Which of the following are signs of miscarriage in the first trimester? Select all that apply.
Vaginal bleeding
Severe abdominal cramping
Increased fundal height
Loss of pregnancy symptoms
Fetal heart rate of 140 beats per minute
Correct Answer : A,B,D
Miscarriage (also called spontaneous abortion) is the loss of a pregnancy before 20 weeks of gestation, with most cases occurring in the first trimester (before 13 weeks). The most common cause is chromosomal abnormalities, followed by maternal conditions like thyroid disorders, infections, or uterine anomalies. Clinical signs include vaginal bleeding, abdominal cramping, and loss of pregnancy symptoms such as nausea and breast tenderness. Diagnosis is supported by ultrasound and quantitative hCG levels, which should double every 48–72 hours in a viable early pregnancy. A fetal heart rate is considered normal between 110–160 beats per minute.
Rationale for correct answers
A. Vaginal bleeding in the first trimester, especially when persistent or heavy, is a common sign of threatened or inevitable miscarriage. It may be accompanied by passage of clots or tissue.
B. Severe abdominal cramping or back pain is a hallmark of miscarriage due to uterine contractions and cervical dilation. It often intensifies as the pregnancy tissue is expelled.
D. Loss of pregnancy symptoms, such as resolution of nausea or breast soreness before the end of the first trimester, may indicate hormonal decline following embryonic demise.
Rationale for incorrect answers
C. Increased fundal height is not a sign of miscarriage. In fact, a decreasing or non-rising fundal height may be more indicative of pregnancy loss or intrauterine growth restriction.
E. A fetal heart rate of 140 beats per minute is within the normal range (110–160 bpm) and strongly indicates a viable pregnancy. Its presence rules out miscarriage at that moment.
Take home points
• First trimester miscarriage presents with bleeding, cramping, and loss of pregnancy symptoms.
• Chromosomal abnormalities are the most common cause.
• Normal fetal heart rate (110–160 bpm) rules out miscarriage.
• Miscarriage is confirmed by ultrasound and declining hCG levels.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Fetal eyelid development follows a defined timeline that reflects neurological and anatomical maturation. The eyelids fuse by approximately week 10 to protect the developing eye and remain fused to allow for proper corneal and conjunctival differentiation. By around week 26, the eyelids separate, allowing the fetus to open and close the eyes in response to light and other stimuli. This milestone is associated with optic nerve myelination and increasing visual system activity, though vision remains immature. The retina is still developing, and light perception is limited. This separation coincides with increased blink-startle responses and maturation of REM-like eye movements.
Rationale for correct answers
B. Separation of the eyelids typically occurs by week 26, allowing the fetus to begin opening its eyes. This marks a significant milestone in fetal neurological and sensory development, including initiation of visual reflexes and responses to light.
Rationale for incorrect answers
A. Taste bud development begins much earlier, around weeks 7–8, and by week 14, taste receptors are already functional. While taste sensation continues to mature, this is not a unique milestone of week 26.
C. Formation of fingerprints (dermal ridges) is completed by weeks 17–19, during the second trimester. This unique feature arises due to genetic and intrauterine influences on skin patterning.
D. Complete lung maturation does not occur by week 26. Type II alveolar cells begin surfactant production around weeks 24–28, but full structural and functional lung maturity typically is not achieved until week 36–37.
Take home points
• Fetal eyelids fuse around week 10 and reopen by week 26.
• Eye opening indicates sensory and CNS maturation.
• Fingerprints form between weeks 17–19, earlier than eye opening.
• Lung maturation continues into late third trimester.
Correct Answer is ["A","B","D"]
Explanation
Neural tube defects (NTDs) are severe congenital malformations resulting from the incomplete closure of the neural tube during the third to fourth week of gestation, specifically between days 21–28. The most common forms include spina bifida, anencephaly, and encephalocele. NTDs are associated with several maternal and environmental risk factors. Folic acid deficiency impairs methylation and DNA synthesis, both critical for neural tube closure. Maternal diabetes, especially poorly controlled pregestational diabetes, increases oxidative stress and teratogenic risk. Anticonvulsant medications, such as valproic acid and carbamazepine, interfere with folate metabolism and increase NTD incidence. Normal folic acid supplementation is 400 mcg/day preconceptionally and in early pregnancy.
Rationale for correct answers
A. Maternal diabetes, particularly if poorly controlled, leads to increased oxidative stress and altered glucose metabolism, which disrupt early embryogenesis, including neural tube formation.
B. Folic acid deficiency is the most established risk factor for NTDs. Folate is vital for nucleotide synthesis and methylation. Low folate levels impair neural tube closure during early embryonic development.
D. Anticonvulsant medications, especially valproate and carbamazepine, are teratogenic due to their interference with folate metabolism, significantly increasing the risk for NTDs.
Rationale for incorrect answers
C. Excessive caffeine intake has not been definitively linked to neural tube defects. While high caffeine levels may be associated with other outcomes like miscarriage or low birth weight, they are not proven NTD risk factors.
E. Advanced maternal age increases the risk of chromosomal abnormalities such as trisomy 21, but it is not a direct risk factor for NTDs. NTD risk is more closely linked to nutritional and metabolic factors.
Take home points
• NTDs occur between days 21–28 of embryogenesis.
• Risk factors include folic acid deficiency, maternal diabetes, and certain anticonvulsants.
• Normal folic acid requirement is 400 mcg/day to prevent NTDs.
• Advanced age and caffeine are not primary contributors to NTDs.
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