1.01 Complications of Early Pregnancy- Abortion and Molar Pregnancy

Question 1

Abortion is defined by a nonviable intrauterine pregnancy without fetal heart activity within what specific time frame?

Answer 1

first 12 weeks and 6 days of gestation

Question 2

T/F: A first heartbeat during the 11th, 12th, or 13th weeks means pregnancy will probably progress (viable pregnancy)

Answer 2

T

Question 3

Explain the pathogenesis of spontaneous abortion

Answer 3

When there is embryonic demise, there comes hemorrhage to the decidua basalis then tissue necrosis. The body will try to remove these by uterine contractions and expulsion

Question 4

T/F: Half of miscarriages have a baby with aneuploidy

Answer 4

T

Question 5

T/F: even mild endocrine disorders can cause a miscarriage

Answer 5

F
- it does not cause a miscarriage

The ff can cause miscarriage: antiphospholipid antibody syndrome, high BMI, PCOS, some thyroid disorders and pregestational diabetes

Question 6

What classifications of spontaneous abortions present with closed cervical os?

Answer 6

Missed, Threatened, Complete abortions

Question 7

Classification of spontaneous abortion having vaginal bleeding but with fetal cardiac activity

Answer 7

Threatened

Question 8

Classification of spontaneous abortion having vaginal bleeding and cramping, membrane rupture, with products of conception seen or felt above cervical os

Answer 8

Inevitable abortion

Question 9

In septic abortion, this must be performed for retained products of conception

Answer 9

Suction curettage

Question 10

Having a crown-rump length of ___mm or greater and no heartbeat is a diagnostic finding of pregnancy failure

Answer 10

7mm

<7mm and no heartbeat = suspicious but not diagnostic

Question 11

Having mean sac diameter of ____ or greater without an embryo is a diagnostic finding of pregnancy failure

Answer 11

25mm

Mean sac diameter of 16-24mm and no embryo = suspicious but not diagnostic

Question 12

Absence of embryo WITH heartbeat ___ weeks or more after a scan that showed a gestational sac without a yolk sac a diagnostic finding of pregnancy failure

Answer 12

2 weeks

Question 13

Absence of embryo WITH heartbeat 7-13 days after a scan that showed a gestational sac without a yolk sac means:

Answer 13

Suspicious but not diagnostic of pregnancy failure

Question 14

Absence of embryo WITH heartbeat ___ days or more after a scan that showed a gestational sac WITH a yolk sac is a diagnostic finding of pregnancy failure

Answer 14

11 days

7-10 days = suspicious but not diagnostic

Question 15

Absence of embryo for 6 weeks or longer after lest menstrual period may suggest:

Answer 15

suspicion but not diagnostic of pregnancy failure

Question 16

With adequate time of up to __ weeks, expectant management is successful

Answer 16

8 weeks

Question 17

These can be criteria for complete expulsion

Answer 17

Absence of gestational sac
Endometrial thickness being less than 30mm

Question 18

Indications of sharp curette or suction curettage

Answer 18

Hemorrhage
Hemodynamic instability
Signs of infection

Expectant management is ruled out when any of the 3 are present

Question 19

Abortion Methods by general gestation range

Answer 19

Medication
Vacuum aspiration
Dilatation and evacuation
Induction

Question 20

What is midtrimester abortion?

Answer 20

Fetal loss from the end of the first trimester until the fetus reaches 500g or 20 weeks

Question 21

T/F: Chorioamnionitis may cause midtrimester abortion

Answer 21

T

Question 22

T/F: Leiomyomas cannot cause midtrimester spontaneous pregnancy loss

Answer 22

F - it can

Question 23

When is a patient diagnosed with recurrent pregnancy loss?

Answer 23

When she has 3 or more consecutive pregnancy losses <20 weeks or fetal weight <500 gms

Question 24

T/F: Primary RPL refers to condition where there is still one or more previous pregnancies progressing beyond 24 weeks

Answer 24

F: it’s secondary RPL
-Primary RPL has no previous viable pregnancy

Question 25

What are the obstetric criteria for antiphospholipid antibody syndrome?

Answer 25

One or more unexplained deaths of a morphologically normal fetus at or beyond 10 weeks OR Severe preeclampsia or vascular insufficiency necessitating delivery before 34 weeks OR Three or more unexplained consecutive spontaneous abortion before 10 weeks

Question 26

What are the vascular criterion for antiphospholipid antibody syndrome? What are the laboratory criteria for antiphospholipid antibody syndrome?

Answer 26

At least one episode of arterial, venous, or small vessel thrombosis on any organ or tissue Lab criteria: Has lupus anticoagulant (LAC) or Has med to high serum levels of IgG or IgM anticardiolipin antibodies or Anti-B2 glycoprotein-1 IgG or IgM antibody

Question 27

Normal shape of cervix: Shape of cervix with insufficiency:

Answer 27

Normal shape of cervix: T (inverted wine bottle) Shape of cervix with insufficiency: U (funneling)

Question 28

T/F: Either 1 clinical or laboratory criteria are needed for APAS diagnosis

Answer 28

F at least 1 clinical and 1 lab criteria If positive, must be repeated after 12 weeksT

Question 29

T/F: A patient after 20-24 wks that presents with a miscarriage due to incompetent cervix may present with painful bleeding followed by expulsion of products of conception

Answer 29

F- painless bleeding

Question 30

Why is completion cutterage avoided?

Answer 30

As this can increase risk for incompetent cervix due to surgical trauma

Question 31

How is cervical insufficiency diagnosed?

Answer 31

Based on history of PAINLESS cervical dilatation AFTER THE FIRST trimester with SUBSEQUENT EXPULSION Serial transvaginal ultrasound must show cervical length of not less than or equal to 25mm

Question 32

What should be done if cervical length was observed to be decreasing?

Answer 32

Cervical cerclage

Question 33

This type of cerclage is done most of the time, with purse-string suturing This type of cerclage involves colpotomy and bladder dissection due to a higher suture placement

Answer 33

McDonald's Cerclage Shirodkar Cerclage

Question 34

When is pessary used?

Answer 34

It can be used when cerclage could be difficult or the cervix still shortens desipte cerclage. The pessary is used to hold it together to prevent miscarriage

Question 35

In partial moles, the uterine growth is larger than expected for age of gestation

Answer 35

F - complete mole

Question 35

Appearance of H mole in ultrasound

Answer 35

Snowstorm appearance

Question 36

T/F: Intervention on Theca lutein cysts is only necessary when ovarian torsion is present

Answer 36

T wait for it to be resolved as the serum B hcg levels decreases

Question 37

Management for molar pregnancies

Answer 37

Molar evacuation via suction curettage

Question 38

For post-evacuation surveillance, monthly BHCG determination is done for ___ months to monitor for malignancy

Answer 38

6 months

Question 39

Median time for resolution Partial moles: Complete moles:

Answer 39

Partial moles: 7 weeks Complete moles: 9 weeks