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OBSTETRICS II > 1.01 Complications of Early Pregnancy- Abortion and Molar Pregnancy > Flashcards

1.01 Complications of Early Pregnancy- Abortion and Molar Pregnancy Flashcards

1
Q

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

A

first 12 weeks and 6 days of gestation

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2
Q

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

A

T

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3
Q

Explain the pathogenesis of spontaneous abortion

A

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

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4
Q

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

A

T

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5
Q

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

A

F
- it does not cause a miscarriage

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

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6
Q

What classifications of spontaneous abortions present with closed cervical os?

A

Missed, Threatened, Complete abortions

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7
Q

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

A

Threatened

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8
Q

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

A

Inevitable abortion

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9
Q

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

A

Suction curettage

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10
Q

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

A

7mm

<7mm and no heartbeat = suspicious but not diagnostic

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11
Q

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

A

25mm

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

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12
Q

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

A

2 weeks

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13
Q

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

A

Suspicious but not diagnostic of pregnancy failure

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14
Q

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

A

11 days

7-10 days = suspicious but not diagnostic

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15
Q

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

A

suspicion but not diagnostic of pregnancy failure

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16
Q

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

A

8 weeks

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17
Q

These can be criteria for complete expulsion

A

Absence of gestational sac
Endometrial thickness being less than 30mm

18
Q

Indications of sharp curette or suction curettage

A

Hemorrhage
Hemodynamic instability
Signs of infection

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

19
Q

Abortion Methods by general gestation range

A

Medication
Vacuum aspiration
Dilatation and evacuation
Induction

20
Q

What is midtrimester abortion?

A

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

21
Q

T/F: Chorioamnionitis may cause midtrimester abortion

A

T

22
Q

T/F: Leiomyomas cannot cause midtrimester spontaneous pregnancy loss

A

F - it can

23
Q

When is a patient diagnosed with recurrent pregnancy loss?

A

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

24
Q

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

A

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

25
Q

What are the obstetric criteria for antiphospholipid antibody syndrome?

A

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

26
Q

What are the vascular criterion for antiphospholipid antibody syndrome?

What are the laboratory criteria for antiphospholipid antibody syndrome?

A

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

27
Q

Normal shape of cervix:
Shape of cervix with insufficiency:

A

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

28
Q

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

A

F
at least 1 clinical and 1 lab criteria

If positive, must be repeated after 12 weeksT

29
Q

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

A

F- painless bleeding

30
Q

Why is completion cutterage avoided?

A

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

31
Q

How is cervical insufficiency diagnosed?

A

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

32
Q

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

A

Cervical cerclage

33
Q

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

A

McDonald’s Cerclage

Shirodkar Cerclage

34
Q

When is pessary used?

A

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

35
Q

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

A

F
- complete mole

35
Q

Appearance of H mole in ultrasound

A

Snowstorm appearance

36
Q

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

A

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

37
Q

Management for molar pregnancies

A

Molar evacuation via suction curettage

38
Q

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

A

6 months

39
Q

Median time for resolution
Partial moles:
Complete moles:

A

Partial moles: 7 weeks
Complete moles: 9 weeks

OBSTETRICS II (4 decks)

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