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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
Sonogram finding of a nonviable pregnancy without vaginal bleeding, uterine cramping, or cervical dilation
Missed abortion
26
Mx of Missed abortion
Scheduled suction D&C, conservative management | awaiting a spontaneous completed abortion, or induce contractions with misoprostol (Cytotec®) (PGE 1).
27
Sonogram finding of a viable pregnancy with vaginal bleeding but no cervical dilation. Half of these pregnancies will continue to term successfully
Threatened abortion
28
Mx of Threatened abortion
Often the cause is implantation bleeding. Observation. No intervention is generally indicated or effective
29
Vaginal bleeding and uterine cramping leading to cervical dilation, but no POC has yet been passed
Inevitable abortion
30
Mx of Inevitable abortion
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
Vaginal bleeding and uterine cramping leading to cervical dilation, with some, but not all, POC having been passed
Incomplete abortion
32
Incomplete abortion Mx
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
Vaginal bleeding and uterine cramping have led to all POC being passed. This is confirmed by a sonogram showing no intrauterine contents or debris.
Completed abortion
34
Completed abortion Mx
Management: Conservative if an | intrauterine pregnancy had been previously confirmed
35
What should be done in complete abortion
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
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
FETAL DEMISE
37
Disseminated intravascular coagulation (DIC) is the most serious consequence with prolonged fetal demise (>2 weeks) resulting from release of tissue________ from deteriorating fetal organ
thromboplastin
38
Fetal demise is most commonly _________
idiopathic
39
RF for fetal demise
antiphospholipid syndrome, overt maternal diabetes, maternal trauma, severe maternal isoimmunization, fetal aneuploidy, and fetal infection
40
Fetal demise Before 20 weeks’ gestation, the most common finding is ________
uterine fundus less than dates
41
Fetal demise After 20 weeks’ gestation, the most common symptom is ______
maternal report of absence of fetal movements
42
DIC is usually not seen until_____ weeks after demise
4
43
Dxtics for DIC
Coagulopathy should be ruled out with appropriate laboratory testing: platelet count, d-dimer, fibrinogen, prothrombin time, partial thromboplastin time
44
If DIC is identified, _________ is necessary with selective blood product transfusion as clinically indicated.
immediate delivery
45
How to manage fetal demise if DIC is not present.
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
Fetal demise A dilatation and evacuation (D&E) procedure may be appropriate in pregnancies of_______ gestation if no fetal autopsy is indicated
<23 weeks’
47
Induction of labor with ______ is appropriate in pregnancies of ≥23 weeks or if a fetal autopsy is indicated.
vaginal prostaglandin
48
____ is almost never appropriate for dead fetus
Cesarean delivery
49
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 ________
lethal anatomic syndrome, suspected aneuploidy, suspected osteochondrodysplasia, Kleihauer-Betke (peripheral smear for suspected fetomaternal bleed).
50
This is a pregnancy in which implantation has occurred outside of the uterine cavity
ECTOPIC PREGNANCY
51
ECTOPIC PREGNANCY MC location
The most common location of ectopic pregnancies is an oviduct. The most common location within the oviduct is the distal ampulla.
52
MC RF for EP
The most common predisposing cause is previous pelvic inflammatory disease (PID
53
RF for EP
infectious (PID, IUD), postsurgical (tubal ligation, tubal surgery), or congenital (diethylstilbestrol [DES] exposure).
54
Classic triad for EP
The classic triad with an unruptured ectopic pregnancy is amenorrhea, vaginal bleeding, and unilateral pelvic-abdominal
55
The classic findings with an unruptured ectopic pregnancy are __________
unilateral adnexal and cervical motion tenderness
56
With a ruptured ectopic pregnancy, the findings reflect __________
peritoneal irritation and the degree of hypovolemia. Hypotension and tachycardia indicate significant blood loss. This results in abdominal guarding and rigidity
57
__________ is presumptive diagnosis of an ectopic pregnancy
Failure to see a normal intrauterine gestational sac when the serum b-hCG titer is >1,500 mIU
58
Mx of EP
Immediate surgical intervention to stop the bleeding | is vital, usually by laparotomy.
59
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.
T
60
This folate antagonist attacks rapidly proliferating tissues including trophoblastic villi
Methotrexate
61
Criteria for methotrexate include 1 2 3
pregnancy mass <3.5 cm diameter, absence of fetal heart motion, b-hCG level <6,000 mIU, and no history of folic supplementation.
62
MTX dose
Single dose 1 mg/kg is 90% success
63
Dxtics for MTX Tx
Follow-up with serial b-hCG levels is crucial to ensure | pregnancy resolution. Rh-negative women should be administered RhoGAM
64
The preferred procedure for an unruptured ampullary tubal pregnancy is a _______, in which the trophoblastic villi are dissected free preserving the oviduct
salpingostomy
65
Isthmic tubal pregnancies are managed with a ______, in which the tubal segment containing the pregnancy is resected.
segmental resection
66
______ is reserved for the patient with a ruptured ectopic pregnancy or those with no desire for further fertility
Salpingectomy

CK OB (15 decks)

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