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CK OB > Failed Pregnancies > Flashcards

Failed Pregnancies Flashcards

1
Q

T or F

Numerous epidemiologic studies have shown no association between abortion and breast cancer or any other type of cancer.

A

T

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2
Q

The maternal mortality associated with childbirth is about

_____times as high as that associated with early first-trimester abortion.

A

12

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3
Q

This is the most common abortion procedure in the United States (90%), and is performed before 13 weeks’ gestation.

A

Vacuum curettagedilation and curettage (D&C)

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4
Q

Vacuum curettagedilation and curettage (D&C)

The cervical canal is dilated with tapered metal cervical dilators or hygroscopic/ osmotic dilators such as _____

A

laminaria

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5
Q

CX of Vacuum curettagedilation and curettage (D&C)

A

Complications are rare but include endometritis, treated with outpatient antibiotics; and retained products of conception (POC), treated by repeat curettage

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6
Q

Vacuum curettagedilation and curettage (D&C)

Maternal mortality ratio:________

A

1 per 100,000 women.

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7
Q

_______has been marketed over the past decade as an alternative to surgical abortion

A

Mifepristone

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8
Q

How to induce medical abortion

A

Medical induction of abortion can be induced using oral mifepristone (Mifeprex; a progesterone antagonist) and oral misoprostol (Cytotec; prostaglandin E1).

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9
Q

With medical abortion, Approximately ______ of patients will abort within 3 days

A

85%

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10
Q

Medical abortion, About ______ of patients abort incompletely and require vacuum curettage

A

2%

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11
Q

Rare cases of__________sepsis have been reported with medical abortion

A

Clostridium sordellii

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12
Q

First-Trimester Methods for abortion

A

Vacuum curettagedilation and curettage (D&C)

Medical abortion

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13
Q

This is the most common second-trimester abortion procedure

A

Dilation and evacuation (D&E)

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14
Q

Cervical dilation is performed by inserting osmotic laminaria dilators 24 hours prior to the procedure. The cervical dilation in millimeters equals _______

A

the number of weeks of gestation (e.g., at 18 weeks, the cervix should be dilated 18 mm).

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15
Q

When to do intact D and E

A

An intact D&E involves more advanced pregnancies, with 2 or more days of laminaria treatment to obtain wide cervical dilation allowing assisted breech delivery of the fetus
under ultrasound guidance and decompression of the calvaria, with the fetus otherwise
delivered intact

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16
Q

intact D and E can be performed up to

A

24 weeks

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17
Q

Immediate complications of intact D and E may include

A

uterine perforation, retained tissue, hemorrhage,

infection, and, rarely, disseminated intravascular coagulation

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18
Q

Delayed complications of D and E may include _______

A

cervical trauma with resulting cervical insufficiency

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19
Q

Stimulation of uterine contractions to dilate the cervix can be achieved with any of the following:

A

prostaglandins (intra-amniotic PGF2a), vaginal PGE2 (dinoprostone [Cervidil®]),

IM 15-methyl PGF2a (carboprost tromethamine [Hemabate®]), PGE1 (misoprostol [Cytotec®]).

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20
Q

Delivery of a live fetus may occur with use of prostaglandin (PG) analogs; feticidal agents used include ________

A

intracardiac injection of KCl or digoxin

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21
Q

Second Trimester Induced Abortion
1
2

A

Surgical Dilation & evacuation (D&E)

PGE1 Induction of labor contractions

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22
Q

Bleeding that occurs before 12 weeks’ gestation. The most common cause of early pregnancy loss is fetal in origin

A

EARLY PREGNANCY BLEEDING

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23
Q

______should be administered to all Rh-negative gravidas who undergo dilatation and curettage (D&C).

A

RhoGAM

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24
Q

_____ and ______ should be ruled out in all patients with early pregnancy bleeding

A

Molar and ectopic pregnancy

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25
Q

Sonogram finding of a nonviable pregnancy without vaginal bleeding, uterine cramping, or cervical dilation

A

Missed abortion

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26
Q

Mx of Missed abortion

A

Scheduled suction D&C, conservative management

awaiting a spontaneous completed abortion, or induce contractions with misoprostol (Cytotec®) (PGE 1).

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27
Q

Sonogram finding of a viable pregnancy with vaginal bleeding but no cervical dilation. Half of these pregnancies will continue to term successfully

A

Threatened abortion

28
Q

Mx of Threatened abortion

A

Often the cause is implantation bleeding. Observation. No intervention is generally indicated or effective

29
Q

Vaginal bleeding and uterine cramping leading to cervical dilation, but no POC has yet been passed

A

Inevitable abortion

30
Q

Mx of Inevitable abortion

A

Emergency suction D&C if bleeding is heavy to prevent further blood loss and anemia. Otherwise conservative management awaiting a spontaneous completed
abortion or induce contractions with misoprostol (Cytotec®) PGE 1.

31
Q

Vaginal bleeding and uterine cramping leading to cervical dilation, with some, but not all, POC having been passed

A

Incomplete abortion

32
Q

Incomplete abortion Mx

A

Emergency suction D&C if bleeding is heavy to prevent
further blood loss and anemia. Otherwise conservative management awaiting a spontaneous
completed abortion or induce contractions with misoprostol (Cytotec(R)) PGE1

33
Q

Vaginal bleeding and uterine cramping have led to all POC being passed. This is confirmed by a sonogram showing no intrauterine contents or debris.

A

Completed abortion

34
Q

Completed abortion Mx

A

Management: Conservative if an

intrauterine pregnancy had been previously confirmed

35
Q

What should be done in complete abortion

A

Otherwise, serial b-human chorionic
gonadotropin (b-hCG) titers should be obtained weekly until negative to ensure an ectopic
pregnancy has not been missed.

36
Q

From a medical viewpoint, the term applies to any death after the embryo period (≥10 menstrual weeks).

From a perinatal statistics viewpoint, the term applies to in utero death of a fetus after 20 weeks’ gestation before birth

A

FETAL DEMISE

37
Q

Disseminated intravascular coagulation (DIC) is the most serious consequence with prolonged fetal demise (>2 weeks) resulting from release of tissue________
from deteriorating fetal organ

A

thromboplastin

38
Q

Fetal demise is most commonly _________

A

idiopathic

39
Q

RF for fetal demise

A

antiphospholipid syndrome, overt maternal diabetes, maternal trauma, severe
maternal isoimmunization, fetal aneuploidy, and fetal infection

40
Q

Fetal demise

Before 20 weeks’ gestation, the most common finding is ________

A

uterine fundus less than dates

41
Q

Fetal demise

After 20 weeks’ gestation, the most common symptom is ______

A

maternal report of absence of fetal movements

42
Q

DIC is usually not seen until_____ weeks after demise

A

4

43
Q

Dxtics for DIC

A

Coagulopathy should be ruled out with appropriate laboratory testing: platelet count, d-dimer, fibrinogen,
prothrombin time, partial thromboplastin time

44
Q

If DIC is identified, _________ is necessary with selective blood product transfusion as clinically indicated.

A

immediate delivery

45
Q

How to manage fetal demise if DIC is not present.

A

Delivery may best be deferred for a number of days to allow for an appropriate grief response to begin.

Or if the patient wishes conservative management,
follow weekly serial DIC laboratory tests. Ninety percent of patients start spontaneous labor after 2 weeks.

46
Q

Fetal demise

A dilatation and evacuation (D&E) procedure may be appropriate in pregnancies of_______ gestation if no fetal autopsy is indicated

A

<23 weeks’

47
Q

Induction of labor with ______ is appropriate in pregnancies of ≥23 weeks or if a fetal autopsy is indicated.

A

vaginal prostaglandin

48
Q

____ is almost never appropriate for dead fetus

A

Cesarean delivery

49
Q

Workup for fetal demise may

include cervical and placental cultures for suspected
infection,

autopsy for suspected _________

karyotype for _________

total body x-ray for_______

maternal blood for ________

A

lethal anatomic syndrome,

suspected aneuploidy,

suspected osteochondrodysplasia,

Kleihauer-Betke (peripheral smear for suspected fetomaternal bleed).

50
Q

This is a pregnancy in which implantation has occurred outside of the uterine cavity

A

ECTOPIC PREGNANCY

51
Q

ECTOPIC PREGNANCY MC location

A

The most common location of ectopic pregnancies is an oviduct. The most common location within the oviduct is the distal ampulla.

52
Q

MC RF for EP

A

The most common predisposing cause is previous pelvic inflammatory disease (PID

53
Q

RF for EP

A

infectious (PID, IUD), postsurgical (tubal ligation, tubal surgery), or congenital (diethylstilbestrol [DES] exposure).

54
Q

Classic triad for EP

A

The classic triad with an unruptured ectopic pregnancy is amenorrhea, vaginal bleeding, and unilateral pelvic-abdominal

55
Q

The classic findings with an unruptured ectopic pregnancy are __________

A

unilateral adnexal and cervical motion tenderness

56
Q

With a ruptured ectopic pregnancy, the findings reflect __________

A

peritoneal irritation and the degree of hypovolemia. Hypotension and tachycardia indicate significant
blood loss. This results in abdominal guarding and rigidity

57
Q

__________ is presumptive diagnosis of an ectopic pregnancy

A

Failure to see a normal intrauterine gestational sac when the serum b-hCG titer is >1,500 mIU

58
Q

Mx of EP

A

Immediate surgical intervention to stop the bleeding

is vital, usually by laparotomy.

59
Q

T or F

If the sonogram does not reveal an IUP, but the quantitative b-hCG is <1,500 mIU, it is impossible to differentiate a normal IUP from an ectopic pregnancy.

A

T

60
Q

This folate antagonist attacks rapidly proliferating tissues including trophoblastic villi

A

Methotrexate

61
Q

Criteria for methotrexate include
1
2
3

A

pregnancy mass <3.5 cm diameter, absence of fetal heart motion, b-hCG level <6,000 mIU, and no history
of folic supplementation.

62
Q

MTX dose

A

Single dose 1 mg/kg is 90% success

63
Q

Dxtics for MTX Tx

A

Follow-up with serial b-hCG levels is crucial to ensure

pregnancy resolution. Rh-negative women should be administered RhoGAM

64
Q

The preferred procedure for an unruptured ampullary tubal pregnancy is a _______, in which the trophoblastic villi are dissected free preserving the oviduct

A

salpingostomy

65
Q

Isthmic tubal pregnancies are managed with a ______, in which the tubal segment containing the pregnancy is resected.

A

segmental resection

66
Q

______ is reserved for the patient with a ruptured ectopic pregnancy or those with no desire for further fertility

A

Salpingectomy

CK OB (15 decks)

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