Abortion Flashcards
Symptoms of hematometra
Cyclic midline abdominal cramping pain
What are structural causes of miscarriage?
Septate or bicornuate uterus
Early pregnancy loss is associated with which systemic diseases?
Diabetes; chronic renal disease; lupus
Early pregnancy loss is associated with what lifestyle aspects?
Smoking, alcohol, caffeine
Not vigorous exercise
What should be done for a patient with early pregnancy loss?
Hemodynamically stable: Observation (up to 8 weeks); misoprostol (800 mcg intravaginal); D&C
Unstable: Dilation and suction curettage (to get rid of conception products)
What should patients expect with misoprostol for miscarriage?
Heavy bleeding
Severe cramping
Should be prescribed pain medication
What to do for patient with recurrent pregnancy loss with dilated cervix?
This is cervical insufficiency: Place cervical cerclage at 14 weeks (after fetal anatomic survey and aneuploidy testing rule minimize risk of miscarriage)
What are main causes of pregnancy loss in 2nd trimester?
Uterine - cervical length US
Environmental
How to assess for chromosome abnormalities causing recurrent 1st trimester loss?
Parental karyotype analysis
What is anti-mullerian hormone tested for?
Ovarian function - considered during infertility evaluation
Risk factors for molar pregnancy
Asian (1/800 vs 1/1,500-2,000)
Age <20 or >40
Deficient beta-carotene or folic acid
2+ miscarriages
Symptoms of molar pregnancy
Vaginal bleeding
Abnormally high b-hCG
Complete mole: Multiple hydropic villi (cystic areas within placenta)
What is workup for molar pregnancies?
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)
What is standard treatment for molar pregnancies?
Suction curettage
Methotrexate if patient develops post-molar GTD
What aspects of molar pregnancy increase risk of persisting, post-molar GTD?
Large uterus, high b-hCG, theca lutein cysts (from high b-hCG)
Methotrexate can be given prophylactically in face of these signs
How is choriocarcinoma diagnosed?
Persistent b-hCG (should be 0 by 3 months postpartum) with recent pregnancy
DO NOT biopsy as it is vascular
What is post-evacuation management for patient with molar pregnancy?
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
Hydropic, grape-like villi through cervical os means what?
Molar pregnancy (pathognomonic)
Symptoms of septic abortion
Fever
Bleeding with dilated cervix
Treatment for septic abortion
Broad-spectrum antibiotics
Uterine evacuation
Symptoms of threatened abortion
Bleeding with closed or uneffaced cervical os
What is a missed abortion?
Retention of nonviable intrauterine pregnancy for extended period of time (i.e. embryonic demise)
What is an anembryonic pregnancy?
Gestational sac forms but no embryo forms
Beta-hCG is produced
What order should medications for abortion be given?
Mifepristone (anti-progestin) followed by misoprostol (prostaglandin) to induce uterine contractions to expel products
Associated with greater blood loss
Up to what age is medical abortion permitted?
Preferably <7 wga, up to 9-10 wga
Up to what gestational age is vacuum aspiration permitted?
<8 wga
What gestational age is dilation and curettage used for abortion?
1st trimester
If medical abortion causes excessive bleeding and retained products of conception, what next?
Dilation and curettage
What gestational age is dilation and evacuation used for abortion?
2nd trimester
Prepare cervix with laminaria the night before
Safe but most common complications are retained product or blood clot, infection, and cervical lacerations
When is emergency contraceptive taken?
Levonorgestrel (Plan B): within 72h
Ulipristal: within 5d
What effect does emergency contraception have on next menstrual cycle?
Earlier or later with lighter, normal, or heavier bleeding
How would you distinguish between an ectopic pregnancy and a nonviable intrauterine pregnancy when ultrasound does not reveal and bhCG does not riske >=35%?
Dilation and curettage: if bhCG continues to rise, it is ectopic pregnancy; if not, then it was nonviable intrauterine pregnancy now cleared
