4.3.3 Reproductive Issues in Pregnancy

Question 1

How to make a diagnosis of EPL?

Answer 1

MUST KNOW THIS

Question 2

WHAT CAUSES EPL?

Answer 2

DUE TO CHROMOSOMAL ABNORMALITIES

Question 3

What is the mechanism of Misoprostol?

Answer 3

Prostaglandin E1 analong and induces uterine contractions

Question 4

For a patient desiring a medical abortion, which of the following regimens are recommended?

Answer 4

Mifepristone followed by misoprostol

Question 5

What are the clinical stages of EPL?

Answer 5

Complete Ab: spontaneous expulsion fetal and placental tissue from ut cavity

Incomplete Ab: passage of some fetal/placental tissue through cervix

Inevitable Ab: ut bleeding; with cx dilation but no passage tissue

16-25% recognized IUP’s have early vaginal bleeding

up to half have spontaneous abortion

**DIAGNOSIS DEPENDS ON PHYSICAL EXAM, SO DON’T FORGET TO DO THAT!!!!

Question 6

A 30 year old is found to have an embryonic demise on ultrasound. She asks what the reason for the miscarriage is. You tell her that the most common cause of miscarriage is:

Answer 6

Genetic abnormalities

Question 7

What are the characteristics of recurrent pregnancy loss?

Answer 7

Question 8

What is the presentation of EPL?

Answer 8

Urgent - Vaginal bleeding and abdominal pain, passing tissue, loss of pregnancy related symptoms

Question 9

Which of the following is a potential consequence of unsafe abortion?

Answer 9

Maternal death

Question 10

What is the normal process of implantation?

Answer 10

Blastocyst implants 6-12 days after ovulation à synctiotrophoblasts produce HCG. When implantation happens, then you can detect HCG

Implantation: 5-7 days after fertilization

Takes ~72 hours

Invasion of trophoblast into decidua

Embryonic disc: 1 wk post-implantation

If no embryonic disc, trophoblast still grows, but no embryo

Embryonic discàembryonic/fetal pole

Cardiac activity when pole>=5mm

Question 11

What is early pregnancy loss?

Answer 11

Question 12

Which of the following is the most common location for an ectopic pregnancy?

Answer 12

The tube

Question 13

What is the best evaluation for ectopic pregnancy?

Answer 13

Ultrasound and hCG

Question 14

Mifepristone functions by

Answer 14

Sensitizing the uterus to prostaglandins

Question 15

How to diagnose pregnancy?

Answer 15

Question 16

A 24 year old presents with vaginal bleeding and pelvic pain. One week ago, she had an ultrasound that showed an intrauterine pregnancy. On exam, the cervix is dilated and products of conception are noted in the cervical os. Which of the following best describes this patient’s diagnosis?

Answer 16

An incomplete abortion

Question 17

What is uterine aspiration?

Answer 17