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Obstetrics and Gynecology > Abortion > Flashcards

Abortion Flashcards

1
Q

Spontaneous or induced termination of pregnancy before fetal viability

A

Abortion

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2
Q

Pregnancy termination before 20 weeks gestation

With a fetus born weighing <500 g (520)

A

Abortion

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3
Q

Distiguishes between clinical vs chemical pregnancy

A

UTZ

B HCG

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4
Q

Presumptive signs and symptoms of pregnancy and with evidence of ultrasound

A

Clinical abortion

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5
Q

Pregnancy test is +
Patient will bleed
Will turn out pregnancy test -
Very early pregnancy losses

A

Chemical abortion

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6
Q

Pregnancy wherein you have signs of pregnancy and + pregnancy test but when UTZ is done, no intrauterine or extrauterine pregnancy is identified

SERIAL B HCG and UTZ

A

Pregnancy of unknown location

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7
Q

First trimester abortions more common
Within the first 12 weeks (First Trimester)

80% spontaneous

Death of embryo precedes the expulsion
Death is accompanied by hemorrhage in decidua basalis followed by adjacent tissue necrosis stimulating uterine contractions and expulsion

A

Early abortion

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8
Q

Abortion after 12 weeks (Post First trimester)

Fetus is expelled alive / fetus does not die before expulsion

A

Late abortion

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9
Q

Early abortions

subdivided:

A

Embryonic 50% - developmental abnormality of zygote, embryo, fetus or placenta
Anembryonic (blighted ovum) 50%

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10
Q

Half of emrbyonic early abortions are

A

Euploid

Aneuploid

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11
Q

Most common aneuploidy (22-32)

A

Autosomal trisomy
Down syndrome

From isolated nondysjunction

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12
Q

Single most frequent specific chromosomal abnormality

A

Monosomy

45 XO Turner

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13
Q

Aneuploid abortion in third trimester

A

Still birth
Because fetus is already big
Abortion rates and chromosomal anomalies decrease with advancing gestational age

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14
Q

Contain normal chromosomal complement
Late abortions
Peaks at 13 weeks or immediately after 1st trimester

Incidence increases dramatically after maternal age exceeds 35 years

A

Euploid abortion

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15
Q

Maternal factors that cause Euploid abortion in late first tri

A 
Infections
Medical disorders
Cancer treatment
Uncontrolled DM
Thyroid disorders
Immunologic factors
Surgical procedures 
Nutrition
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16
Q

Infection found to be present in 4% abortuses

A

Chlamydia trachomatis

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17
Q

Linked to 2-4 fold increase risk for abortions

A

Polymicrobial infection from periodontal disease

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18
Q

Infection with an association between 2nd trimester but not 1st

A

Bacterial vaginosis

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19
Q

Medical disorder that causes recurrent abortions and male and female infertility

A

Celiac disease

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20
Q

Medical conditions that increase risk for abortion

A

Unrepaired cyanotic heart disease
Inflammatory bowel disease
SLE

Women vascular disease who have miscarriages are more likely to suffer MI

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21
Q

Has effect on subfertility, preterm delivery, fetal growth restriction

A

Eating disorder

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22
Q

Does not confer significant risk for abortion

A

Chronic hypertension

23
Q

Increased risk for septic abortion

A

IUD

24
Q

Uncontrolled DM increases risk for

A

Spontaneous abortion
Major congenital malformations
Recurrent or repetitive abortion (overt DM within first tri)

25
Q

Associated with recurrent abortion

A 
Thyroid disorders
Severe iodine deficiency
Overt hypothyroidism
Uncontrolled DM 
Hashimoto’s thyroiditis
26
Q

Marker for increased miscarriage

A

Abnormally high serum antibodies to thyroid peroxidase TPO

Antibodies to thyroglobulin

27
Q

Most potent immune-mediated disorder directed against binding proteins in plasma

Associated with repetitive, recurrent miscarriage

Treat with aspirin

A

Anti-phospholipid Antibody Syndrome APAS

28
Q

Surgical procedures that induce abortion

A

Manipulation of female genitalia in removal of ovarian cyst
Early removal of corpus luteum or ovary
<10 weeks AOG give progesterone
Abdominal trauma

29
Q

Uncontested risk factor for abortion and subfertility

A

Obesity

30
Q

Alcohol and abortion

A

Increased only if regular and heavy consumption

Low does not but causes fetal malformations

31
Q

Cigarettes and abortion

A

Increase

32
Q

Excessive caffeine consumption

A

Increase
5 cups/day 500 mg caffeine
<200 mg does not

33
Q 
Arsenic
Lead
Formaldehyde
Benzene
Ethylene oxide
DDT-containing insecticides 
Cytotoxic antineoplastic chemotherapeutic agents
A

Increase risk

34
Q

Thrombophilia and abortion

A

No r

35
Q

Uterine defects and abortikn

A

Early and late recurrent abortions

36
Q

Bloody vaginal discharge + closed cervical os during the first 20 weeks

Bleeding
cramping abdominal pain

Tx

A

Threatened abortion

Tocolytics
Isoxuprine, Progesterone to resolve contraction
Bed rest

37
Q

Gross rupture of membrane + Cervical dilatation

Uterine contraction or infection

Tx

A

Inevitable abortion

Expectant

If without fever, pain, bleeding or amniotic fluid escape, ambulation and pelvic rest.

38
Q

Passage of meaty tissues

Partial or complete placental separation + dilatation of cervical os + bleeding

Before 10 weeks expelled together

Tx

A

Incomplete abortion

Complete curettage

39
Q

History of passage of meaty tissues
Expulsion of entire pregnancy + CLOSED cervix upon examination

> 20 weeks gestation

Tx

A

Complete abortion

Expectant

40
Q

On UTZ a complete abortion will look

A

Minimally thickened endometrium without a gestational sac

41
Q

Dead products of conception that were retained for days to months in the uterus with a closed cervical os

Tx

A

Missed abortion
Early pregnancy loss
Early fetal wastage

Suction Curettage

42
Q

Early pregnancy loss or wastage with mean death-to-abortion interval of 6 weeks

A

Current missed abortion

43
Q

Results from women with threated or incomplete abortion develop a pelvic infection or sepsis syn

Tx

A

Septic abortion

Bacteria gain uterine entry from a premature rupture usually due to non-sterile instruments -> colonized dead products -> invade myometrium -> parametritis -> peritonitis -> septicemia -> endocarditis -> severe sepsis syndrome with ARDS, AKI, DIC

Broad-spectrum antibiotics and curettage
If no response remove whole organ

44
Q

> /= 3 consecutive pregnancy losses at = 20 weeks or with a fetal weight <500

It has to be consecutive

A

Recurrent miscarriage

Recurrent spontaneous abortion

45
Q

Causes of recurrent abortion

A

Parental chromosomal abnormality (2-4%)
Anatomical factors - acquired or congenital
Immunologic factors
Endocrine factors (8-12) - progestone deficiency caused by luteal-phase defect and polycystic ovarian syndrome
Timing - early embryonic loss
Autoimmune or anatomic abnormalities - 2nd trimester

46
Q

Can cause recurrent miscarriage because it impinges upon the uterine cavity causing contractions and early abortion

A

Submucous myoma

47
Q

History of previous dilatation and curettage

Limited uterine cavity causing the recurrent miscarriage

A

Synechiae

48
Q

Destruction of large areas of endometrium

Follow uterine curettage or ablative procedure

Treatment directed hysteroscopic lysis of adehsions

A

Asherman syndrome

49
Q

Uterine anomalies causing miscarriage

A 
Didelphys
Bicornuate uterus
Septate uterus (congenital)
50
Q

Painless cervical dilatation in second trimester

Followed by prolapse and ballooning of membranes into the vagina and ultimately expulsion of immature fetus

When pregnancy becomes heavy, the tendency of the cervix is to open, at 16-22 weeks and usually happens in cases of recurrent abortion

A

Cervical insufficiency

51
Q

Cervical insufficiency Dx

And look for

A

TVS at 14 weeks or earlier

Funneling
Cervical length shorter than 2.5cm

52
Q

Ballooning of the membranes into a dilated internal cervical os, but with a closed external os

A

Funneling

53
Q

Risk factors for cervical insufficiency

A

History of D&C
Conization
Cauterization
Amputation

54
Q

surgically reinforces weak cervix by suturing (purse-string)

A

Cerclage

Elective - 12-14 weeks if previously diagnosed with insufficiency

Emergent - 20 weeks with cervical dilatation and bag of water already prolapsing

Obstetrics and Gynecology (18 decks)

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