Preterm Labor/Threatened Abortion Lecture Powerpoint

Question 1

15% (1/6) of all pregnancies end in…

Answer 1

…miscarriage

Question 2

Implantation bleeding

Answer 2

A source of first trimester bleeding that may be mistaken as presence of the period, is common and usually lighter than menses and benign

Question 3

Causes of bleeding in the 1st trimester (6)

Answer 3

• implantation bleeding (from invasion into the spiral arterioles of the uterine wall, occurs around the time of the first missed period - often mistaken for being a period)
• subchorionic hemorrhage (usually self resolving)
• miscarriage
• ectopic pregnancy
• cervix infection (chlamydia often)
• trauma from sex

Question 4

Bleeding in the first trimester will lead to loss of pregnancy __% of the time

Answer 4

50%

Question 5

Causes of early abortion (3)

Answer 5

• most often chromosomal abnormality*** (aneuploidy or triploidy are most common or inversions or deletions)
• infection
• environmental factors (smoking, diabetes, aging gametes, incompetent cervix)

Question 6

Recurrent abortion definition and plan (2)

Answer 6

3 or more abortions in a row, parental chromosomal screening, uterine cavity eval

Question 7

Asherman syndrome

Answer 7

Intrauterine adhesions that prevent the opening of the uterus often becoming a source of miscarriage

Question 8

Spontaneous abortion

Answer 8

Abortion without medical or mechanical means to empty the uterus (empties on own without coaching), more than 80% occur before 13 weeks, increased with parity and with increased maternal and paternal age

Question 9

Threatened abortion

Answer 9

Cramping and bleeding without passage of tissue, os remains closed

Question 10

Inevitable abortion

Answer 10

Threatned abortion with more severe cramping and opened os

Question 11

Mifepristone

Answer 11

Antiprogesterone that is used for elective abortion, ineffective in low progesterone spontaneous abortions in helping them pass, causes less bleeding than surgical intervention

Question 12

Gold standard for treatment of ectopic pregnancy

Answer 12

surgery, but most often non gold standard and more commonly used is medical management because it is less invasive

Question 13

Ectopic pregnancy definition

Answer 13

Implantation anywhere other than endometrial lining of uterine cavity, most often fallopian tubal in origin, has increased risk of death due to hemorrhage than vaginal delivery

Question 14

Risk factors for ectopic pregnancy (4)

Answer 14

• tubal corrective surgery
• previous ectopic pregnancy
• IUD
• previous STD

Question 15

Criteria for medical treatment of ectopic pregnancy (4)

Answer 15

• has to be smaller than 3.5cm on ultrasound (too much fetal tissue)
• no cardiac activity present on fetus (too much fetal tissue)
• no signs of intra abdominal bleeding
• liver functioning (for methotrexate)

Question 16

Required studies to treat an ectopic pregnancy (2)

Answer 16

• ultrasound with empty uterus

- 2 hCG levels that aren’t progressing properly

Question 17

Drug of choice for ectopic pregnancy

Answer 17

Methotrexate 50mg/meter square of body surface

Question 18

Preterm labor isn’t a miscarriage or an ectopic pregnancy in that…

Answer 18

….it is common 10-11% in the population and that these infants are able to be self sustained

Question 19

As birth weight decreases, survival rates…

Answer 19

…also decrease

Question 20

Complications of prematurity are responsible for over half of…

Answer 20

…perinatal morbidity and mortality

Question 21

No induction of labor or c section should occur sooner than __ weeks to prevent prematurity

Answer 21

39

Question 22

Aneuploid abortions peak at ___ weeks, euploid at ___

Answer 22

8 weeks, 13 (later)

Question 23

Incomplete abortion

Answer 23

Bleeding and passage of tissue but some is retained

Question 24

Complete abortion

Answer 24

Abortion has passed tissue and os is now closed

Question 25

Missed abortion

Answer 25

Retention of dead products of conception for several weeks

Question 26

Discriminatory zone

Answer 26

Refers to how hCG must exceed 1500 units before an intrauterine pregnancy can typically be detected on transvaginal ultrasound exam, if above threshold but not see on ultrasound may have aborted or have ectopic

Question 27

Spontaneous abortion is in a sense, a form of delivery, and as a result, it typically presents with…

Answer 27

…uterine pain until delivery then sudden cessation after the cervix has dilated and ox has gone back to closed

Question 28

Misoprostol

Answer 28

Drug used to induce abortion in mothers with dead fetus syndrome or empty fetal sac that have low progesterone levels and thus do not respond to elective abortion medication

Question 29

Treatment for incomplete or missed abortion

Answer 29

D&C

Question 30

3 biggest causes of early labor

Answer 30

• spontaneous preterm labor
• obstetrical complications
• fetal distress

Question 31

Prior preterm birth is a large predictive factor for…

Answer 31

….future preterm births

Question 32

Criteria that determine labor commencement

Answer 32

• 4 contractions over 20 minutes or 8 over 60 + cervical changes
• cervical dilation >1cm
• cervical effacement (thinning) >80%

Question 33

Fetal fibronectin

Answer 33

Vaginal swab test to determine fake labor, negative has high predictive value for remaining pregnant for 3 more weeks while positive 50% chance of remaining pregnant for 2 more weeks

Question 34

Inhibition of labor (tocolysis) and its contraindications (4)

Answer 34

Medications that can stop the uterus from contracting, contraindicated in fetal distress, pre/eclampsia, hydramnionos, infection

Question 35

Tocolytic drugs (3)

Answer 35

• terbutaline (B2 adrenergic blockers)
• magnesium sulfate
• ca2+ channel blockers

Question 36

Drug for prevention of preterm delivery (1)

Answer 36

-17 a hydroxyprogesterone IM injection in those that have previous preterm birth

Question 37

Cervix length and indication

Answer 37

Normal is 36mm at 22 weeks,

<10mm can put at risk for 32 weeks delivery, and shorter the cervix, earlier risk of delivery

Question 38

Vaginal progesterone gel

Answer 38

Intravaginal gel that reduces delivery before 34 weeks in almost half of patients

Question 39

If a fetus is too large for methotrexate treatment in ectopic pregnancy, then treatment is…

Answer 39

…surgery

Question 40

Intrauterine pregnancy with no fetus 3 treatment options

Answer 40

• D&C
• observation (let nature take its course)
• misoprostol