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Obstetrics > Abortion - Mary > Flashcards

Abortion - Mary Flashcards

1
Q

definition of abortion

A

pregnancy termination prior to 20 wks or fetus born weight < 500 gm

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2
Q

when do more than 80% of spontaneous abortions of clinically recognized pregnancies occur?

A

within the 1st 12 weeks of pregnancy

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3
Q

what increases the risk for SAB?

A

increase with parity and maternal and paternal age

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4
Q

Most common cause of early pregnancy aneuploid abortions

A

45X

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5
Q

when are euploid abortions more likely to occur?

A

later in pregnancy

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6
Q

Rate of ____ and ____ are increased in women with insulin-dependent diabetes → risk is related to degree of metabolic control in early pregnancy

A

spontaneous abortion and major congenital malformation

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7
Q

Maternal risk factors that can cause SAB

A 
infection
chronic disease (Celiac dz)
endocrine abnormalities (hypothyroid, DM)
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8
Q

Frequent alcohol use in ____ weeks of pregnany can cause SAB and fetal anomalies → dose dependent

A

first 8 weeks

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9
Q

In relation to caffeine use, increased risk of SAB is seen in women who consume ____

A

> 5 cups/day [500 mg caffeine]

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10
Q

what inherited thrombophilias put a woman at risk for SAB?

A

factor V leiden, prothrombin, antithrombin, proteins C and S

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11
Q

when is the best time to do abdominal or pelvic surgery in pregnancy?

A

2nd trimester if possibe → can do early if it is uncomplicated procedure

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12
Q

Early removal of ___ can increase the risk for SAB

A

corpus luteum cyst

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13
Q

if you remove a corpus luteum cyst before 10 weeks GA what is needed?

A

supplemental progesterone

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14
Q

acquired uterine defects that can cause SAB

A

leiomyomas and uterine synechiae

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15
Q

developmental uterine defects that can cause SAB

A

abnormal mullerian duct formation of fusion

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16
Q

vaginal bleeding with closed cervical ox

cramping/abdominal pain/low backache/pelvic pressure

A

threatened abortion

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17
Q

what percent of threatened abortions will abort?

A

50%

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18
Q

what is something important to rule out with threatened abortion?

A

ectopic pregnancy

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19
Q

90-96% of pregnancies with both _____ and _____ between 7-11 wk GA will result in continued pregnancy

A

fetal cardiac activity

vaginal bleeding

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20
Q

increasing vaginal bleeding, painful uterine cramps/contractions reach peak intensity, cervix is dilated
gestational tissue is felt or seen through internal cervical os

A

inevitable abortion

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21
Q

internal os is open and blood and tissue passes (fetus and placenta may remain inside entirely or extrude through dilated os

A

incomplete abortion

22
Q

what will you see on US of incomplete abortion?

A

thickened endometrial stripe >15 mm

23
Q

Management of incomplete abortion

A

conservative
medication (misoprostol)
surgical (D&C)

24
Q

cervix is closed and all products of conception are expelled

A

complete abortion

25
Q

in utero death of embryo or fetus prior to 20th week of gestation → retention of pregnancy for period of time
early pregnancy symptoms less (nausea, tender breast, etc)
vaginal bleeding may occur
closed cervix

A

missed abortion

26
Q

how do you confirm missed abortion?

A

US → anembryonic gestation or embryonic death

27
Q

management of missed abortion

A

conservative
medication (misoprostol)
surgical (D&C)

28
Q

infection of prodcuts of conception in previable pregnancy

sx: fever, chills, malaise, abdominal pain, vaginal bleeding, sanguinopurulent discharge

A

septic abortion

29
Q

physical exam findings in septic abortion

A

tachycardia, tachypnea, lower abdomen tenderness, boggy and tender uterus with dilated cervix

30
Q

possible causes of a septic abortion

A

foreign bodies (IUD)
invasive procedure (amiocentesis, chorionic villus sampling)
maternal bacteremia
incomplete spontaneous or legally induced abortion

31
Q

Pathogens most likely cause septic abortion

A

S. aureus, Gram (-) bacilli, Gram (+) cocci

32
Q

Septic abortions can spread and lead to

A

salpingitis, peritonitis, septicemia

33
Q

Management of septic abortion

A

IV antibiotics and evacuation of uterine cavity

34
Q

what is the Expectant management of an abortion?

A

spontaneous completion in half cases of incomplete abortion

35
Q

When do majority of expulsions occur?

A

first 2 weeks after diagnosis

36
Q

what type of miscarriage is more likely to proceed to expulsion?

A

incomplete abortion > missed abortion

37
Q

Medical management for incomplete or missed abortion

A

PGE1 (misoprostol) PO or vaginally

38
Q

Preferred method of administration of misoprostol

A

vaginal → less s/e than buccally

39
Q

what is the expulsion rate of misoprostol?

A

70-90%

40
Q

Surgical management of abortion

A

D&C

41
Q

D&C is the preferred lifesaving method in a patient who is

A

hemodynamically unstable

42
Q

complications of D&C

A

uterine perforation, intrauterine adhesions, cervical trauma, infection

43
Q

definition of recurrent abortion

A

three or more consecutive pregnancy losses @ 20 weeks or fetal weight <500 grams

44
Q

when should you evaluate recurrent abortions?

A

after 2 consecutive losses

45
Q

Preferred method for surgical abortion in 1st trimester

A

D&C

46
Q

Preferred method for surgical abortion in 2nd trimester

A

D&E

47
Q

What antibiotics can you give prophylactically prior to surgical abortion?

A

doxycycline or metronidazole

48
Q

Complications of surgical abortion

A

pain, bleeding, infection, uterine perforation

49
Q

Method for medical abortion

A

mifepristone (progesterone receptor antagonist)

misoprostol (24-48 hr after)

50
Q

Side effects of medical abortion

A

bleeding, cramping, N/V/D

51
Q

When is medical abortion most effective

A

before 9 weeks

52
Q

If woman is Rh(-) and has miscarriage, what should she receive?

A

RhoGAM

Obstetrics (17 decks)

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