Mehlm abortions 02-19 (2) Flashcards
USMLE wants you to know that the MCC of spontaneous abortion is? 2
chromosomal abnormality OR unbalanced chromosomal rearragement. This is not specific to any abortion type.
Threatened definition?
Means miscarriage may occur, but not inevitable.
Threatened CP?
Vaginal bleeding from closed cervix, with or without cramping, usually during first trimester.
Threatened usually in what trimester?
First
Threatened bleeding?
Bleeding can be heavy. “Heavy” vaginal bleeding on USMLE can be described as passage of “clots” per vaginum. This is the same for menses.
Threatened, how differs from implantation bleeding?
Different from implantation bleeding, which is light vaginal bleeding that sometimes occurs 1-2 weeks after ovulation.
Threatened Tx?
Classic Tx is bed rest, but new guidelines suggests evidence for benefit is lacking.
Inevitable definition?
As the name implies, means miscarriage that is ensuing / unavoidable.
Inevitable Cp? when?
Vaginal bleeding from open cervix, usually during first trimester.
Inevitable trimester?
Usually during first trimester.
Inevitable what CP if labor?
Labor during first trimester usually presents as severe cramping.
Inevitable Tx?
Treatment is expectant management – i.e., allow for spontaneous first-trimester labor to occur. Misoprostol (PGE1 analogue) can be given to ripen the cervix.
Surgical interventions like dilation & curettage (D&C) or suction curettage are also sometimes indicated.
Complete. definition?
All products of conception have been expelled; no gestational sac seen.
As the name implies, the abortion is completed.
Missed. definition?
Miscarriage that the body has not detected or attempted to expel yet.
Missed. cervix, ug?
Picked up on ultrasound as absent fetal heartbeat.
Cervix is closed.
Missed. Tx?
Treatment similar to inevitable abortion (i.e., expectant, prostaglandin, surgical).
Incomplete. uterine contents?
Only some of the uterine contents have been expulsed.
Incomplete.
Most difficult abortion type on USMLE because it will sound like missed, where they say a fetus with no heartbeat is visualized on ultrasound, but the difference is that they will say there’s been passage of clots through an open cervix.
.
Incomplete. what means in Q ,,passage of clots”?
As mentioned before, passage of clots can indicate “heavy” passage of material, indicating components of the fetal material has already passed.
Incomplete. vs threatened?
Even though heavy bleeding / passage of clots can occur with threatened abortion as well, in the latter, there is a closed cervix and the fetus is viable.
Incomplete. Tx?
Treatment is expectant, prostaglandin, surgical.
Septic. result of what?
Miscarriage as a result of chorioamnionitis (infection of the gestational sac during pregnancy).
Septic. USMLE Q will give fever and discharge in a pregnant woman and then say buzzy details such as that it was an unwanted pregnancy + there is a laceration visualized on the cervix, indicating an attempt to self-abort with a hanger, which inoculated / seeded the infection.
.
Septic. Tx?
Treatment is usually IV antibiotics and surgical evacuation.
Blighted ovum. aka?
Aka anembryonic pregnancy.
Blighted ovum. Obscure diagnosis, but is asked on 2CK NBME and confuses people.
.
Blighted ovum. mechanism?
Fertilized egg that implants onto uterine wall, a gestational sac starts to develop, but then the embryo fails to develop + resorbs, resulting in an empty gestational sac.
Blighted ovum. beta-hCG levels change?
b-hCG starts to rise normally because the placenta is present but the body doesn’t yet recognize that the embryo is unviable.
Blighted ovum.
The answer on USMLE for early pregnancy where they say ultrasound shows a gestational sac but no yolk sac or embryo.
.
Recurrent/habitual. aka?
Aka repeated pregnancy loss.
Recurrent/habitual. definition?
Defined as 2 or more consecutive spontaneous abortions.
Recurrent/habitual. Distinct from isolated miscarriages, which occur in 15-20% of pregnancies.
.
Recurrent/habitual. MCC?
Most important cause on USMLE is anti-phospholipid syndrome in SLE.
