Obgyn - Spontaneous and artificial abortions

Question 1

OBG - 10.1
Meaning of subclinical abortion:
A) termination of pregnancy in 2-3 weeks after conception
B) termination of pregnancy until 16th week after last menstrual bleeding
C) termination of pregnancy until 24th week after last menstrual bleeding
D) termination of pregnancy until 28th week after last menstrual bleeding
E) termination of pregnancy with heavy bleeding

Answer 1

ANSWER
A) termination of pregnancy in 2-3 weeks after conception
EXPLANATION
When the miscarriage is after conception in 2-3 weeks, there are no clinical signs, the menstruation comes later with heavier bleeding, and only the pregnancy test signs the gestation existed.

Question 2

OBG - 10.2
Meaning of early abortion:
A) termination of pregnancy in 2-3 weeks after conception
B) termination of pregnancy until 12th week after last menstrual bleeding
C) termination of pregnancy until 24h week after last menstrual bleeding
D) termination of pregnancy until 28h week after last menstrual bleeding
E) termination of pregnancy with heavy bleeding

Answer 2

ANSWER
B) termination of pregnancy until 12th week after last menstrual bleeding
EXPLANATION
From the first day of the last period until the 12th gestational week the abortion counts as early miscarriage. At this time the abortion is still one phased, so that the embryo or the fetus with the amniotic membrane and the placenta leave together.

Question 3

OBG - 10.3
Meaning of late abortion:
A) termination of pregnancy in 2-3 weeks after conception
B) termination of pregnancy until 16th week after last menstrual bleeding
C) termination of pregnancy until 24h week after last menstrual bleeding
D) termination of pregnancy until 28h week after last menstrual bleeding
E) termination of pregnancy with heavy bleeding

Answer 3

ANSWER
C) termination of pregnancy until 24h week after last menstrual bleeding
EXPLANATION
Abortions occur between 12-24th gestional weeks calculated from the first day of the last period, count as late miscarriages. At this time the fetus leaves first, after the placenta does.

Question 4

OBG - 10.4
We talk about spontaneous abortion, when:
A) the artificial abortion happens spontaneously
B) the abortion occurs spontaneously without any intervention
C) two pregnancies after each other end with miscarriage
D) the nonviable tissue is not expelled after the death of the fetus
E) the nonviable tissue absorbs spontaneously

Answer 4

ANSWER
B) the abortion occurs spontaneously without any intervention
EXPLANATION
The spontaneous interruption of pregnancy before the 24th weeks of gestation , is called spontaneous abortion. When the gestational age is not determined, and the fetus is under 500 gr weight, as well as under 30 cm lenght, and in the case of the fetus is not showing any vital signs we can talk about spontaneous miscarriage

Question 5

OBG - 10.6
We talk about arteficial abortion, when:
A) after the abortion occurs we evacuate the cavity of the uterus
B) the pregnancy ends because of a previous operation on the uterus
C) the pregnancy ends after assisted reproductive technique
D) we finish the incomplete miscarriage instrumentally
E) the pregnancy without any complaints ends by arteficial intervention

Answer 5

ANSWER
E) the pregnancy without any complaints ends by arteficial intervention
EXPLANATION
An uncomplicated pregnancy can only be terminated based on medical or not medical (social) indication.

Question 6

OBG - 10.7
We talk about criminal abortion, when:
A) the pregnancy without any complaints is finished legally
B) serious complications occur during the procedure of the abortion
C) the pregnancy without any complaints is finished illegally
D) the finishing of the miscarriage happens in criminal situation
E) we finish a pregnancy which has conceived during crime

Answer 6

ANSWER
C) the pregnancy without any complaints is finished illegally
EXPLANATION
The not desired pregnancy is finished under illegal circumstances, without any expertise, sterility, and hygienic regulations.

Question 7

OBG - 10.8
Meaning of missed abortion is:
A) the nonviable tissue is not expelled after the death of the fetus
B) the death embryo is expelled from the cavity of the uterus spontaneously
C) two or more pregnancies after each other end with miscarriage
D) there are retained products of conception after we finished the pregnancy instrumentally
E) serious complications occur during the finishing of the abortion

Answer 7

ANSWER
A) the nonviable tissue is not expelled after the death of the fetus
EXPLANATION
In case of missed abortion, after the death of the embryo the abortion has not started.

Question 8

OBG - 10.9
We talk about complete abortion, when:
A) during the artificial abortion we totally evacuate the cavity of the uterus
B) during the abortion the fetus is expelled from the uterus in full
C) during the early abortion all products of conception is expelled from the uterus
D) the death embryo is absorbed and there is no visible embryo in the gestational sac
E) after the spontaneous abortion we totally evacuate the cavity of the uterus

Answer 8

ANSWER
C) during the early abortion all products of conception is expelled from the uterus
EXPLANATION
In early gestion the fertilized egg leaves „in toto”. In the second trimester it is possible to happen, that firstly the fetus and after the placenta leaves in two phases, spontaneously. After the abortion itself, the cervix is getting closed, the bleeding stops, with ultrasound examination the uterus is empty.

Question 9

OBG - 10.10
In case of tubal abortion:
A) the pregnancy which is implanted in the cavity of the uterus leaves through the Fallopian tube
B) the pregnancy which is implanted in the Fallopian tube leaves through the cavity of the uterus
C) the pregnancy which is implanted in the Fallopian tube is absorbed spontaneously
D) during the abortion the pregnancy leaves through the cervical os, the other part of the bleeding leaves through the Fallopian tube
E) the ectopic pregnancy which is implanted in the Fallopian tube leaves into the abdominal cavity

Answer 9

ANSWER
E) the ectopic pregnancy which is implanted in the Fallopian tube leaves into the abdominal cavity
EXPLANATION
The ectopic pregnancy implanted in the fallopian tube leaves toward the abdominal cavity accompanied by bleeding and pain.

Question 10

OBG - 10.11
Spontaneous abortion can be caused by:
A) maternal reasons
B) paternal reasons
C) fetoplacental reasons
D) teratogenic reasons
E) all of them

Answer 10

ANSWER
E) all of them
EXPLANATION
The etiology of abortions are extremely varied, in the most cases we are not able to identify the cause. By didactic purpose we can differentiate maternal, paternal, fetal, and teratogenic causes.

Question 11

OBG - 10.12
How many per cent of desired pregnancy end with spontaneous abortion?
A) 5–9%
B) 10–13%
C) 15–20%
D) 19–25%
E) 25–30%

Answer 11

ANSWER
C) 15–20%
EXPLANATION
15-20% of identified and desired pregnancies are finished by clinically detectable spontaneous abortion.

Question 12

OBG - 10.16
What is the most important difference between threatened abortion and inevitable abortion?
A) the quality of the bleeding
B) the quantity of the cramping low abdominal pain
C) opened or closed internal cervical status
D) the quality of expelled products of the conception through the opened cervical os

Answer 12

ANSWER
C) opened or closed internal cervical status
EXPLANATION
Threatening abortion (imminent abortion) is characterized by little bleeding, low abdominal cramping pain, but the cervix is closed. In case of beginning abortion (incipient abortion) the symptoms of threatening abortion are more pronounced, the cervical os is opened, permeable to finger.

Question 13

OBG - 10.17
What is the most important difference between incomplete abortion and complete abortion?
A) the quality of the bleeding
B) the quantity of the cramping low abdominal pain
C) open or closed internal cervical status
D) the empty cavity of the uterus
E) the quality of expelled products of the conception

Answer 13

ANSWER
D) the empty cavity of the uterus
EXPLANATION
In case of incomplete abortus the fertilized egg and its’ supplementary part leaves from the uterus just partly, while in case of complete abortion the fertilized egg and its’ extra parts leaves totally, there is no retention in the uterus by ultrasound examination.

Question 14

OBG - 10.18
An early pregnant woman complaints of low abdominal cramp, bleeding and during vaginal examination the internal cervical os is closed. What type of spontaneous abortion do you think?
A) threatened abortion
B) inevitable abortion
C) incomplete abortion
D) complete abortion
E) criminal abortion

Answer 14

ANSWER
A) threatened abortion
EXPLANATION
Despite of low abdominal cramping pain and little bleeding in imminent abortion the cervix is closed.

Question 15

OBG - 10.20
An early pregnant woman complaints of low abdominal cramp, bleeding and during vaginal examination the internal cervical os is open and some products of conception is expelled. What type of spontaneous abortion do you think?
A) threatened abortion
B) inevitable abortion
C) incomplete abortion
D) complete abortion
E) criminal abortion

Answer 15

ANSWER
C) incomplete abortion
EXPLANATION
In case of incomplete abortion next to low abdominal cramping pain, and bleeding egg parts leaves through the opened cervix.

Question 16

OBG - 10.21
We can diagnose missed abortion certainly:
A) based on the palpation findings
B) based on the hormone tests
C) based on the ultrasound findings
D) based on the clinical symptoms
E) only if based on all of these findings

Answer 16

ANSWER
C) based on the ultrasound findings
EXPLANATION
After the mortification of the ovum the rejection does not occur. If the fetal heart beats are not detectable after two consecutive ultrasound examinations the diagnosis of missed abortion can be stated.

Question 17

OBG - 10.22
The essence of menstrual regulation:
A) After the last missed menses, we induce uterinary bleeding with medicines.
B) In six weeks after the first day of the last menstrual period we aspirate the pregnancy from the cavity of the uterus without cervical dilatation.
C) After medical dilatation of the cervix we aspirate the pregnancy from the cavity of the uterus.
D) After medical dilatation of the cervix we remove the pregnancy from the cavity of the uterus by curettage.
E) After mechanical dilatation of the cervix we remove the pregnancy from the cavity of the uterus

Answer 17

ANSWER
B) In six weeks after the first day of the last menstrual period we aspirate the pregnancy from the cavity of the uterus without cervical dilatation.
EXPLANATION
During menstrual regulation in 6 weeks from the 1st day of last period without the dilation of the cervix we enter into the uterus with a 4-5mm plastic tube, sucking out the pregnancy. The procedure can be done only in the possession of interruption protocol.

Question 18

OBG - 10.23
The essence of menstrual induction:
A) After the last missed menses, (amenorrhoea is not more than 48 days) we induce uterinary bleeding with medicines.
B) In six weeks after the first day of the last menstrual period we aspirate the pregnancy from the cavity of the uterus without cervical dilatation.
C) After medical dilatation of the cervix we aspirate the pregnancy from the cavity of the uterus.
D) After medical dilatation of the cervix we remove the pregnancy from the cavity of the uterus by curettage.
E) After mechanical dilatation of the cervix we remove the pregnancy from the cavity of the uterus.

Answer 18

ANSWER
A) After the last missed menses, (amenorrhoea is not more than 48 days) we induce uterinary bleeding with medicines
EXPLANATION
During the menstrual induction the suspected pregnancy is excreted with a menstruation-like bleeding to the effect of prostaglandin product inserted after a few days of period into the vaginal vault or cervix. The procedure can be done only in the possession of interruption protocol.

Question 19

OBG - 10.24
When the genetic and/or teratogenic harm risk is more than 10% (genetic and teratology indication), until which week can we perform the abortion?
A) until 8th week of pregnancy
B) until 12th week of pregnancy
C) until 18th week of pregnancy
D) until 20th week of pregnancy
E) whenever during pregnancy

Answer 19

ANSWER
B) until 12th week of pregnancy
EXPLANATION
Pregnancy interruption can be allowed until 12th gestational week in case of risk more than 10 % for genetical and/or teratologic harm

Question 20

OBG - 10.25
When the risk is 50-100 %, that the fetus has a serious disease/abnormality and we have a minimal chance to treat it (fetal indication), until which week can we perform the abortion?
A) until 8th week of pregnancy
B) until 12th week of pregnancy
C) until 18th week of pregnancy
D) until 20th, exceptionally 24th week of pregnancy
E) whenever during pregnancy

Answer 20

ANSWER
D) until 20th, exceptionally 24th week of pregnancy
EXPLANATION
Pregnancy interruption can be allowed until the 20th gestational week, in case of probability more than 50% (100%) for the fetus severe or only with minimal chance treatable disease, and in case of delayed prenatal diagnosis, if it is not due to failure of pregnant the induction of abortion can be allowed exceptionally until the 24th weeks of gestation.

Question 21

OBG - 10.26
A 36-year-old woman after 8 weeks without any menstrual bleeding visited her ob/gyn doctor to terminate her pregnancy, but during the gynecological examination there was not any probable pregnancy, only fibroid in the uterus. Five weeks later the ultrasound examination showed a 13th week of pregnancy. Is the termination of pregnancy allowed?

A) the termination of pregnancy is not allowed because it is more than 12 weeks of pregnancy
B) the termination of pregnancy is allowed because the woman is more than 35 years old
C) the termination of pregnancy is allowed because of the uterine fibroid
D) the termination of pregnancy is allowed because the woman visited the ob/gyn doctor earlier, but the doctor did not identify the pregnancy, so that the pregnancy is more than 13 weeks is outside her control
E) the pregnancy is more than 12 weeks, so there is no reason to terminate it

Answer 21

ANSWER
D) the termination of pregnancy is allowed because the woman visited the ob/gyn doctor earlier, but the doctor did not identify the pregnancy, so that the pregnancy is more than 13 weeks is outside her control

EXPLANATION
Pregnancy interruption between the 13-18. gestational weeks is only possible in regulated cases by the law. Such as: the expecting woman does not recognize pregnancy earlier due to reason can not be hold against her (delayed administration in medical institute or any authority , medical diagnostic mistake)

Question 22

OBG - 10.27
Meaning of blighted ovum (cystic ovum):
A) there is cystic degeneration in the trophoblast
B) there are lutein cysts in the ovaries
C) there are echo-free, cystic areas subchorially
D) the cavity of the uterus is filled of echo-free cysts
E) the embryo dies early, most of it is absorbed and the gestational sac developes empty for a while

Answer 22

ANSWER
E) the embryo dies early, most of it is absorbed and the gestational sac developes empty for a while
EXPLANATION
In case of blighted ovum (cystic ovum) the embryo dies early, is mainly absorbed, but the yolk sac is still growing futher for a while.

Question 23

OBG - 10.31
Symptoms of threatened abortion:
1) low abdominal cramp
2) vaginal bleeding
3) closed cervical os
4) open cervical os
5) products of conception are expelled

A) 1, 2 and 3 are correct
B) 2 and 4 are correct
C) 3 and 5 are correct
D) all of them are correct
E) none of them are correct

Answer 23

ANSWER
A) 1, 2 and 3 are correct
EXPLANATION
Imminent abortion is characterized by low abdominal cramping, little bleeding, and closed cervix

Question 24

OBG - 10.34
We talk about febrile abortion, when:
1) a previous febrile state leads to the abortion later
2) during the abortion a febrile complication is presenting
3) some weeks after finishing the abortion a febrile state occurs
4) during the abortion febrile state and pelvic inflammation are presenting
5) during the abortion the infection through the blood vessels affects the whole body

A) 1, 2 and 3 are correct
B) 2, 4 and 5 are correct
C) 1, 2 and 4 are correct
D) all of them are correct
E) none of them are correct

Answer 24

ANSWER
B) 2, 4 and 5 are correct
EXPLANATION
The inflammation in the background of feverish complication occuring in miscarriage is only located to the uterus initially, then it can spread to the pelvic region, finally all the body can be involved. In case of not proper treatment endotoxin shock can develop.

Question 25

OBG - 10.35
Methods for abortion before 12th pregnant week:
1) menstrual regulation
2) menstrual induction
3) cervical dilatation and curettage (D+C)
4) cervical dilatation and vacuum aspiration (D+VA)
5) cervical dilatation and pain augmentation
6) hysterotomia (sectio parva) and hysterotomia vaginalis

A) 1, 2 and 3 are correct
B) 2 and 4 are correct
C) 1, 2, 3 and 4 are correct
D) all of them are correct
E) none of them are correct

Answer 25

ANSWER
C) 1, 2, 3 and 4 are correct
EXPLANATION
During younger than 12 weeks of pregnancy interruption after few days of skipped menstruation menstrual induction, until the 6th gestational weeks menstrual regulation, later cervical dilation and uterinal curettage or cervical dilation and vacuum aspiration is the optimal method to choose.

Question 26

OBG - 10.36
Methods for abortion after 12th pregnant week:
1) menstrual regulation
2) menstrual induction
3) cervical dilatation and curettage (D+C)
4) cervical dilatation and vacuum aspiration (D+VA)
5) cervical dilatation and pain augmentation
6) hysterotomia (sectio parva) and hysterotomia vaginalis

A) 1, 2 and 3 are correct
B) 5 and 6 are correct
C) 2 and 4 are correct
D) all of them are correct
E) none of them are correct

Answer 26

ANSWER
B) 5 and 6 are correct
EXPLANATION
During older than 12 weeks of pregnancy interruption the choice of method is cervical dilation and induction of uterine contactions. In case of failure hysterotomy (sectio parva) must be done. Vaginal hysterotomy is less common practice nowadays.

Question 27

OBG - 10.37
Early complications of artificial abortion can be:
1) inflammation
2) uterinary wall perforation and injury of the surrounding organs
3) injury of the endometrial basal layer
4) retained parts of the conception, bleeding
5) anesthesiological complications

A) answers 1, 2 and 3 are correct
B) answers 2 and 4 are correct
C) answers 1, 2 and 4 are correct
D) all of the answers are correct
E) none of the answers are correct

Answer 27

ANSWER
D) all of the answers are correct
EXPLANATION
During instrumental pregnancy interruption uterine perforation can occur with the possible damage of surrounding organs, inflammation can develop, the endometrial basal layer can be impaired, there might be retentions of ovum parts, which can maintain bleeding, and anesthesiologic complications can occur.

Question 28

OBG - 10.38
Late complications of arteficial abortion can be:
1) Asherman-syndrome
2) infertility
3) changing of regular menstrual cycle
4) psychical abnormalities
5) cervical incompetence

A) 1, 2 and 3 are correct
B) 2 and 4 are correct
C) 1, 2 and 4 are correct
D) all of them are correct
E) none of them are correct

Answer 28

ANSWER
D) all of them are correct
EXPLANATION
After instrumental pregnancy interruption late complications may occur. Asherman-syndrome may occur due to impairment of endometrial layer the endometrial cavity can adhere together. Inflammation related adhesions can lead to infertility. Regular periods may change. After mechanical cervical dilation cervical insufficiency may occur. Mental trauma related to arteficial abortion can lead to psychological deviations.

Question 29

OBG - 10.39
Usually the mechanism of the abortion consists of one phase until the 16th week , so in case of complete abortion the instrumental completion is not absolutely indicated.
A) both are correct and there is a causal relationship between them
B) both are correct but there is no causal relationship between them
C) the first sentence in itself is correct and the second one is not correct
D) the first sentence is not correct and the second one in itself is correct
E) both are incorrect

Answer 29

ANSWER
B) both are correct but there is no causal relationship between them
EXPLANATION
Completion of miscarriages until the 16th gestational weeks are usually one phased, but due to the potential ovum part retention performing of intrauterine palpation is reasonable. In case of complete abortion if the uterus is empty verified by ultrasound, we can beware of instrumental curettage of the uterus. Both statement is truth, but in case of abortions before the 16th week, instrumental curettage only at proven empty uterus can be missed.

Question 30

OBG - 10.40
The mechanism of the abortion consists of 2 phases until 16th week, therefore in this case the instrumental completion of the abortion is indicated.
A) both are correct and there is a causal relationship between them
B) both are correct but there is no causal relationship between them
C) the first sentence in itself is correct and the second one is not correct
D) the first sentence is not correct and the second one in itself is correct
E) both are incorrect

Answer 30

ANSWER
A) both are correct and there is a causal relationship between them
EXPLANATION
Miscarrage is two phased after the 12th gestational week. After leaving of the fetus, ovum parts retain, that’s why at these times retained ovum parts must be removed by instrumental curettage.