LE4 - Abortion Flashcards by - -

A 26-year-old G1P0 at 8 weeks gestation presents with mild vaginal bleeding and lower abdominal discomfort for 1 day. She denies passage of clots or tissue. On examination, the cervix is closed, and the uterus is of size consistent with the gestational age. Ultrasound confirms a viable intrauterine pregnancy with normal fetal cardiac activity.

Question: What is the most likely diagnosis?
A. Threatened abortion
B. Incomplete abortion
C. Missed abortion
D. Inevitable abortion

Follow-Up Question: What is the most appropriate management for this patient?
A. Perform suction curettage
B. Bed rest and progesterone supplementation
C. Administer oxytocin infusion
D. Observe and wait for spontaneous resolution

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A 29-year-old G2P1 at 10 weeks gestation presents with mild spotting for the past 2 days. She reports no cramping or passage of tissue. On examination, the cervix is closed, and the uterus corresponds to the gestational age. Ultrasound shows a single intrauterine pregnancy with fetal cardiac activity.

Question: What is the most likely diagnosis?
A. Missed abortion
B. Threatened abortion
C. Complete abortion
D. Inevitable abortion

Follow-Up Question: What is the appropriate management for this patient?
A. Administer misoprostol for uterine evacuation
B. Reassure the patient and schedule a follow-up ultrasound
C. Prescribe bed rest and progesterone supplementation
D. Perform suction curettage

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A 32-year-old G3P2 presents at 9 weeks gestation with intermittent spotting. She denies cramping or abdominal pain. On examination, the cervix is closed, and the uterus size matches the gestational age. Ultrasound reveals a viable intrauterine pregnancy with subchorionic hemorrhage.

Question: What is the most likely diagnosis?
A. Missed abortion
B. Threatened abortion
C. Inevitable abortion
D. Incomplete abortion

Follow-Up Question: What is the best next step in management?
A. Perform dilation and curettage
B. Bed rest with close follow-up
C. Administer oxytocin to prevent bleeding
D. Immediate surgical evacuation

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A 28-year-old G1P0 presents at 7 weeks gestation with mild vaginal bleeding and no abdominal pain. She denies passing clots or tissue. On examination, the cervix is closed, and the uterus is consistent with 7 weeks gestation. Ultrasound confirms a viable pregnancy.

Question: What is the most likely diagnosis?
A. Threatened abortion
B. Complete abortion
C. Missed abortion
D. Inevitable abortion

Follow-Up Question: What is the appropriate management for this patient?
A. Perform suction curettage immediately
B. Administer methotrexate
C. Prescribe progesterone and recommend bed rest
D. Monitor β-hCG levels weekly

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A 30-year-old G2P1 at 6 weeks gestation presents with spotting and mild lower abdominal pain for 2 days. On examination, the cervix is closed, and there is no evidence of tissue passage. Ultrasound reveals a viable intrauterine pregnancy with normal fetal cardiac activity.

Question: What is the most likely diagnosis?
A. Complete abortion
B. Missed abortion
C. Threatened abortion
D. Inevitable abortion

Follow-Up Question: What is the best management for this patient?
A. Bed rest and reassurance
B. Immediate surgical evacuation
C. Administer oxytocin
D. Perform dilation and curettage

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A 28-year-old G1P0 at 11 weeks gestation presents with moderate vaginal bleeding and watery discharge. She reports cramping and denies passage of tissue. On examination, the cervix is open, and there are no visible products of conception. Ultrasound confirms a viable intrauterine pregnancy with ruptured membranes.

Question: What is the most likely diagnosis?
A. Threatened abortion
B. Inevitable abortion
C. Missed abortion
D. Incomplete abortion

Follow-Up Question: What is the next best step in management?
A. Bed rest and progesterone supplementation
B. Perform suction curettage
C. Administer methotrexate
D. Perform dilation and evacuation (D&E)

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A 33-year-old G3P2 at 14 weeks gestation presents with severe vaginal bleeding and cramping. She denies passage of tissue. On examination, the cervix is open, and membranes are ruptured. Ultrasound reveals a nonviable fetus consistent with 14 weeks gestation.

Question: What is the most likely diagnosis?
A. Missed abortion
B. Complete abortion
C. Inevitable abortion
D. Threatened abortion

Follow-Up Question: What is the best management for this patient?
A. Administer oxytocin infusion
B. Perform dilation and curettage
C. Prescribe bed rest and progesterone
D. Perform immediate cesarean section

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A 25-year-old G1P0 at 10 weeks gestation presents with heavy vaginal bleeding and lower abdominal cramping. She denies passing clots or tissue. On examination, the cervix is dilated, and membranes have ruptured. The uterus size is consistent with the gestational age.

Question: What is the most likely diagnosis?
A. Threatened abortion
B. Incomplete abortion
C. Inevitable abortion
D. Complete abortion

Follow-Up Question: What is the most appropriate management?
A. Perform suction curettage
B. Observe and monitor β-hCG levels weekly
C. Administer misoprostol
D. Perform hysteroscopy

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A 30-year-old G2P1 at 16 weeks gestation presents with watery vaginal discharge, heavy bleeding, and cramping. On examination, the cervix is open, and no fetal tissue is visible at the os. Ultrasound confirms an intrauterine pregnancy with ruptured membranes and no fetal cardiac activity.

Question: What is the most likely diagnosis?
A. Missed abortion
B. Inevitable abortion
C. Incomplete abortion
D. Threatened abortion

Follow-Up Question: What is the next best step in management?
A. Administer oxytocin for evacuation
B. Perform dilation and curettage
C. Observe and reassure the patient
D. Administer progesterone

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A 27-year-old G2P0 at 9 weeks gestation presents with moderate vaginal bleeding and intermittent abdominal pain. She denies passing clots or tissue. On examination, the cervix is open, and membranes are ruptured. Ultrasound shows a gestational sac consistent with the gestational age but no fetal heart tones.

Question: What is the most likely diagnosis?
A. Complete abortion
B. Missed abortion
C. Threatened abortion
D. Inevitable abortion

Follow-Up Question: What is the most appropriate next step in management?
A. Perform suction curettage
B. Monitor β-hCG levels for spontaneous resolution
C. Administer methotrexate

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A 30-year-old G2P1 at 10 weeks gestation presents with moderate vaginal bleeding and passage of fleshy tissue earlier today. She continues to have lower abdominal cramps, though the pain has decreased since passing the tissue. On examination, the cervix is open, and placental tissue is visible at the os. Ultrasound shows retained products of conception.

Question: What is the most likely diagnosis?
A. Missed abortion
B. Incomplete abortion
C. Complete abortion
D. Inevitable abortion

Follow-Up Question: What is the most appropriate management?
A. Perform suction curettage
B. Administer methotrexate
C. Observe and reassure the patient
D. Monitor β-hCG levels weekly

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A 28-year-old G1P0 at 12 weeks gestation presents with heavy vaginal bleeding and abdominal cramping. She reports passage of tissue earlier today but continues to experience significant bleeding. On examination, the cervix is open, and ultrasound confirms retained products of conception.

Question: What is the most likely diagnosis?
A. Threatened abortion
B. Complete abortion
C. Incomplete abortion
D. Inevitable abortion

Follow-Up Question: What is the next best step in management?
A. Administer oxytocin infusion
B. Perform dilation and curettage
C. Observe and reassure the patient
D. Perform hysterectomy

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A 32-year-old G3P2 at 9 weeks gestation presents with moderate vaginal bleeding and crampy abdominal pain. She passed tissue-like material yesterday but continues to bleed. On examination, the cervix is open, and there is visible placental tissue at the os. The uterus is smaller than expected for the gestational age.

Question: What is the most likely diagnosis?
A. Missed abortion
B. Incomplete abortion
C. Inevitable abortion
D. Threatened abortion

Follow-Up Question: What is the most appropriate management for this patient?
A. Perform suction curettage to remove retained tissue
B. Administer misoprostol to expel remaining tissue
C. Monitor β-hCG levels weekly for resolution
D. Prescribe bed rest and reassurance

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A 27-year-old G2P0 at 8 weeks gestation presents with severe vaginal bleeding and intermittent lower abdominal pain. She reports passing large clots and some tissue earlier today. On examination, the cervix is open, and ultrasound shows retained products of conception.

Question: What is the most likely diagnosis?
A. Complete abortion
B. Incomplete abortion
C. Missed abortion
D. Threatened abortion

Follow-Up Question: What is the next best step in management?
A. Perform completion curettage
B. Administer methotrexate
C. Observe and reassure the patient
D. Induce labor with oxytocin

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A 26-year-old G1P0 presents with moderate vaginal bleeding and cramping at 10 weeks gestation. She passed tissue two days ago, but ultrasound reveals retained products of conception in the uterus. The cervix is open, and the uterus is smaller than expected for the gestational age.

Question: What is the most likely diagnosis?
A. Incomplete abortion
B. Missed abortion
C. Inevitable abortion
D. Threatened abortion

Follow-Up Question: What is the most appropriate management for this patient?
A. Administer oxytocin infusion and observe
B. Perform suction curettage to remove retained tissue
C. Prescribe bed rest and monitor β-hCG levels
D. Perform immediate laparotomy

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A 28-year-old G1P0 at 10 weeks gestation presents with a history of vaginal bleeding and severe cramping, which resolved after passing tissue 2 days ago. On examination, the cervix is closed, and there is no active bleeding. Ultrasound reveals an empty uterus.

Question: What is the most likely diagnosis?
A. Incomplete abortion
B. Complete abortion
C. Missed abortion
D. Threatened abortion

Follow-Up Question: What is the next best step in management?
A. Perform suction curettage
B. Observe and reassure the patient
C. Administer methotrexate
D. Induce labor with oxytocin

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A 30-year-old G3P2 at 12 weeks gestation presents with a history of heavy bleeding and cramping, which subsided after she passed clots and tissue. On examination, the cervix is closed, and there is no active bleeding. Ultrasound reveals an empty uterine cavity.

Question: What is the most likely diagnosis?
A. Missed abortion
B. Complete abortion
C. Incomplete abortion
D. Inevitable abortion

Follow-Up Question: What is the most appropriate next step in management?
A. Confirm expulsion of products of conception and discharge the patient
B. Perform dilation and curettage
C. Administer oxytocin
D. Repeat ultrasound in one week

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A 25-year-old G2P1 presents at 9 weeks gestation with a history of moderate vaginal bleeding and cramping. She reports passage of clots and tissue 24 hours ago and states that her symptoms have since resolved. On examination, the cervix is closed, and there is no active bleeding. Ultrasound shows no retained products of conception.

Question: What is the most likely diagnosis?
A. Complete abortion
B. Incomplete abortion
C. Missed abortion
D. Threatened abortion

Follow-Up Question: What is the next best step in management?
A. Reassure the patient and provide follow-up instructions
B. Perform suction curettage
C. Monitor β-hCG levels weekly
D. Administer misoprostol

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A 32-year-old G1P0 at 8 weeks gestation presents with a history of severe cramping and heavy vaginal bleeding, which resolved after passage of tissue 2 days ago. On examination, the cervix is closed, and there is no active bleeding. Ultrasound reveals an empty uterus and no evidence of retained tissue.

Question: What is the most likely diagnosis?
A. Incomplete abortion
B. Complete abortion
C. Missed abortion
D. Threatened abortion

Follow-Up Question: What is the next best step in management?
A. Observe and reassure the patient
B. Perform dilation and curettage
C. Administer oxytocin infusion
D. Repeat ultrasound in one week

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A 27-year-old G2P1 at 10 weeks gestation presents with a history of vaginal bleeding and cramping for 2 days, which resolved after passing tissue. On examination, the cervix is closed, and there is no active bleeding. Ultrasound shows no retained products of conception in the uterine cavity.

Question: What is the most likely diagnosis?
A. Complete abortion
B. Incomplete abortion
C. Inevitable abortion
D. Missed abortion

Follow-Up Question: What is the best management for this patient?
A. Confirm expulsion of products of conception and reassure the patient
B. Perform suction curettage
C. Administer methotrexate
D. Monitor β-hCG levels weekly

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A 29-year-old G2P1 at 10 weeks gestation presents with a history of dark brown vaginal discharge for 3 days. She reports loss of pregnancy symptoms, including nausea and breast tenderness, over the past week. On examination, the cervix is closed, and the uterus size is smaller than expected for the gestational age. Ultrasound confirms the absence of fetal cardiac activity.

Question: What is the most likely diagnosis?
A. Threatened abortion
B. Missed abortion
C. Incomplete abortion
D. Inevitable abortion

Follow-Up Question: What is the next best step in management?
A. Administer methotrexate
B. Perform dilation and suction curettage
C. Observe and reassure the patient
D. Administer oxytocin infusion

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A 32-year-old G3P2 at 8 weeks gestation presents with complaints of dark brown spotting and a complete absence of pregnancy symptoms. She denies cramping or passage of tissue. On examination, the cervix is closed, and ultrasound reveals a gestational sac with no fetal heart activity.

Question: What is the most likely diagnosis?
A. Complete abortion
B. Missed abortion
C. Threatened abortion
D. Incomplete abortion

Follow-Up Question: What is the most appropriate next step in management?
A. Perform suction curettage
B. Administer oxytocin infusion
C. Monitor β-hCG levels weekly
D. Prescribe bed rest

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A 25-year-old G1P0 at 11 weeks gestation reports a loss of pregnancy symptoms and intermittent dark brown vaginal discharge. On examination, the cervix is closed, and the uterus is smaller than expected for 11 weeks gestation. Ultrasound reveals a non-viable intrauterine pregnancy with no fetal cardiac activity.

Question: What is the most likely diagnosis?
A. Threatened abortion
B. Missed abortion
C. Complete abortion
D. Incomplete abortion

Follow-Up Question: What is the next best step in management for this patient?
A. Administer prostaglandins for uterine evacuation
B. Perform dilation and curettage
C. Monitor β-hCG levels for spontaneous resolution
D. Prescribe progesterone supplementation

A 30-year-old G2P1 at 14 weeks gestation presents with loss of pregnancy symptoms and a history of intermittent dark vaginal discharge for 1 week. On examination, the cervix is closed, and the uterus is smaller than expected for 14 weeks gestation. Ultrasound confirms a fetal demise with no cardiac activity.

Question: What is the most likely diagnosis?
A. Missed abortion
B. Complete abortion
C. Incomplete abortion
D. Threatened abortion

Follow-Up Question: What is the most appropriate management for this patient?
A. Administer prostaglandins or oxytocin infusion
B. Perform dilation and curettage
C. Observe and reassure the patient
D. Perform hysterectomy

A 28-year-old G3P2 at 9 weeks gestation presents with persistent dark brown discharge and absence of pregnancy symptoms for 2 weeks. She denies pain or bleeding. On examination, the cervix is closed, and ultrasound reveals a gestational sac with no fetal cardiac activity.

Question: What is the most likely diagnosis?
A. Missed abortion
B. Complete abortion
C. Incomplete abortion
D. Threatened abortion

Follow-Up Question: What is the best management for this patient?
A. Perform suction curettage
B. Administer oxytocin infusion
C. Observe and monitor weekly β-hCG levels
D. Prescribe bed rest

A 32-year-old G4P0 presents with a history of four consecutive pregnancy losses, all occurring before 12 weeks of gestation. She has no living children. Genetic testing reveals a balanced translocation in one partner.

Question: What is the most likely classification of her condition?
A. Primary recurrent pregnancy loss
B. Secondary recurrent pregnancy loss
C. Antiphospholipid antibody syndrome (APAS)
D. Structural uterine abnormality

Follow-Up Question: What is the next step in management?
A. Offer genetic counseling and assisted reproductive technologies (ART)
B. Prescribe low-dose aspirin and low-molecular-weight heparin
C. Perform hysteroscopy to evaluate for uterine abnormalities
D. Reassure the patient and advise natural conception

Answer: A. Primary recurrent pregnancy loss
Rationale: This patient has had multiple losses with no live births, fulfilling the criteria for primary recurrent pregnancy loss. The presence of a balanced translocation supports a genetic cause.
Follow-Up Answer: A. Offer genetic counseling and assisted reproductive technologies (ART)
Rationale: Genetic counseling and ART with preimplantation genetic testing can help reduce the risk of chromosomal abnormalities in future pregnancies.

A 28-year-old G5P2 presents with three consecutive pregnancy losses, all confirmed at 10–12 weeks of gestation. She has two prior live births. Laboratory testing reveals positive lupus anticoagulant antibodies.

Question: What is the most likely underlying etiology?
A. Balanced translocation
B. Antiphospholipid antibody syndrome (APAS)
C. Structural uterine abnormality
D. Hormonal imbalance

Follow-Up Question: What is the most appropriate treatment for future pregnancies?
A. Low-dose aspirin and low-molecular-weight heparin
B. Genetic testing and preimplantation genetic diagnosis (PGD)
C. Surgical correction of uterine abnormalities
D. Empiric progesterone supplementation

Answer: B. Antiphospholipid antibody syndrome (APAS)
Rationale: Positive lupus anticoagulant and a history of recurrent pregnancy loss support the diagnosis of APAS.
Follow-Up Answer: A. Low-dose aspirin and low-molecular-weight heparin
Rationale: Combined anticoagulation therapy is the standard treatment for APAS to reduce the risk of thrombosis and pregnancy loss.

A 35-year-old G3P1 presents with two consecutive first-trimester pregnancy losses following her first live birth. Pelvic ultrasound reveals a septate uterus.

Follow-Up Question: What is the recommended management for this patient?
A. Surgical resection of the uterine septum
B. Anticoagulation with low-molecular-weight heparin
C. Genetic counseling and karyotyping
D. Empiric progesterone supplementation

Answer: B. Secondary recurrent pregnancy loss
Rationale: The patient’s losses occurred after a prior live birth, classifying her condition as secondary recurrent pregnancy loss. A septate uterus is a known structural cause.
Follow-Up Answer: A. Surgical resection of the uterine septum
Rationale: Correcting the septate uterus via hysteroscopic resection improves pregnancy outcomes.

A 30-year-old G3P0 presents with three first-trimester pregnancy losses and no prior live births. Laboratory workup, including genetic and autoimmune testing, is negative. Hysteroscopy reveals adhesions within the uterine cavity (Asherman’s syndrome).

Question: What is the most likely cause of her recurrent pregnancy loss?
A. Structural uterine abnormality
B. Parental chromosomal abnormality
C. Antiphospholipid antibody syndrome (APAS)
D. Hormonal imbalance

Follow-Up Question: What is the next step in management?
A. Surgical hysteroscopic removal of adhesions
B. Low-dose aspirin and heparin therapy
C. Genetic testing and preimplantation genetic diagnosis (PGD)
D. Empiric use of progesterone therapy

Answer: A. Structural uterine abnormality
Rationale: Asherman’s syndrome, identified via hysteroscopy, is a structural cause of recurrent pregnancy loss.
Follow-Up Answer: A. Surgical hysteroscopic removal of adhesions
Rationale: Removing intrauterine adhesions improves uterine cavity integrity, enhancing future pregnancy success.

A 34-year-old G4P1 presents with three consecutive second-trimester pregnancy losses following one live birth. Imaging reveals a bicornuate uterus.

Question: What is the most likely etiology of her condition?
A. Antiphospholipid antibody syndrome (APAS)
B. Structural uterine abnormality
C. Parental chromosomal abnormality
D. Hormonal imbalance

Follow-Up Question: What is the next step in management?
A. Surgical correction of the uterine anomaly
B. Anticoagulation therapy during future pregnancies
C. Genetic counseling and karyotyping
D. Recommend cervical cerclage in future pregnancies

Answer: B. Structural uterine abnormality
Rationale: A bicornuate uterus is a congenital structural anomaly associated with recurrent second-trimester losses.
Follow-Up Answer: D. Recommend cervical cerclage in future pregnancies
Rationale: Cervical cerclage helps reduce the risk of pregnancy loss associated with structural uterine abnormalities.

A 28-year-old G2P0 at 16 weeks gestation presents with painless cervical dilation and a history of a prior second-trimester pregnancy loss. Ultrasound shows a viable fetus and no signs of uterine contractions or bleeding.

Question: What is the most likely diagnosis?
A. Cervical incompetence
B. Preterm labor
C. Threatened abortion
D. Placenta previa

Follow-Up Question: What is the most appropriate management?
A. Administer oxytocin to enhance contractions
B. Perform prophylactic cervical cerclage
C. Prescribe bed rest and observe
D. Deliver the fetus immediately

Answer: A. Cervical incompetence
Rationale: Painless cervical dilation in mid-trimester pregnancy with no contractions or bleeding is characteristic of cervical incompetence.
Follow-Up Answer: B. Perform prophylactic cervical cerclage
Rationale: Cerclage reinforces the cervix to prevent further dilation and potential pregnancy loss.

A 32-year-old G3P2 at 18 weeks gestation presents with a history of three consecutive mid-trimester pregnancy losses. She denies any cramping or bleeding during those pregnancies. Examination today reveals a shortened cervix and funneling on ultrasound but no signs of infection or rupture of membranes.

Question: What is the most likely cause of her previous losses?
A. Cervical incompetence
B. Chromosomal aneuploidies
C. Placental insufficiency
D. Uterine rupture

Follow-Up Question: What is the recommended next step in management for this pregnancy?
A. Perform dilation and curettage
B. Place a prophylactic cerclage immediately
C. Administer corticosteroids to enhance fetal lung maturity
D. Monitor cervical length with serial ultrasounds

Answer: A. Cervical incompetence
Rationale: History of recurrent mid-trimester losses and a short, funneling cervix on ultrasound suggest cervical incompetence.
Follow-Up Answer: B. Place a prophylactic cerclage immediately
Rationale: Cerclage prevents further cervical dilation and reduces the risk of preterm loss.

A 29-year-old G1P0 at 16 weeks gestation presents with active bleeding and uterine contractions. Cervical dilation is noted on examination, and the membranes have ruptured. The patient denies any history of cervical procedures or previous pregnancy losses.

Question: What is the most appropriate diagnosis?
A. Cervical incompetence
B. Inevitable abortion
C. Threatened abortion
D. Missed abortion

Follow-Up Question: What is the next best step in management?
A. Perform immediate uterine evacuation
B. Place a cervical cerclage
C. Administer progesterone to halt contractions
D. Observe for spontaneous resolution

Answer: B. Inevitable abortion
Rationale: Active bleeding, uterine contractions, and ruptured membranes indicate inevitable abortion rather than cervical incompetence.
Follow-Up Answer: A. Perform immediate uterine evacuation
Rationale: Evacuation of the uterus is required to prevent complications like infection or hemorrhage.

A 35-year-old G3P2 at 15 weeks gestation opts for pregnancy termination due to a prenatal diagnosis of severe fetal anomalies confirmed on ultrasound. The patient has no significant medical history.

Question: What is the most appropriate classification of this procedure?
A. Elective abortion
B. Therapeutic abortion
C. Mid-trimester abortion due to cervical incompetence
D. Missed abortion

Follow-Up Question: What is the recommended method of termination in this case?
A. Suction curettage
B. Administration of prostaglandins or oxytocin
C. Perform cesarean section
D. Bed rest and observation

Answer: B. Therapeutic abortion
Rationale: Termination due to severe fetal anomalies is classified as a therapeutic abortion.
Follow-Up Answer: B. Administration of prostaglandins or oxytocin
Rationale: Prostaglandins or oxytocin are appropriate for mid-trimester pregnancy termination to induce uterine contractions.

A 25-year-old G2P0 presents requesting termination of her pregnancy at 14 weeks gestation for personal reasons. She has no medical or obstetrical complications.

Question: What is the appropriate classification of this procedure?
A. Elective abortion
B. Therapeutic abortion
C. Missed abortion
D. Incomplete abortion

Follow-Up Question: What is the most appropriate method of termination in this case?
A. Suction curettage
B. Administration of methotrexate
C. Perform immediate cesarean section
D. Observe and monitor weekly β-hCG levels

Answer: A. Elective abortion
Rationale: Termination requested for personal reasons without medical indications is classified as an elective abortion.
Follow-Up Answer: A. Suction curettage
Rationale: Suction curettage is the preferred method for termination in the early second trimester for elective abortions.

A 25-year-old G1P0 at 8 weeks gestation presents with moderate vaginal bleeding and lower abdominal pain. Ultrasound reveals retained products of conception in the uterus. The patient is hemodynamically stable and desires immediate management.

Question: What is the most appropriate management option?
A. Methylergometrine Maleate
B. Expectant management
C. Dilation and Curettage (D&C)
D. Administer oxytocin infusion

C. Dilation and Curettage (D&C)
Rationale: D&C is the most definitive method for evacuating retained products of conception and controlling bleeding, particularly in a stable patient seeking immediate resolution.

A 28-year-old G3P2 at 7 weeks gestation opts for pregnancy termination. She prefers a method that avoids surgery and can be managed at home. The physician decides to prescribe medications for medical abortion.

Question: What combination of medications should be prescribed?
A. Methylergometrine Maleate and oxytocin
B. Mifepristone followed by misoprostol
C. Methotrexate followed by leucovorin
D. Misoprostol alone

B. Mifepristone followed by misoprostol
Rationale: This combination is the standard for medical abortion. Mifepristone blocks progesterone, while misoprostol induces uterine contractions to expel the pregnancy.

A 30-year-old G2P1 presents at 10 weeks gestation with persistent vaginal bleeding following a suspected miscarriage. Ultrasound reveals retained products of conception. The patient prefers a definitive approach to ensure complete evacuation.

Question: What is the best management option for this patient?
A. Methylergometrine Maleate
B. Vacuum aspiration
C. Expectant management
D. Administer misoprostol

B. Vacuum aspiration
Rationale: Vacuum aspiration is a safe, efficient, and effective method to ensure complete uterine evacuation in cases of retained products of conception.

A 32-year-old G2P1 at 11 weeks gestation presents with vaginal spotting and mild cramping. Ultrasound reveals a nonviable pregnancy with no fetal cardiac activity. The patient prefers a method that will allow her body to naturally expel the pregnancy.

Question: What is the most appropriate management option?
A. Dilation and Curettage (D&C)
B. Vacuum aspiration
C. Expectant management
D. Methylergometrine Maleate

C. Expectant management
Rationale: Allowing the pregnancy to pass naturally aligns with the patient’s preference. Close monitoring is necessary to ensure complete expulsion without complications.

A 27-year-old G1P0 at 6 weeks gestation desires an elective pregnancy termination. She prefers a method that is efficient and minimally invasive.

Question: What is the most appropriate management option?
A. Methylergometrine Maleate
B. Vacuum aspiration
C. Expectant management
D. Mifepristone and misoprostol

B. Vacuum aspiration
Rationale: Vacuum aspiration is preferred for elective termination in early pregnancy due to its efficiency, minimal invasiveness, and quick recovery time.

A 28-year-old G2P0 at 14 weeks gestation presents with a history of two prior second-trimester pregnancy losses, both occurring around 18 weeks without any preceding contractions. On transvaginal ultrasound, the cervical length is 15 mm, and funneling is noted. The patient is scheduled for a cerclage.

Question: What is the most appropriate type of cerclage for this patient?
A. Expectant management
B. McDonald cerclage
C. Shirodkar cerclage
D. Administration of progesterone only

B. McDonald cerclage
Rationale: McDonald cerclage is the most commonly performed procedure for cervical insufficiency with a history of recurrent second-trimester losses. It is effective for this patient’s situation.

A 30-year-old G3P1 presents at 16 weeks gestation with a history of a prior Shirodkar cerclage placed during her last pregnancy due to extreme cervical shortening. Ultrasound today reveals a cervical length of 10 mm and significant funneling. The patient desires cerclage placement for this pregnancy.

Question: What is the most appropriate type of cerclage for this patient?
A. McDonald cerclage
B. Shirodkar cerclage
C. Vaginal pessary
D. Immediate delivery

B. Shirodkar cerclage
Rationale: Shirodkar cerclage is preferred for patients with extreme cervical shortening or anatomical challenges, particularly in cases where a McDonald cerclage may not be sufficient.

A 32-year-old G2P1 at 13 weeks gestation presents for evaluation due to a history of a mid-trimester loss at 20 weeks gestation. Ultrasound reveals a cervical length of 25 mm without funneling. She is hemodynamically stable with no signs of contractions or rupture of membranes.

Question: What is the most appropriate management for this patient?
A. Perform McDonald cerclage
B. Perform Shirodkar cerclage
C. Start vaginal progesterone therapy
D. Monitor with serial ultrasounds

C. Start vaginal progesterone therapy
Rationale: Vaginal progesterone is the first-line treatment for cervical lengths between 20–25 mm without symptoms. Serial monitoring is also essential in this case.

A 35-year-old G4P1 presents at 18 weeks gestation with painless cervical dilation noted on examination and no signs of contractions or bleeding. She has a history of two previous pregnancies complicated by cervical incompetence. This case requires a more invasive cerclage procedure due to anatomical challenges.

Question: What type of cerclage is most appropriate for this patient?
A. McDonald cerclage
B. Shirodkar cerclage
C. Vaginal pessary
D. Expectant management

B. Shirodkar cerclage
Rationale: Shirodkar cerclage is more invasive and better suited for cases with anatomical challenges or previous failed cerclages.

A 29-year-old G3P2 at 12 weeks gestation presents with a history of two prior cerclages. During her last pregnancy, a McDonald cerclage was successful in allowing her to carry to term. Ultrasound today reveals a normal cervical length of 30 mm without evidence of funneling.

Question: What is the best management for this patient?
A. Perform McDonald cerclage prophylactically
B. Monitor cervical length and perform cerclage if indicated
C. Perform Shirodkar cerclage
D. Prescribe bed rest for the duration of the pregnancy

B. Monitor cervical length and perform cerclage if indicated
Rationale: Since the cervical length is normal and there is no evidence of insufficiency, close monitoring is preferred. Prophylactic cerclage is not warranted unless issues develop.

A 34-year-old G4P2 presents at 38 weeks gestation with sudden-onset severe abdominal pain, followed by cessation of uterine contractions. On examination, the fetal heart rate is non-reassuring, and there is significant maternal tachycardia and hypotension. The patient has a history of a prior cesarean section.

Question: What is the most likely diagnosis?
A. Placental abruption
B. Uterine rupture
C. Preterm labor
D. Amniotic fluid embolism

Follow-Up Question: What is the next best step in management?
A. Perform an emergency laparotomy
B. Administer magnesium sulfate
C. Perform immediate uterine evacuation via suction curettage
D. Observe and monitor for spontaneous recovery

A 28-year-old G2P1 presents with a history of amenorrhea and secondary infertility following a dilation and curettage (D&C) performed after a missed abortion. Hysteroscopy reveals intrauterine adhesions and obliteration of the uterine cavity.

Question: What is the most likely diagnosis?
A. Asherman’s Syndrome
B. Endometriosis
C. Uterine fibroids
D. Uterine rupture

Follow-Up Question: What is the most appropriate management for this condition?
A. Administer methotrexate
B. Perform hysteroscopic adhesiolysis
C. Prescribe progesterone therapy
D. Perform uterine artery embolization

A 30-year-old G3P1 presents at 37 weeks gestation with a history of severe abdominal pain, followed by prolonged fetal bradycardia. She has a history of two prior cesarean sections. On examination, uterine tone is decreased, and fetal parts are palpable through the maternal abdomen.

Question: What is the most likely diagnosis?
A. Placental abruption
B. Uterine rupture
C. Preterm labor
D. Cord prolapse

Follow-Up Question: What is the immediate next step in management?
A. Perform an emergency cesarean delivery
B. Administer corticosteroids
C. Perform immediate uterine evacuation
D. Administer uterotonics

A 26-year-old G1P0 with a history of a D&C for incomplete abortion 6 months ago presents with complaints of scanty menses and inability to conceive. Ultrasound shows a thin endometrial stripe, and hysteroscopy confirms the presence of dense intrauterine adhesions.

Question: What is the most likely diagnosis?
A. Endometriosis
B. Asherman’s Syndrome
C. Uterine septum
D. Chronic endometritis

Follow-Up Question: What is the first-line treatment?
A. Perform hysteroscopic adhesiolysis
B. Administer misoprostol
C. Prescribe oral contraceptives for cycle regulation
D. Observe and recommend natural conception

A 32-year-old G4P3 presents with a history of sharp abdominal pain during labor, followed by a sudden loss of fetal station. She has a history of two prior cesarean deliveries. Examination reveals a soft abdomen, and the fetal heart rate is undetectable.

Question: What is the most likely diagnosis?
A. Uterine rupture
B. Placenta previa
C. Cord prolapse
D. Shoulder dystocia

Follow-Up Question: What is the next best step in management?
A. Perform an emergency laparotomy and cesarean delivery
B. Administer uterotonics and wait for spontaneous delivery
C. Perform external cephalic version
D. Observe and await labor progression

A 29-year-old G2P0 presents with 9 weeks of amenorrhea, mild vaginal spotting, and crampy lower abdominal pain. Ultrasound reveals an anembryonic pregnancy (blighted ovum) with no fetal pole.

Question: What is the most likely diagnosis?
A. Embryonic miscarriage
B. Complete abortion
C. Threatened abortion
D. Early abortion

Follow-Up Question: What is the most appropriate management for this patient?
A. Expectant management
B. Medical management with misoprostol
C. Perform suction curettage
D. Administer methotrexate

A 32-year-old G1P0 presents with 13 weeks of amenorrhea, vaginal bleeding, and passage of fleshy tissue. Ultrasound reveals fetal parts in the uterus, but no fetal cardiac activity.

Question: What is the most likely diagnosis?
A. Threatened abortion
B. Late abortion
C. Missed abortion
D. Incomplete abortion

Follow-Up Question: What is the best next step in management?
A. Perform suction curettage immediately
B. Administer oxytocin infusion
C. Expectant management
D. Surgical evacuation with caution for bony spicules

A 28-year-old G2P1 presents with 6 weeks of amenorrhea, dark brown vaginal discharge, and loss of pregnancy symptoms. Transvaginal ultrasound shows a fetus with no cardiac activity and a crown-rump length consistent with 8 weeks.

Question: What is the most likely diagnosis?
A. Threatened abortion
B. Complete abortion
C. Missed abortion
D. Late abortion

Follow-Up Question: What is the best management for this patient?
A. Prostaglandins or oxytocin infusion
B. Perform suction curettage
C. Monitor with serial β-hCG
D. Repeat ultrasound in 1 week

A 26-year-old G3P1 presents with 11 weeks of amenorrhea, moderate vaginal bleeding, and crampy lower abdominal pain. Physical examination reveals an open cervix with products of conception partially protruding through the cervical os.

Question: What is the most likely diagnosis?
A. Threatened abortion
B. Incomplete abortion
C. Early abortion
D. Missed abortion

Follow-Up Question: What is the immediate management for this condition?
A. Perform suction curettage
B. Administer methotrexate
C. Administer oxytocin infusion
D. Observe with expectant management

A 35-year-old G4P3 presents at 15 weeks gestation with vaginal bleeding and passage of fetal parts. The ultrasound confirms the presence of retained placental fragments.

Question: What is the most likely diagnosis?
A. Complete abortion
B. Late abortion
C. Threatened abortion
D. Incomplete abortion

Follow-Up Question: What is the best management for this patient?
A. Perform suction curettage
B. Perform surgical evacuation with careful monitoring
C. Observe expectantly
D. Administer oxytocin infusion only

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LE4 - Abortion Flashcards

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