Abortion, Ectopic Pregnancy, and Molar Pregnancy

Question 1

What are different types of abortion?

Answer 1

Elective
Indicated (not fully formed fetus)
Spontaneous

Question 2

Indications for abortion

Answer 2

maternal- serious systemic disease

fetal- fatal genetic abnormality, life threatening structural abnormality

Question 3

Techniques for 1st trimester abortions

Answer 3

medical- mifepristone plus misoprstol (advantages- privacy, less expensive, less invasive; cons- hemorrhage, incomplete abortion)

suction curettage (advantages- definative time=30 minutes; cons- hemorrhage, infection, incomplete abortion, uterine proliferation)

Question 4

Techniques for 2nd trimester abortions

Answer 4

Misoprostol (advantages- non-invasive, intact fetus for pathological examination; cons- lengthy procedure- 12 hr, retained POC, ruptured uterus

Dilation and evacuation (advantages- definitive, limited time= 30 min; cons- hemorrhage, infection, retained POC, uterine proliferation)

Question 5

What percentage of pregnancies end in spontaneous loss in first trimester?

Answer 5

10-15%

Question 6

What are the most common causes of spontaneous abortions?

Answer 6

Karyotype abnormality

Serious systemic disease (antiphospholipid syndrome, diabetes)

Question 7

Threatened abortion

Answer 7

pregnant, bleeding, no cervical dilation

Question 8

Incomplete abortion

Answer 8

Passage of some, but not all, of the POC

Question 9

Complete abortion

Answer 9

Passage of all of the POC

Question 10

What are the management options of first term pregnancy failures?

Answer 10

expectant management- (pros- non-invasie, inexpensive; cons- unpredicatable, 30% failure rate)

suction curettage- (pros- definitive, quick <30 min; cons- expensive, risk of hemmorhage, infection, proliferation)

Misoprostol- (pros- non-invasive, private, inexpensive; cons- 10% failure rate)

Question 11

How frequent are ectopic pregnancies?

Answer 11

1%

Question 12

What are key risk factors for ectopic pregnancies?

Answer 12

PID and Tubal surgery

Question 13

Ectopic pregnancy

Answer 13

one of the leading causes of maternal death, especially in underserved populations

Question 14

What is a common denominator in deaths of ectopic pregnancy?

Answer 14

delay in diagnosis

Question 15

ectopic pregnancies anatomical locations

Answer 15

ampulla
ampulla-isthmus
isthmus
intramural
cesarean scar
cervical
intra-abdominal

Question 16

What is the clinical presentation of and ectopic pregnancy?

Answer 16

missed period
irregular bleeding
pelvic pain
adnexal mass (less common today because of earlier diagnosis)

Question 17

Ectopic pregnancy diagnosis

Answer 17

Abnormal increase in quantitative HCG (failure to double in 72 hours)
US- absense of intrauterine pregnancy, adnexal mass, blood in the cul-de-sac

Question 18

Management of ectopic pregnancies

Answer 18

small, ruptured ectopic- methotrexate
larger, ruptured, ectopic- surgery- removal of ectopic vs removal of tube
recurrence risk- 10%

Question 19

Molar pregnancy

Answer 19

tumor of placental tissue

may develop de novo or after a spontaneous abortion or term pregnancy

Question 20

What is the most common form of molar pregnancy?

Answer 20

complete mole- karyotype of placental tissue is 46XX

a partial mole is very uncommon (accompanying fetus is triploid (69 chromosomes)

Question 21

Clinical presentation of molar pregnancies

Answer 21

Persistent bleeding in the early half of pregnancy
PERSISTENT BLEEDING AFTER A SPONTANEOUS ABORTION OR TERM PREGNANCY
Uterus large for days (NO FHT)

Question 22

Diagnosis of a molar pregnancy

Answer 22

Quantitative HCG- markedly elevated

US

Question 23

Management of a molar pregnancy

Answer 23

Suction evacuation
Monitoring of serum HCG (10-15% of patients have persistent GTD, these patients need to be treated and evaluated for metastases)
Chemotherapy for persistent GTD (methotrexate, actinomycin D)
effective contraception x 6 months
recurrence risk 10%
EARLY US IN NEXT PREGNANCY