Abortion, GTDs, PPH Flashcards
Abortion definition
Termination of pregnancy (spontaneous or intentional) prior to 20 weeks gestation or less than 500 grams
Recurrent abortion
Three or more consecutive spontaneous abortions
80% of all abortions in the first 12 weeks
Spontaneous abortion
MC etiology of spontaneous abortion
Chromosomal abnormality (aneuploidy)
Most common aneuploidy causing spontaneous abortions
Autosomal trisomy
Second most common aneuploidy causing spontaneous abortion
Monosomy X (Turner’s)
Congenital anomaly specific to DM mothers
Caudal regression
Patient complains of painful bleeding and cervix is closed upon IE - diagnosis?
Threatened abortion
Bed rest
Where is Retrochoreal hemorrhage seen?
Ultrasound finding in threatened or inevitable abortion
Bleeding and pain with leaking AF; cervix is dilated upon IE
Inevitable abortion
Do ultrasound to assess cardiac activity
If absent cardiac activity, do D&C
Passage of meaty material, cervix is closed. Empty cavity on ultrasound.
Complete abortion
Observe
Heavy bleeding with passage of meaty material. Cervix is dilated.
Incomplete abortion
Retained products seen on ultrasound
Emergency D&C
With what type of abortion can you do elective D&C?
Missed abortion
Habitual abortion
Aka recurrent abortions
Three or more consecutive spontaneous abortions < 20 weeks AOG
Incompetent cervix
Short cervix <3 cm long with widening of internal cervical canal (beaking/ funneling)
Where do you see beaking or funneling of the cervix?
Incompetent cervix
Screening test for APAS?
Lupus anticoagulant
Anti-cardiolipin antibodies
Infectious causes of recurrent pregnancy losses
Listeria monocytogenes
Toxoplasma gondii
Management for antiphospholipid syndrome as etiology of recurrent pregnancy losses?
Low dose aspirin and heparin
Two types of cervical cerclage
McDonald cerclage - most common
Shirodkar cerclage - for failed McDonald
When is a McDonald cerclage done and removed?
Done between 14-18 weeks, removed at 37 weeks
Most commonly used cerclage
McDonald
Cerclage used if there’s a structural abnormality in the cervix
Shorodkar
Resumption of ovulation after an abortion?
2 weeks
Two types of benign GTDs
Complete mole and incomplete mole
GTDs refer to abnormalities in what structure?
Chorionic villi
3 types of malignant GTDs
Persistent/ invasive mole
Choriocarcinoma
Placental site tumor
Cause of a complete/ classic mole
Dyspermic fertilization of an EMPTY EGG by one NORMAL SPERM
Cause of a partial/ incomplete mole
Dyspermic fertilization of a NORMAL EGG by 2 NORMAL SPERMS
MC symptom of complete mole
Vaginal bleeding before 12 weeks
Most common finding in complete mole
Uterine enlargement out of proportion to AOG
HCG levels in complete mole
> 100,000
Which benign GTD is more associated with theca lutein cysts?
Complete mole
Dyspermic fertilization of an empty egg by one normal sperm
Complete/ classic mole
Gold standard for identifying molar pregnancies
Ultrasonography
MC metastasis of moles
Lungs
Treatment of choice for H. mole
Suction curettage
Second most common site for metastasis of GTT
Vagina
Post partum hemorrhage definition
NSD: > 500 ml
CS: > 1000 ml
After completion of 3rd stage of labor
Most important risk factor in PPH
Uterine atony
Absence of decidua basalis and imperfect development of fibrinoid layer
Placenta accreta
Mgt of placenta accreta
Prompt hysterectomy
Immediate blood replacement
Organism that can be cultured from septic abortus
Clostridium sordelli
