2T Abortions (12-20 wk GA)

Question 1

When is a D&E usually performed? Advantages? Disadvantages?

Answer 1

16-24 wks.

Procedure is faster than IOL.

However, needs aggressive dilation with laminaria and there is risk of uterine perforation and cervical lacerations

Question 2

Pre-term Labor (PTL) v. Incompetent Cervix

Answer 2

PTL: contractions leading to cervical change

Incompetent cervix: painless dilation of cervix.

Question 3

Incompetent cervix risk factors

Answer 3

cervical trauma/lacerations with vaginal delivery
DES exposure
surgery (cone biopsy, cervical dilation)
Uterine anomalies

Question 4

Tx Incompetent Cervix. When?

Answer 4

Elective Cerclage at 12-14 wk GA and maintained til 36-38 wks if at all possible.