Abortion Flashcards
Question
Answer
Define abortion
a. less than 15 weeks
b. less than 20 weeks
c. less than 500g
d. less than 250g
b. or c.
Loss of a fetus less than 20 weeks age of gestation or a birthweight less than 500g
When do more than 80% of spontaneous abortion occur?
First 12 weeks
Fetal factors of abortion and which is more likely?
. Anembryonic
. Embryonic
Both are 50%
What is/are the anembryonic defect?
Blighted ovum; fertilized egg attaches to the uterine wall but does not develop
What is/are the embryonic defect?
. Aneuploid
. Euploid
Which embryonic defect has normal chromosomes?
Euploid
Aneuploid has chromosomal anomalies
Which trimester is aneuploid abortion most likely?
First trimester - 55%
2nd - 35%, 3rd 5%
Which parent is most likely to contribute to aneuploid abortion?
Maternal gametogenesis errors 95%
Paternal - 5%
What are the 5 types of aneuploid abortion? Which are the first most common and second most common?
. Autosomal trisomy - 1st mc
. Monosomy X (45, X) aka Turner Syndrome - 2nd mc
. Triploidy
. Tetraploid aboruses
. Chromosomal structural abnormalities
Which is the most likely cause of trisomy?
Isolated nondisjunction
Most common trisomy autosomes are?
13, 16, 18, 21, 22
When do most aneuploid abortions occur?
By 8 weeks - 75%
Which of the following is aborted later and when does it peak?
. Aneuploid
. Euploid
Euploid; peaks are 13 weeks
Which infections increases abortion?
. Chlamydia trachomatis . Polymicrobial infection fromperiodental disease . Mycoplasma . Ureaplasma . HIV
When does bacterial vaginosis cause abortion?
2nd trimester
When is the best time for operation for benign ovarian cyst? Why?
2nd trimester (14-16 weeks); placenta is already established
When is abdominal trauma most likely to cause miscariage? Earlier or later gestation
Advanced AOG
What are the the pathophysiological models of the immunoligical factors of abortion? Which is most potent?
. Autoimmune; antiphospholipid antibodies directed against binding proteins in plasma
. Alloimmunity; against another person
MOA of Mifepristone
a. acts on trophoblast and halts implantation
b. increases uterine contractility by reversing the progesterone-induced inhibition of contraction
c. increasing uterine contractility by stimulating the myometrium directly
b. increases uterine contractility by reversing the progesterone-induced inhibition of contraction
MOA of Misoprostol
a. acts on trophoblast and halts implantation
b. increases uterine contractility by reversing the progesterone-induced inhibition of contraction
c. increasing uterine contractility by stimulating the myometrium directly
c. increasing uterine contractility by stimulating the myometrium directly
MOA of Methotrexate
a. acts on trophoblast and halts implantation
b. increases uterine contractility by reversing the progesterone-induced inhibition of contraction
c. increasing uterine contractility by stimulating the myometrium directly
a. acts on trophoblast and halts implantation
What thyroid related lab result is a marker for increase of miscarriage?
high serum to level of Ab to thyroid peroxidase
This level of caffeine consumption is associatd with increased risk of miscarriage
a. 200 mg
b. 300 mg
c. 400 mg
d. 500 mg
d. 500 mg
200 mg is moderate
What environmental toxins are linked to miscarriage
. Bisphenol A
. Phthalates
. Polychlorinated byphenyls
. DDT
What serum progestorone concentrations suggest a dying pregnancy?
A. <5 ng/ml
b. <10 ng/ml
c. >15 ng/ml
d. > 20ng/ml
A. <5 ng/ml
What serum progestorone concentrations suggest a healthy pregnancy?
A. <5 ng/ml
b. <10 ng/ml
c. >15 ng/ml
d. > 20ng/ml
d. > 20ng/ml
What is the bhCG levels discriminatry for transvaginal sonography?
A. 1500
b. 3000
c. 4500
d. 6000
A. 1500
What is the bhCG levels discriminatry for transabdominal sonography?
A. 1500
b. 3000
c. 4500
d. 6000
d. 6000
What is yolk sac visible and diameter?
5.5 weeks w/ 10 mm
What is the management for incomplete abortion?
. acetaminophen-based analgesia . administration of broad spectrum . antibiotics . bed rest . curettage . expectant management . medical evacuation . misoprostol . observation . suction curretage . surgical or medical evactuation
. Curettage
. Misoprostol (oral)
. Expectant management
What is the management for threatened abortion?
. acetaminophen-based analgesia . administration of broad spectrum . antibiotics . bed rest . curettage . expectant management . medical evacuation . misoprostol . observation . suction curretage . surgical or medical evactuation
. Observation
. acetaminophen-based analgesia
. bed rest
What is the management for complete abortion?
. acetaminophen-based analgesia . administration of broad spectrum . antibiotics . bed rest . curettage . expectant management . medical evacuation . misoprostol . observation . suction curretage . surgical or medical evactuation
. observation
What is the management for missed abortion?
. acetaminophen-based analgesia . administration of broad spectrum . antibiotics . bed rest . curettage . expectant management . medical evacuation . misoprostol . observation . suction curretage . surgical or medical evactuation
. surgical or medical evactuation
. Misoprostol (vaginal)
. Observation
What is the management for inevitable abortion?
. acetaminophen-based analgesia . administration of broad spectrum . antibiotics . bed rest . curettage . expectant management . medical evacuation . misoprostol . observation . suction curretage . surgical or medical evactuation
. Curettage
What is the management for septic abortion?
. acetaminophen-based analgesia . administration of broad spectrum . antibiotics . bed rest . curettage . expectant management . medical evacuation . misoprostol . observation . suction curretage . surgical or medical evactuation
. suction curretage
. administration of broad spectrum antibiotic
What type of medicine id misoprostol? (letters)
Prostaglandin E1
What is the characteristic findings of complete abortion?
minimally thickened endometrium without a gestational sac
Complete gestation in complete abortion should be discerned from what 2?
Blood clots
Decidual cast
What is a decidual cast?
a layer of endometrium in the shape of the uterine cavity can appear as collapsed sac
When can fetal cardiac activity be detected?
6 to 6.5 weeks
What value difference of <5mm raises concern in missed abortion?
MSD (mean sac diameter) and CRL
In cases of suspected inevitable abortion what is the laboratory finding?
amnionic fluid will fern on a microscope slide or will have a pH of >7
What sonographic finding in suspected inevitable abortion?
oligohydramnios
What are biological causes of septic abortion?
. Group a streptococcus-S pyogenes
. Clostridium perigens
In recurrent miscarriagees are what the two most common chromosomal abnormalities?
- reciprocal translocation
2. robertsonian translocation
What are anatomical factors in recurrent miscarriage?
. Ascherman syndrom - uterine synechiae
. Uterine leiomyomas
. Congenital genital tract anamolies
What is the treatment for ascherman syndrome?
hysteroscopic adhesiolysis
What is antiphospholipid antibody syndrome?
defined by antiphospholipid antibodies in combination with barious forms of reprodutive loss and increased risks for venous thromboembolism
Cervical clerage is offered to women whose cervical length is
a. <15mm
b. <20mm
c. <25mm
d. <30mm
c. < 25mm
When is cervical cerclage often performed?
A. 8 - 12 weeks
b. 12 - 14 weeks
c. 15 - 18 weeks
d. 18 - 21 weeks
b. 12 - 14 weeks
When is vagical cerclage often performed?
A. 8 - 12 weeks
b. 12 - 14 weeks
c. 15 - 18 weeks
d. 18 - 21 weeks
c. 15 - 18 weeks
In surgical abortion, what is often used for cervical ripening?
A. antiprogestin mifepristone
b. hygroscopic dilators
c. dilapan-S
d. Misoprostol
d. Misoprostol
In suction curettage, what is swabbed on cervix?
Povidoneiodine
For pregnancies beyond 16 weeks what instrument is used?
sopher forceps
What drugs are used for medical abortion?
. Mifepristone + Misoprostol
or
. Misoprostol
