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Abortion Flashcards

1
Q

What is Abortion?

A

Preg loss before 20 weeks of pregnancy or before wt of fetus is 500 g

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2
Q

What is Recurrent abortion?

A

Conventional: >=3 abortions
ACC to ASRM: Occurence of 2 or more consecutive losses of recognised pregnancies by USG or HPE before 20 weeks

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3
Q

M/C risk factors for abortions

A
  1. Inc in maternal age
  2. Previous H/O abortion
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4
Q

Four established causes of RPL

A
  1. APLA syndrome
  2. Uterine structural abnormalities
  3. Chromosomal abnormalities
  4. Hypothyroidism
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5
Q

What are the uterine structural abnormalities resp for RPL?

A
  1. Congenital: Septate uterus
  2. Acquired: Cervical incompetence, fibroid, polyp
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6
Q

What is the M/C chromosomal abnormalities?

A

Balance translocation of chromosomes

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7
Q

Investigations for RPL

A
  1. Ultrasound uterus (TVS)
  2. APLA antibodies
  3. Parental karyotype
  4. TSH
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8
Q

M/C group causing RPL

A

Endocrine causes > Uterine causes

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9
Q

Types of Abortion

A
  1. Incomplete abortion
  2. Complete abortion
  3. Inevitable abortion
  4. Threatened abortion
  5. Missed abortion
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10
Q

What is Threatened abortion?

A

Process of abortion begins but is at a stage from where it can be reversed
Os: Closed, no h/o expulsion of POC

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11
Q

Management of Threatened abortion

A

Expectant management

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12
Q

What is Inevitable abortion?

A

Process of abortion can’t be reversed
Os: Open, no POC coming out

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13
Q

Management of Inevitable abortion

A

Emergency suction evacuation if bleeding is heavy to prevent further blood loss and anemia
Otherwise, consecutive management awaiting spontaneous completed abortion

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14
Q

What is Incomplete abortion?

A

POC starts coming out but process is incomplete

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15
Q

Management of Incomplete abortion

A

Emergency suction evacuation

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16
Q

What is Complete abortion?

A

Entire POC comes out spontaneously

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17
Q

Management of Complete abortion

A

Conservative if an intrauterine pregnancy had been previously confirmed
Otherwise, serial beta- HCG titres obtained weekly until -ve to ensure an ectopic pregnancy has not been missed

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18
Q

What is Missed abortion?

A

US based diagnosis:
1. If MSD >=25 mm and CRL cannot be measured OR
2. If CRL is >=7 mm and fetal cardiac activity cannot be detected OR
3. If cardiac activity was present earlier and then disappears

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19
Q

What is Cervical incompetence?

A

Spontaneous dilatation of cervix (int os) d/t shortening of cervix

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20
Q

Patient with cervical insufficiency presents with

A

H/o painless recurrent T2 abortions

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21
Q

History based diagnosis of Cervical insufficiency

A

> =2 abortions of second trimester (painless): Confirm cervical insufficiency (No need to measure cervical length)

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22
Q

USG based diagnosis of Cervical insufficiency

A

H/o one second trimester abortion + TVS done in present pregnancy shows length of cervix <=2.5 cm

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23
Q

Cervical insufficiency on TVS

A

Length of cervix: <=2.5 cm
Shape of cervix: U shaped

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24
Q

Management of Cervical insufficiency

A
  1. Cervical cerclage
  2. Progesterone
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25
If pregnant woman has previous 2 T2 abortions, what is the next step?
USG not required Mx: Cervical cerclage+Progesterone
26
If pregnant woman has h/o 1 T2 abortion, what is the next step?
Measure cervical length: 1. <=2.5 cm: Cervical cerclage+Progesterone 2. >2.5 cm: Only progesterone
27
If pregnant woman has no h/o T2 abortion but cervical length is <=2.5 cm, what is the next step?
Progesterone
28
Cervical cerclage in Pregnant women
Can be done: 1. Tranvaginally: > McDonald cerclage >Shirodkar cerclage >Wurms cerclage 2. Transabdominally: >Benson and Durfee cerclage
29
Cervical cerclage in Non pregnant women
1. Vaginally: LASH and LASH procedure 2. Abdominally: Laparoscopic cerclage
30
What is McDonald cerclage?
Purse string sutures applied on portiovaginalis Suture: Nonabsorbable monofilament
31
Time at which McDonald cerclage is done
Time: 14-16 weeks 1. Earliest: By 12 weeks 2. Maximum: By 24 weeks
32
Contraindications for cerclage
1. Ruptured membranes (Chorioamnionitis) 2. Bleeding 3. Uterine contractions 4. Fetal demise/gross congenital anomalies 5. Current pelvic infection 6. Cervix dilated >=3 cm
33
Relative C/I for cerclage
Placenta previa
34
Time to remove stitch in McDonald cerclage
37 weeks
35
What is Wurms cerclage?
Transvaginal emergency cerclage where 2 stitches are applied anteroposteriorly
36
What is Benson and Durfee cerclage?
Transabdominal cerclage done laparoscopically Can be done before or after pregnancy
37
Indication of Benson and Durfee cerclage
Failed transvaginal cerclage
38
Drawback of Benson and Durfee cerclage
Suture has to be removed transabdominally (Suture should be removed only after female has completed her family)
39
Delivery should be done by _________ in Transabdominal cervical cerclage
Cesarean section
40
What is LASH and LASH procedure?
Here defective cervix is removed surgically Patient advised to give gap of 3 months before conceiving
41
Fetus delivered by _________ in LASH and LASH procedure
Cesarean section
42
LASH and LASH procedure not done d/t
Inc in complications
43
Antibodies present in APLA
1. Lupus anticoagulant 2. Anti Cardiolipin antibody (IgM, IgG) 3. Anti B2 glycoprotein (IgM, IgG) Cause of abortion: Inhibits trophoblast function
44
Diagnostic criteria for APLA
Modified Sapporo criteria/SYDNEY criteria: 1 clinical+1 lab criteria for diagnosis Clinical: 1. >=1 episode of thrombosis (Arterial/venous/small vessel) 2. >=3 fetal loss at <10 weeks 3. >=1 fetal loss >=10 weeks 4. >=1 preterm delivery before 32 weeks d/t severe pre-eclampsia or uteroplacental insufficiency Lab: Any one of 3 antibodies positive on 2 occasions at least 12 weeks apart
45
M/C single cause of recurrent abortions
APLA syndrome
46
Obstetric APLA (Recent update)
1. >=3 consecutive abortions at <10 weeks or early fetal death at 10-15 weeks (+6 days) 2. >=1 fetal death >=16 weeks to 34 weeks (No pre-eclampsia or uteroplacental insufficiency) 3. Pre-eclampsia with severe features at <34 weeks (With/without fetal death) 4. Uteroplacental insufficiency with severe features at <34 weeks (With/without fetal death)
47
Management if APS present without thrombotic event and without pregnancy loss
Aspirin only
48
Management if APS present with thrombotic event or with pregnancy loss
LMWH+Aspirin
49
Intrapartum management of APLA syndrome
Stop anticoagulation
50
Postpartum management of APLA syndrome
Resume or start anticoagulants in 6 hours (After vaginal delivery) or 12 hours (After CS)
51
When should Aspirin be started?
As soon as pregnancy is diagnosed
52
When should LMWH be started?
Should be started once intrauterine pregnancy is confirmed
53
MTP can be done until
24 weeks
54
In cases of contraceptive failure, MTP can be done by
Till 20 weeks only
55
In severe congenital anomalies of fetus, MTP can be done by
No upper limit (If medical board permits)
56
Medical board consists of
1. Gynaecologist 2. Radiologist 3. Paediatrician 4. Govt officer appointed
57
Qualification to do MTP till 12 weeks
RMP who has assisted in 25 MTPs (At least 5 should be as primary surgeon)
58
Qualifications to do MTP between 12-20 weeks
1. RMP with 6 months of house job in Obs gynae or RMP with 1 year of experience in any hospital with all facilities 2. Diploma/Degree/DNB in Obs gynae
59
Requirements for MTP
1. Female’s consent needed 2. In minor/mentally retarded pts: Guardian consent needed 3. Age proof not needed 4. Marriage certificate: Not needed 5. FIR report of rape: Not needed 6. All records of MTP should be maintained for 5 years
60
Best method of MTP at <9 weeks of GA
Medical abortion
61
Best method of MTP at 9-12 weeks of GA
Suction evacuation
62
Best method of MTP at >=12 weeks of GA
Abortion using Misoprost (In patient)
63
Methods to do MTP in T1
Mnemonic: MSM 1. Medical abortion (OPD basis) 2. Suction evacuation 3. Manual vacuum aspiration (MVA)
64
Methods to do MTP at T2
Mnemonic: MSDH 1. Medical abortion (In patient): Using Misoprost (Best method), extra-amniotic ethacrine, intraamniotic saline or oxytocin 2. Suction evacuation 3. Dilatation and evacuation (Ovum forceps) 4. Hysterotomy
65
What is Suction evacuation?
Procedure to remove POC from uterus using -ve pressure (vacuum)
66
Indications of Suction evacuation
1. Missed abortion 2. Incomplete abortion 3.MTP (up to 12 weeks GA) 4. Hydatiform mole evacuation
67
Suction evacuation done using
Karman cannula+Suction machine
68
Pressure generated with Suction machine
600 mmHg
69
No of Karman cannula corresponds to
Size of uterus (Corresponding to GA or 1 week less)
70
Manual vacuum aspiration done in which condition?
In areas where electricity is not available
71
MVA done using
MVA syringe (2 pinch valves)
72
Capacity of MVA syringe
60 mL
73
Pressure generated in MVA syringe
660>600 mmHg
74
Menstrual regulation syringe (Study)
1 pinch valve or now no valve 50 mL syringe
75
Medical abortion approved till
9 weeks (Indian govt/WHO)
76
Day 1 of Medical abortion
Mifepristone 200 mg single dose orally
77
Day 3 of Medical abortion
Misoprost 800 mcg orally/sublingually/per vaginally Within 24 hours: Abortion (Bleeding)
78
If uterine perforation happens during suction evacuation
D/t Hegar’s dilators: Stop procedure; monitor vitals D/t Karman cannula: Stop procedure; do not take cannula; immediate laparotomy

Obstetrics And Gynaecology (10 decks)

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