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Patho OB 2 > Abortion > Flashcards

Abortion Flashcards

1
Q

Question

A

Answer

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2
Q

Define abortion

a. less than 15 weeks
b. less than 20 weeks
c. less than 500g
d. less than 250g

A

b. or c.

Loss of a fetus less than 20 weeks age of gestation or a birthweight less than 500g

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3
Q

When do more than 80% of spontaneous abortion occur?

A

First 12 weeks

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4
Q

Fetal factors of abortion and which is more likely?

A

. Anembryonic
. Embryonic

Both are 50%

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5
Q

What is/are the anembryonic defect?

A

Blighted ovum; fertilized egg attaches to the uterine wall but does not develop

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6
Q

What is/are the embryonic defect?

A

. Aneuploid

. Euploid

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7
Q

Which embryonic defect has normal chromosomes?

A

Euploid

Aneuploid has chromosomal anomalies

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8
Q

Which trimester is aneuploid abortion most likely?

A

First trimester - 55%

2nd - 35%, 3rd 5%

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9
Q

Which parent is most likely to contribute to aneuploid abortion?

A

Maternal gametogenesis errors 95%

Paternal - 5%

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10
Q

What are the 5 types of aneuploid abortion? Which are the first most common and second most common?

A

. Autosomal trisomy - 1st mc
. Monosomy X (45, X) aka Turner Syndrome - 2nd mc

. Triploidy
. Tetraploid aboruses
. Chromosomal structural abnormalities

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11
Q

Which is the most likely cause of trisomy?

A

Isolated nondisjunction

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12
Q

Most common trisomy autosomes are?

A

13, 16, 18, 21, 22

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13
Q

When do most aneuploid abortions occur?

A

By 8 weeks - 75%

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14
Q

Which of the following is aborted later and when does it peak?

. Aneuploid
. Euploid

A

Euploid; peaks are 13 weeks

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15
Q

Which infections increases abortion?

A 
. Chlamydia trachomatis
. Polymicrobial infection fromperiodental disease
. Mycoplasma
. Ureaplasma
. HIV
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16
Q

When does bacterial vaginosis cause abortion?

A

2nd trimester

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17
Q

When is the best time for operation for benign ovarian cyst? Why?

A

2nd trimester (14-16 weeks); placenta is already established

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18
Q

When is abdominal trauma most likely to cause miscariage? Earlier or later gestation

A

Advanced AOG

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19
Q

What are the the pathophysiological models of the immunoligical factors of abortion? Which is most potent?

A

. Autoimmune; antiphospholipid antibodies directed against binding proteins in plasma

. Alloimmunity; against another person

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20
Q

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

A

b. increases uterine contractility by reversing the progesterone-induced inhibition of contraction

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21
Q

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

A

c. increasing uterine contractility by stimulating the myometrium directly

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22
Q

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

a. acts on trophoblast and halts implantation

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23
Q

What thyroid related lab result is a marker for increase of miscarriage?

A

high serum to level of Ab to thyroid peroxidase

24
Q

This level of caffeine consumption is associatd with increased risk of miscarriage

a. 200 mg
b. 300 mg
c. 400 mg
d. 500 mg

A

d. 500 mg

200 mg is moderate

25
Q

What environmental toxins are linked to miscarriage

A

. Bisphenol A
. Phthalates
. Polychlorinated byphenyls
. DDT

26
Q

What serum progestorone concentrations suggest a dying pregnancy?

A. <5 ng/ml

b. <10 ng/ml
c. >15 ng/ml
d. > 20ng/ml

A

A. <5 ng/ml

27
Q

What serum progestorone concentrations suggest a healthy pregnancy?

A. <5 ng/ml

b. <10 ng/ml
c. >15 ng/ml
d. > 20ng/ml

A

d. > 20ng/ml

28
Q

What is the bhCG levels discriminatry for transvaginal sonography?

A. 1500

b. 3000
c. 4500
d. 6000

A

A. 1500

29
Q

What is the bhCG levels discriminatry for transabdominal sonography?

A. 1500

b. 3000
c. 4500
d. 6000

A

d. 6000

30
Q

What is yolk sac visible and diameter?

A

5.5 weeks w/ 10 mm

31
Q

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
A

. Curettage
. Misoprostol (oral)
. Expectant management

32
Q

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
A

. Observation
. acetaminophen-based analgesia
. bed rest

33
Q

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
A

. observation

34
Q

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
A

. surgical or medical evactuation
. Misoprostol (vaginal)
. Observation

35
Q

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
A

. Curettage

36
Q

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
A

. suction curretage

. administration of broad spectrum antibiotic

37
Q

What type of medicine id misoprostol? (letters)

A

Prostaglandin E1

38
Q

What is the characteristic findings of complete abortion?

A

minimally thickened endometrium without a gestational sac

39
Q

Complete gestation in complete abortion should be discerned from what 2?

A

Blood clots

Decidual cast

40
Q

What is a decidual cast?

A

a layer of endometrium in the shape of the uterine cavity can appear as collapsed sac

41
Q

When can fetal cardiac activity be detected?

A

6 to 6.5 weeks

42
Q

What value difference of <5mm raises concern in missed abortion?

A

MSD (mean sac diameter) and CRL

43
Q

In cases of suspected inevitable abortion what is the laboratory finding?

A

amnionic fluid will fern on a microscope slide or will have a pH of >7

44
Q

What sonographic finding in suspected inevitable abortion?

A

oligohydramnios

45
Q

What are biological causes of septic abortion?

A

. Group a streptococcus-S pyogenes

. Clostridium perigens

46
Q

In recurrent miscarriagees are what the two most common chromosomal abnormalities?

A
  1. reciprocal translocation

2. robertsonian translocation

47
Q

What are anatomical factors in recurrent miscarriage?

A

. Ascherman syndrom - uterine synechiae
. Uterine leiomyomas
. Congenital genital tract anamolies

48
Q

What is the treatment for ascherman syndrome?

A

hysteroscopic adhesiolysis

49
Q

What is antiphospholipid antibody syndrome?

A

defined by antiphospholipid antibodies in combination with barious forms of reprodutive loss and increased risks for venous thromboembolism

50
Q

Cervical clerage is offered to women whose cervical length is

a. <15mm
b. <20mm
c. <25mm
d. <30mm

A

c. < 25mm

51
Q

When is cervical cerclage often performed?

A. 8 - 12 weeks

b. 12 - 14 weeks
c. 15 - 18 weeks
d. 18 - 21 weeks

A

b. 12 - 14 weeks

52
Q

When is vagical cerclage often performed?

A. 8 - 12 weeks

b. 12 - 14 weeks
c. 15 - 18 weeks
d. 18 - 21 weeks

A

c. 15 - 18 weeks

53
Q

In surgical abortion, what is often used for cervical ripening?

A. antiprogestin mifepristone

b. hygroscopic dilators
c. dilapan-S
d. Misoprostol

A

d. Misoprostol

54
Q

In suction curettage, what is swabbed on cervix?

A

Povidoneiodine

55
Q

For pregnancies beyond 16 weeks what instrument is used?

A

sopher forceps

56
Q

What drugs are used for medical abortion?

A

. Mifepristone + Misoprostol

or

. Misoprostol

Patho OB 2 (10 decks)

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