Failed Prego

Question 1

MC abortion procedure done in US….up to when can this be done?

Answer 1

D&C

Question 2

complications of D&C

Answer 2

endometritis and retained products of conception(POC)

Question 3

medical abortion drugs….when can you use these?

Answer 3

Mifepristone = progesterone antagonist + Misoprostol = PGE1

*used within first 63days, works w/in 3 days

Question 4

D&E use? complications?

Answer 4

2nd trimester abortion procedure; comp: uterine performation, retained tissue, hemorrhage, infection, DIC

Question 5

What 4 things need to be ruled out immediately in early prego bleeding?

Answer 5

Lesions, RH -, Molar Pregnancy, Ectopic Prego

Question 6

type of abortion: sonogram w/nonviable prego but NO bleed, dilation or anything else

Answer 6

missed abortion tx w/D&C

Question 7

type of abortion: viable prego w/vaginal bleeding but no cervical dilation

Answer 7

threatened abortion! = observation

Question 8

type of abortion: vaginal bleeding, cramping, cervical dilation but no POC passed yet..

Answer 8

inevitable abortoin = D&C if bleeding is heavy if not just wiat

Question 9

type of abortion: vaginal bleeding, cramping, cervical dilation with some but not all POC passed

Answer 9

incomplete abortion! = emergency D&C if bleeding is heavy if not wait

Question 10

type of abortion: vaginal bleeding and cramping w/no POC on sonogram

Answer 10

complete abortion; if previous IUP had been confirmed just tx sx. if not then monitor bHCG to r/o ectopic prego

Question 11

what is the most serious complication of fetal demise? when is this seen? what do you do if this is present?

Answer 11

DIC! seen w/fetal death >2 wks ago = due to release of thromboplastic from decaying fetus. if present do emergent D&C(<23wks) or induction w/prostoglandins(>/= 23wks). if not DIC just wait for natural abortion/delivery

Question 12

dx of ectopic prego can be made with….

Answer 12

> 1500 bhCG w/o IUP on vaginal sonogram

Question 13

tx of ruptured ectopic prego

Answer 13

SURGERY NOW!

Question 14

tx of unruptured ectopic prego

Answer 14

1. Methotrexate(<3.5cm, no fetal heart beat found, bhCG <6000)
2. Laproscopy w/Salpinostomy or Salpingectomy

Question 15

Criteria for methotrexate use for ectopic prego

Answer 15

<3.5cm, no fetal heart beat found, bhCG <6000

Question 16

Define Abortion, preterm birth and full term birth

Answer 16

Abortion = <20 wks
PTB = 20-36 wks
FTB = >36 wks