause increased serum bilirubin.

   
Uterine curettage
is needed to distinguish ectopic pregnancy from spontaneous intrauterine abortion by the identification of chorionic villi and implantation site in the specimen.

References

Rajkowa M, Glass MR, Rutherford AJ, et al. Trends in the incidence of ectopic pregnancy in England and Wales from 1966 to 1996.
Br J Obstet Gynaecol.
2000;107(3):369–374.

Silva C, Sammel MD, Zhou L, et al. Human chorionic gonadotropin profile for women with ectopic pregnancy.
Obstet Gynecol.
2006;107:605.

Barnhart KT, Simhan H, Kamelle SA. Diagnostic accuracy of ultrasound above and below the beta-hCG discriminatory zone.
Obstet Gynecol.
1999;94:583.

Rausch ME, Barnhart KT. Serum biomarkers for detecting ectopic pregnancy.
Clin Obstet Gynecol.
2012;55:418.

Verhaegen J, Gallos ID, van Mello NM, et al. Accuracy of single progesterone test to predict early pregnancy outcome in women with pain or bleeding: meta-analysis of cohort studies.
BMJ.
2012;345:e6077.

FETAL DEATH IN UTERO

   Definition

Stillbirth is distinguished from miscarriage by a fetal weight varying from >350 to >500 g or >20 weeks of gestation.

   Clinical Presentation

The rate of fetal loss varies by race, maternal diabetes, and hypertension.

The most common causes are
¹
:

   Obstetric complications 29.3%

   Placental disease 23.6%

   Fetal genetic/structural abnormalities 13.7%

   Maternal or fetal infection 12.9%

   Umbilical cord abnormalities 10.4%

   Hypertensive disorders 9.2%

   Other maternal medical conditions 7.8%

   Laboratory Findings