Mehlm abortions 12-13 (1)

Question 1

USMLE wants you to know that the MCC of spontaneous abortion is? 2

Answer 1

chromosomal abnormality OR unbalanced chromosomal rearragement. This is not specific to any abortion type.

Question 2

Threatened definition?

Answer 2

Means miscarriage may occur, but not inevitable.

Question 3

Threatened CP?

Answer 3

Vaginal bleeding from closed cervix, with or without cramping, usually during first trimester.

Question 4

Threatened usually in what trimester?

Answer 4

First

Question 5

Threatened bleeding?

Answer 5

Bleeding can be heavy. “Heavy” vaginal bleeding on USMLE can be described as passage of “clots” per vaginum. This is the same for menses.

Question 6

Threatened, how differs from implantation bleeding?

Answer 6

Different from implantation bleeding, which is light vaginal bleeding that sometimes occurs 1-2 weeks after ovulation.

Question 7

Threatened Tx?

Answer 7

Classic Tx is bed rest, but new guidelines suggests evidence for benefit is lacking.

Question 8

Inevitable definition?

Answer 8

As the name implies, means miscarriage that is ensuing / unavoidable.

Question 9

Inevitable Cp? when?

Answer 9

Vaginal bleeding from open cervix, usually during first trimester.

Question 10

Inevitable trimester?

Answer 10

Usually during first trimester.

Question 11

Inevitable what CP if labor?

Answer 11

Labor during first trimester usually presents as severe cramping.

Question 12

Inevitable Tx?

Answer 12

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.

Question 13

Complete. definition?

Answer 13

All products of conception have been expelled; no gestational sac seen.

As the name implies, the abortion is completed.

Question 14

Missed. definition?

Answer 14

Miscarriage that the body has not detected or attempted to expel yet.

Question 15

Missed. cervix, ug?

Answer 15

Picked up on ultrasound as absent fetal heartbeat.
Cervix is closed.

Question 16

Missed. Tx?

Answer 16

Treatment similar to inevitable abortion (i.e., expectant, prostaglandin, surgical).

Question 17

Incomplete. uterine contents?

Answer 17

Only some of the uterine contents have been expulsed.

Question 18

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.

Answer 18

.

Question 19

Incomplete. what means in Q ,,passage of clots”?

Answer 19

As mentioned before, passage of clots can indicate “heavy” passage of material, indicating components of the fetal material has already passed.

Question 20

Incomplete. vs threatened?

Answer 20

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.

Question 21

Incomplete. Tx?

Answer 21

Treatment is expectant, prostaglandin, surgical.

Question 22

Septic. result of what?

Answer 22

Miscarriage as a result of chorioamnionitis (infection of the gestational sac during pregnancy).

Question 23

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.

Answer 23

.

Question 24

Septic. Tx?

Answer 24

Treatment is usually IV antibiotics and surgical evacuation.

Question 25

Blighted ovum. aka?

Answer 25

Aka anembryonic pregnancy.

Question 26

Blighted ovum. Obscure diagnosis, but is asked on 2CK NBME and confuses people.

Answer 26

.

Question 27

Blighted ovum. mechanism?

Answer 27

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.

Question 28

Blighted ovum. beta-hCG levels change?

Answer 28

b-hCG starts to rise normally because the placenta is present but the body doesn’t yet recognize that the embryo is unviable.

Question 29

Blighted ovum.
The answer on USMLE for early pregnancy where they say ultrasound shows a gestational sac but no yolk sac or embryo.

Answer 29

.

Question 30

Recurrent/habitual. aka?

Answer 30

Aka repeated pregnancy loss.

Question 31

Recurrent/habitual. definition?

Answer 31

Defined as 2 or more consecutive spontaneous abortions.

Question 32

Recurrent/habitual. Distinct from isolated miscarriages, which occur in 15-20% of pregnancies.

Answer 32

.

Question 33

Recurrent/habitual. MCC?

Answer 33

Most important cause on USMLE is anti-phospholipid syndrome in SLE.