Failed Pregnancy-Kaplan

Question 1

Risk of maternal death assoc with abortion increases with

Answer 1

advancing gestational age

Question 2

What is the most common first trimester method of Induced abortion?

Answer 2

Vacuum curettage - D & C

• cervical canal is tpered with metal dilators or hygroscopic osmotic dilators such as laminaria
• pt gets prophylactic antibiotics

Question 3

What is a medical abortion?

Answer 3

induced using oral 1) Mifepristone–a progesterone antagonist

2) oral Misoprostol
- pt. will abort in 3 days

Question 4

Which procedure carries the risk of Clostridium sordelli infection?

Answer 4

Medical abortion

Question 5

What is the most common second trimester method?

Answer 5

D and E - Dilation and Evacuation - dilate the cervix using laminaria - the mm of dilated cervix will go along with the # weeks of gestation

-early can make morcellated fetus

Question 6

Intact D and E involves more advanced pregnancies

Answer 6

involves 2 or more days of laminaria treatment to widen cervix allowing breech delivery of fetus under U/S guidance w. decompression of the calvaria with fetus rest of fetus otherwise intact—-> basically a partial birth abortion

Question 7

Complications of D and E

Answer 7

uterine perforation, retained tissue, hemorrhage, infection, and rarely DIC

Question 8

Labor Inducing Methods

Answer 8

-prostaglandins (PGF 2alpha)
-vaginal PGE2 (Cervidil)
-15-methyl-PGF2alpha ((Herbamate)
-PGE1 (Misoprostol)
….all strengthen uterine contractions

Question 9

Which one will allow delivery of a live fetus?

Answer 9

prostaglandin analogs—kill fetus via KCL or digoxin intracardiac

Question 10

Complications of inducing labor

Answer 10

immediate retained placenta, hemorrhage, infection

Late complications: cervical trauma resulting in cervical insufficiency

Question 11

What are the first trimester induced abortions?

Answer 11

Surgical - D and C

Medical - Mifepristone

Question 12

What are the second trimester methods of induced abortion?

Answer 12

Surgical- D and E

Medical - induction of labor contractions

Question 13

Which method of induction can be done at any trimester?

Answer 13

hysterotomy or hysterectomy

Question 14

Early pregnancy bleeding: On speculum exam if the internal cervical os is closed, what is the diagnosis?

Answer 14

lower genital tract lesion
missed abortion- embryo has stopped growing (incental finding)
threatened abortion - vag bleeding- viable pregnancy - can give Misoprostol (PGE1)

Question 15

Early pregnancy bleeding: On speculum exam, if the internal cervical os is opened, then it is

Answer 15

Threatened

Inevitable abortion- can be live or dead- matter or time

Question 16

Fetal demise - fetal death after 20 weeks before birth

no movement for 24 hrs

Answer 16

nothing on sonogram
Antenatal demise occurs before birth
Intrapartum demise occurs after the onset of labor

Question 17

What is the complication of fetal demise?

Answer 17

DIC - four weeks after demise; fetus uses up the platelets while dying (PLT down while D-Dimer, fibrin split products increasing)

• if mom wants to let it pass on its own then do weekly PLTS
• -diagnosed w. color Doppler/ U/S to see chest

Question 18

Ruptured ectopic management

Answer 18

Triad (unilateral pelvic pain, amenorea, vaginal bleeding) plus hypotension and tachycardia 
To diagnose ectopic pregnancy: 
1. do vaginal sonogram 
2. serum hCG> 1500
Tx: immediate laparotomy

Question 19

If beta hCG is

Answer 19

hCG> 1500 plus sac
laparoscopy–linear salpingoscopy
Salpingotomy- taking out the fallopian tube; follow weekly