Spontaneous Abortion

Question 1

1. Threatened abortion
2. Inevitable abortion
3. Incomplete abortion
4. Completed abortion
5. Missed abortion

Answer 1

1. Less than 20 weeks gestation, vaginal bleeding, NO cervical dilation
2. Less than 20 weeks gestation, bleeding, dilation, no passage of tissue
3. Less than 20 weeks gestation, bleeding, passage of tissue per vagina but with RETAINED tissue in utero, Open cervix, continuing contractions
4. Less than 20 weeks gestation, all products of conception past, closed cervix
5. Less than 20 weeks gestation, asymptomatic fetal demise

Question 2

Treatment of incompetent cervix?

Answer 2

cerclage – Surgical ligation at level of internal cervical os

Question 3

Treatment of incomplete abortion?

Answer 3

D&C of the uterus

Question 4

Threatened abortion: history? Passage of tissue? Cervical os? Viability of pregnancy? Treatment?

Answer 4

Vaginal bleeding; no passage of tissue; closed; 50% miscarry; transvaginal ultrasound and hCG level

Question 5

Inevitable abortion: history? Passage of tissue? Cervical os? Viability of pregnancy? Treatment?

Answer 5

Cramping/bleeding; no passage of tissue; open; inevitable abortion; suction D&C

Question 6

Incomplete abortion: history? Passage of tissue? Cervical os? Viability of pregnancy? Treatment?

Answer 6

Current cramping/bleeding; some passage of tissue; open; nonviable; D&C

Question 7

Complete abortion: history? Passage of tissue? Cervical os? Viability of pregnancy? Treatment?

Answer 7

Subsided cramping/cleaning; all tissues passed; closed; nonviable; follow hCG until negative

Question 8

Missed abortion: history? Passage of tissue? Cervical os? Viability of pregnancy? Treatment?

Answer 8

No symptoms; no passage of tissues; clothes; nonviable; D&C

Question 9

Clinical presentation of molar pregnancy?

Answer 9

1. Vaginal spotting
2. Absence of fetal heart tones
3. Size greater than dates
4. Elevated hCG

Question 10

Diagnosis of molar pregnancy? Treatment? If trophoblastic disease persists after evacuation?

Answer 10

Ultrasound showing “snowstorm” pattern

Suction curettage followed by weekly hCG levels

Chemotherapy

Question 11

Inevitable abortion versus incompetent cervix?

Answer 11

Uterine contractions lead to cervical dilation

versus

cervical opening (without uterine contractions) resulting in painless dilation