Spontaneous & Elective Abortions

Question 1

Most common etiology of a spontaneous abortion is: _____.

Answer 1

Fetal Chromosomal Abnormalities (50%)

*also consider: maternal infxn, uterine defects, endocrine abnormalities, malnutrition, immunologic (antiphospholipid), physical trauma, smoking, and drug use

Question 2

______ abortion is the only one associated with possible fetal viability.

Answer 2

Threatened

Question 3

_____ abortion is the MC cause of 1st trimester bleeding. No POC is expelled from uterus and cervical OS is closed.

Answer 3

Threatened

• S&S: bloody vaginal d/c
• *Management: Serial B-hCG to see if it is doubling and RhoGAM if indicated

Question 4

In a _____ abortion no POC is expelled. There is progressive cervical dilation > 3cm and cervix is effaced. The pregnancy is not salvageable.

Answer 4

Inevitable

*Management= D&E (2nd trimester), Suction curettage (1st trimester)

Question 5

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.

Answer 5

Incomplete

*Management= May be allowed to finish (can give Pitocin), D&C in 1st trimester and D&E after

Question 6

In a _____ abortion there is complete passage of all products. The cervical os is usually closed.

Answer 6

Complete

Question 7

In a ____ abortion there is fetal demise but it is still retained in the uterus. No POC is expelled. The cervical os is closed.

Answer 7

Missed

*Management= D&C or D&E, Misoprostol (Cytotec)

Question 8

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.

Answer 8

Septic

*Management= D&E to remove POC + broad spectrum abx; hysterectomy if refractory

Question 9

What are the medications of choice for elective abortions 24-72 hours after unprotected sex (and safe up to 9 weeks)?

Answer 9

Mifepristone + Misoprostol

Question 10

What are the medications of choice for elective abortions 3-7 days after conception (and safe up to 7 weeks)?

Answer 10

Methotrexate + Misoprostol

Question 11

Surgical abortions can be performed up to ___ weeks after LMP.

Answer 11

24

Question 12

___ is the surgery of choice for elective abortions during the first 4-12 weeks gestation.

Answer 12

D&C

Question 13

___is the surgery of choice for elective abortions > 12 weeks gestation.

Answer 13

D&E

Question 14

If a pregnant patient presents with PAINLESS, bright red bleeding in the 3rd trimester this may be indicative of a ____ diagnosis.

Answer 14

Placenta previa

• Normally NO fetal distress
• *DX: pelvic US, DO NOT DO A PELVIC EXAM

Question 15

______ (class of medication) stabilize the fetus and prevent preterm uterine contractions.

Answer 15

Tocolytics- Magnesium Sulfate

Question 16

_____ are given between 24-34 weeks to increase fetal lung maturity.

Answer 16

Steroids

Question 17

____ is an indicator of fetal lung maturity. If it is greater than 2.0-2.5 then fetus has likely achieved fetal lung maturity.

Answer 17

L:S

Question 18

Third trimester bleeding that is continuous and often DARK RED with severe abdominal pain is indicative of what diagnosis?

Answer 18

Abruptio placentae

• Fetal bradycardia common
• *Management- IMMEDIATE DELIVERY (C-section preferred). May lead to DIC.

Question 19

____ is the MC cause of abruptio placentae.

Answer 19

Maternal HTN

Question 20

Painless vaginal bleeding with fetal bradycardia and vessels crossing the os seen on fetal US is associated with what dx?

Answer 20

Vasa previa

Question 21

Premature cervical dilation, esp in 2nd trimester, is known as ____.

Answer 21

Cervical insufficiency

Question 22

Bleeding and vaginal discharge in the 2nd trimester in a patient that has previously been treated for CIN most likely has what diagnosis?

Answer 22

Cervical insufficiency

Question 23

How is cervical insufficiency treated?

Answer 23

Cervical cerclage and bed rest

+/- weekly injection of 17 a-hydroxyprogesterone (Makena) in some women with preterm birth history

Question 24

MC site of ectopic pregnancy is where?

Answer 24

Ampulla of fallopian tube

Question 25

The classic ectopic triad includes?

Answer 25

1. Unilateral pelvic/abd pain
2. Vaginal bleeding
3. Amenorrhea (pregnancy)

Question 26

If a woman comes in with severe abdominal pain, dizziness, nausea, vomiting and possibly syncope, tachycardia, and hypotension then _____ should be on your differential.

Answer 26

Ruptured ectopic pregnancy

Question 27

______ is a measurement assessed in the diagnosis of possible ectopic pregnancy.

Answer 27

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.

Question 28

If hemodynamically stable, early gestation < 4cm, b-hCG < 5,000, and no fetal tones then _____ (medication) is given for an unruptured ectopic pregnancy.

Answer 28

Methotrexate

Question 29

In a ruptured/unstable ectopic pregnancy _____ is the 1st treatment choice.

Answer 29

Laparoscopic salpingostomy

Question 30

Preterm labor, spontaneous abortion, preeclampsia, and anemia are maternal complications associated with ______.

Answer 30

Multiple gestations

Question 31

IGF, placental abnormalities, breech presentation, umbilical cord prolapse, and preeclampsia are fetal complications associated with ______.

Answer 31

Multiple gestations

Question 32

If b-hCG is markedly elevated and on US you see a SNOWSTORM or CLUSTER OF GRAPES appearance than you should suspect ______.

Answer 32

Gestational trophoblastic disease (molar pregnancy)

*Management- suction curettage is mainstay ASAP to avoid choriocarcinoma development

Question 33

SEE STUDY GUIDE FOR REVIEW OF GESTATIONAL TROPHOBLASTIC DISEASE

Answer 33

DO IT