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OB/GYN > Abortion > Flashcards

Abortion Flashcards

1
Q

Symptoms of hematometra

A

Cyclic midline abdominal cramping pain

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2
Q

What are structural causes of miscarriage?

A

Septate or bicornuate uterus

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3
Q

Early pregnancy loss is associated with which systemic diseases?

A

Diabetes; chronic renal disease; lupus

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4
Q

Early pregnancy loss is associated with what lifestyle aspects?

A

Smoking, alcohol, caffeine

Not vigorous exercise

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5
Q

What should be done for a patient with early pregnancy loss?

A

Hemodynamically stable: Observation (up to 8 weeks); misoprostol (800 mcg intravaginal); D&C

Unstable: Dilation and suction curettage (to get rid of conception products)

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6
Q

What should patients expect with misoprostol for miscarriage?

A

Heavy bleeding
Severe cramping

Should be prescribed pain medication

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7
Q

What to do for patient with recurrent pregnancy loss with dilated cervix?

A

This is cervical insufficiency: Place cervical cerclage at 14 weeks (after fetal anatomic survey and aneuploidy testing rule minimize risk of miscarriage)

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8
Q

What are main causes of pregnancy loss in 2nd trimester?

A

Uterine - cervical length US
Environmental

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9
Q

How to assess for chromosome abnormalities causing recurrent 1st trimester loss?

A

Parental karyotype analysis

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10
Q

What is anti-mullerian hormone tested for?

A

Ovarian function - considered during infertility evaluation

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11
Q

Risk factors for molar pregnancy

A

Asian (1/800 vs 1/1,500-2,000)
Age <20 or >40
Deficient beta-carotene or folic acid
2+ miscarriages

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12
Q

Symptoms of molar pregnancy

A

Vaginal bleeding
Abnormally high b-hCG
Complete mole: Multiple hydropic villi (cystic areas within placenta)

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13
Q

What is workup for molar pregnancies?

A

Chest X-ray to rule out pulmonary metastases
Liver enzymes
Thyroid function tests (to make sure not hyperthyroid (bhCG alpha subunit identical to LH and TSH) and at risk for thyroid storm before general anesthesia for curettage)

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14
Q

What is standard treatment for molar pregnancies?

A

Suction curettage

Methotrexate if patient develops post-molar GTD

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15
Q

What aspects of molar pregnancy increase risk of persisting, post-molar GTD?

A

Large uterus, high b-hCG, theca lutein cysts (from high b-hCG)

Methotrexate can be given prophylactically in face of these signs

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16
Q

How is choriocarcinoma diagnosed?

A

Persistent b-hCG (should be 0 by 3 months postpartum) with recent pregnancy

DO NOT biopsy as it is vascular

17
Q

What is post-evacuation management for patient with molar pregnancy?

A

Follow b-hCG to zero - 6 months advised prior to renewed attempts for conception
Effective contraception advised to avoid misinterpreting subsequent rise in hCG as persistent neoplasm
If rise starts, repeat bhCG againin 48h to track levels and determine when US may determine/rule out new intrauterine pregnancy

18
Q

Hydropic, grape-like villi through cervical os means what?

A

Molar pregnancy (pathognomonic)

19
Q

Symptoms of septic abortion

A

Fever
Bleeding with dilated cervix

20
Q

Treatment for septic abortion

A

Broad-spectrum antibiotics
Uterine evacuation

21
Q

Symptoms of threatened abortion

A

Bleeding with closed or uneffaced cervical os

22
Q

What is a missed abortion?

A

Retention of nonviable intrauterine pregnancy for extended period of time (i.e. embryonic demise)

23
Q

What is an anembryonic pregnancy?

A

Gestational sac forms but no embryo forms
Beta-hCG is produced

24
Q

What order should medications for abortion be given?

A

Mifepristone (anti-progestin) followed by misoprostol (prostaglandin) to induce uterine contractions to expel products

Associated with greater blood loss

25
Q

Up to what age is medical abortion permitted?

A

Preferably <7 wga, up to 9-10 wga

26
Q

Up to what gestational age is vacuum aspiration permitted?

A

<8 wga

27
Q

What gestational age is dilation and curettage used for abortion?

A

1st trimester

28
Q

If medical abortion causes excessive bleeding and retained products of conception, what next?

A

Dilation and curettage

29
Q

What gestational age is dilation and evacuation used for abortion?

A

2nd trimester

Prepare cervix with laminaria the night before

Safe but most common complications are retained product or blood clot, infection, and cervical lacerations

30
Q

When is emergency contraceptive taken?

A

Levonorgestrel (Plan B): within 72h
Ulipristal: within 5d

31
Q

What effect does emergency contraception have on next menstrual cycle?

A

Earlier or later with lighter, normal, or heavier bleeding

32
Q

How would you distinguish between an ectopic pregnancy and a nonviable intrauterine pregnancy when ultrasound does not reveal and bhCG does not riske >=35%?

A

Dilation and curettage: if bhCG continues to rise, it is ectopic pregnancy; if not, then it was nonviable intrauterine pregnancy now cleared

OB/GYN (29 decks)

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