Spontaneous & Elective Abortions Flashcards
Most common etiology of a spontaneous abortion is: _____.
Fetal Chromosomal Abnormalities (50%)
*also consider: maternal infxn, uterine defects, endocrine abnormalities, malnutrition, immunologic (antiphospholipid), physical trauma, smoking, and drug use
______ abortion is the only one associated with possible fetal viability.
Threatened
_____ abortion is the MC cause of 1st trimester bleeding. No POC is expelled from uterus and cervical OS is closed.
Threatened
- S&S: bloody vaginal d/c
- *Management: Serial B-hCG to see if it is doubling and RhoGAM if indicated
In a _____ abortion no POC is expelled. There is progressive cervical dilation > 3cm and cervix is effaced. The pregnancy is not salvageable.
Inevitable
*Management= D&E (2nd trimester), Suction curettage (1st trimester)
In a _____ abortion the pregnancy is not salvageable. Some POC is expelled and some is retained. The cervical os is DILATED. There is heavy bleeding and retained tissue.
Incomplete
*Management= May be allowed to finish (can give Pitocin), D&C in 1st trimester and D&E after
In a _____ abortion there is complete passage of all products. The cervical os is usually closed.
Complete
In a ____ abortion there is fetal demise but it is still retained in the uterus. No POC is expelled. The cervical os is closed.
Missed
*Management= D&C or D&E, Misoprostol (Cytotec)
In a ____ abortion the retained POC becomes infected. There is CMT. Some POC is expelled. There is a foul, brownish discharge with fever and chills.
Septic
*Management= D&E to remove POC + broad spectrum abx; hysterectomy if refractory
What are the medications of choice for elective abortions 24-72 hours after unprotected sex (and safe up to 9 weeks)?
Mifepristone + Misoprostol
What are the medications of choice for elective abortions 3-7 days after conception (and safe up to 7 weeks)?
Methotrexate + Misoprostol
Surgical abortions can be performed up to ___ weeks after LMP.
24
___ is the surgery of choice for elective abortions during the first 4-12 weeks gestation.
D&C
___is the surgery of choice for elective abortions > 12 weeks gestation.
D&E
If a pregnant patient presents with PAINLESS, bright red bleeding in the 3rd trimester this may be indicative of a ____ diagnosis.
Placenta previa
- Normally NO fetal distress
- *DX: pelvic US, DO NOT DO A PELVIC EXAM
______ (class of medication) stabilize the fetus and prevent preterm uterine contractions.
Tocolytics- Magnesium Sulfate
_____ are given between 24-34 weeks to increase fetal lung maturity.
Steroids
____ is an indicator of fetal lung maturity. If it is greater than 2.0-2.5 then fetus has likely achieved fetal lung maturity.
L:S
Third trimester bleeding that is continuous and often DARK RED with severe abdominal pain is indicative of what diagnosis?
Abruptio placentae
- Fetal bradycardia common
- *Management- IMMEDIATE DELIVERY (C-section preferred). May lead to DIC.
____ is the MC cause of abruptio placentae.
Maternal HTN
Painless vaginal bleeding with fetal bradycardia and vessels crossing the os seen on fetal US is associated with what dx?
Vasa previa
Premature cervical dilation, esp in 2nd trimester, is known as ____.
Cervical insufficiency
Bleeding and vaginal discharge in the 2nd trimester in a patient that has previously been treated for CIN most likely has what diagnosis?
Cervical insufficiency
How is cervical insufficiency treated?
Cervical cerclage and bed rest
+/- weekly injection of 17 a-hydroxyprogesterone (Makena) in some women with preterm birth history
MC site of ectopic pregnancy is where?
Ampulla of fallopian tube
The classic ectopic triad includes?
- Unilateral pelvic/abd pain
- Vaginal bleeding
- Amenorrhea (pregnancy)
If a woman comes in with severe abdominal pain, dizziness, nausea, vomiting and possibly syncope, tachycardia, and hypotension then _____ should be on your differential.
Ruptured ectopic pregnancy
______ is a measurement assessed in the diagnosis of possible ectopic pregnancy.
Serial b-hCG
- In ectopic it fails to double every 24-48 hours
- *On US- see the absence of gestational sac with b-hCG levels > 2,000.
If hemodynamically stable, early gestation < 4cm, b-hCG < 5,000, and no fetal tones then _____ (medication) is given for an unruptured ectopic pregnancy.
Methotrexate
In a ruptured/unstable ectopic pregnancy _____ is the 1st treatment choice.
Laparoscopic salpingostomy
Preterm labor, spontaneous abortion, preeclampsia, and anemia are maternal complications associated with ______.
Multiple gestations
IGF, placental abnormalities, breech presentation, umbilical cord prolapse, and preeclampsia are fetal complications associated with ______.
Multiple gestations
If b-hCG is markedly elevated and on US you see a SNOWSTORM or CLUSTER OF GRAPES appearance than you should suspect ______.
Gestational trophoblastic disease (molar pregnancy)
*Management- suction curettage is mainstay ASAP to avoid choriocarcinoma development
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