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Clin Med- P > termination of pregnancy > Flashcards

termination of pregnancy Flashcards

1
Q

HCG is secreted by the fetus how many days after ovulation?

A

6-8 days

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2
Q

at what levels are HCG tests negative and positive

A

negative: <5 IU/L
positive: >25 IU/L

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3
Q

HCG doubles every ___ days (in the first 30 days of gestation). how do you know that its destined to abort?

A
  1. 2 days

* pregnancies destined to abort will have levels rise more slowly, plateau or decline

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4
Q

what is the “fetal pole”?

A

measure from top to bottom of embryo in US

seen within yoke sac which is within gestational sac

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5
Q

3 US findings that indicate probably fetal demise (spontaneous abortion). Think in terms of presence/size of sacs, embryo presence, etc.

A
  1. gestational sac 8mm WITHOUT yoke sac
  2. gestational sac 16mm WITHOUT embryo
  3. absence of fetal cardiac motion in embryo with CRL >5mm
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6
Q

early pregnancy loss: ___-___% of CLINICALLY recognized pregnancies. what about ALL pregnancies?

A

10-15%
(as opposed to biochemical pregnancies- aka woman never would have known she was pregnant, came out with next menses)

over 50% of ALL pregnancies (clinically + biochemical) are lost

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7
Q

80% of spontaneous abortions occur before ___wks gestation

A

12

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8
Q

if there is a normal pregnancy at ___ wks, fetal loss rate is only 3% over the next 20 weeks

A

8 weeks

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9
Q

define abortion

A

expelling of the embryo or fetus prior to being viable (before 20 wks)

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10
Q

what are the 6 different types of spontaneous abortion?

A 
anembryonic
threatened
inevitable.. leading to complete 
missed
recurrent
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11
Q

anembryonic pregnancy (leading to spontaneous abortion).

A

embryo fails to develop or is resorbed after loss of viability

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12
Q

anembryonic pregnancy on exam

A

cervix is closed. US: empty gestational sac seen without fetal pole.

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13
Q

missed, threatened and anembryonic pregnancies all have similar symptoms. what are these?

A

bleeding maybe

mild pain maybe

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14
Q

what is a threatened abortion? does it always lead to a complete abortion?

A

potential cause of spontaneous abortion
- vaginal bleeding before the 20th week

*25% of women get this, only 20-50% of THESE women will progress to complete abortion

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15
Q

symptoms of threatened abortion

A

maybe vaginal bleeding and pain. but pain is NOT the prominent symptom

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16
Q

exam of threatened abortion

A

cervix is closed, US: normal gestational sac + viable embryo (but irregular sac,fetal pole or heart rate carry poor prognosis)

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17
Q

what is an inevitable abortion? (symptoms and cervix?)

A

clinical pregnancy complicated by vaginal bleeding AND crampy lower abdominal bleeding
**cervix partially dilated.

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18
Q

what is an incomplete abortion?

A

vaginal bleeding, crampy abd pain, cervical dilation (aka inevitable abortion) AND passage of SOME products of conception (POC)
(some POCs retained and seen US)

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19
Q

for an incomplete abortion, what do you do with the products of conception that were passed?

A

send to the lab

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20
Q

what two types of imaging can be used for incomplete abortion?

A

US and color doppler

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21
Q

complete abortion

A

COMPLETE passage of POC and everything returns to pre-pregnant state

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22
Q

US for incomplete vs complete abortion?

A

incomplete: some products of conception visible in cavity
complete: no POCs visible in cavity

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23
Q

a complete abortion is only Dx with certainty if…

A

a previous intrauterine gestation was documented on US (if this wasnt done, HCG levels must follow to confirm absence of ectopic)

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24
Q

missed abortion

A

fetus died but retained in uterus

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25
Q

what major problems can occur with a missed abortion? what do you do?

A

coagulation problems, can be DEADLY for mother

  • check fibrinogen levels
  • remove or induce labor of fetus
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26
Q

what must be done in management of threatened abortion ?

A

Rh testing and administration of immunoglobin Rho-GAM (if mother tests as negative)

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27
Q

3 txt/management options for incomplete or missed abortion

A
  1. surgical D&C - lower rates retained products, quickest solution
  2. medical- Misoprostol. increase rate of retained products, lower rates of infection
  3. Wait for spontaneous passage- HIGHEST rates retained pregnancy
28
Q

large hemorrhagic volume loss. what do you do?

A

large bore IV

29
Q

if intrauterine pregnancy was NOT previously seen on US and there is NO specimen obtained.. what must be done to confirm there was a spontaneous abortion?

A

follow HCG levels, they SHOULD decline

30
Q

what if HCG levels don’t decline as expected after supposed abortion?

A
  • decline rate is slow: ectopic or retained products possible
  • plateau or rise: molar gestation
31
Q

what is a molar gestation?

A

tumor-like thing that produces HCG

32
Q

complications post-abortion: more advanced gestation = more risk for what?

A

greater likelihood of excessive blood loss

33
Q

what is “asherman’s syndrome”?

A

intrauterine adhesions following abortion

34
Q

complications post abortion (4)

A
  • excessive blood loss (more with advanced gestation)
  • infection
  • asherman’s syndrome
  • infertility
35
Q

complications from D&C

A
  • perf of uterus
  • injury to bowel / bladder
  • hemorrhage
  • infection
  • cervical trauma and/or insufficiency
36
Q

what defines “recurrent abortion”?

A

more than three spontaneous abortions in a row

squishy definition

37
Q

evaluation of recurrent abortion: general factors: 5 possibly causes to consider

A
  • infrequent event (random)
  • infection
  • exposures (i.e. smoke and alcohol)
  • medical disorders
  • age
38
Q

what factor increases the incidence of chromosomally NORMAL abortions?

A

smoking and alcohol

39
Q

eval for recurrent abortions: local factors (4)

A
  1. cervical incompetence (usually trauma from D&C)
  2. congenitally abnormal uterus
  3. acquired abnormalities (i.e. fibroids, asherman’s)
40
Q

sudden loss and painless expulsion of POC is likely an abortion from what?

A

cervical incompetence

41
Q

ectopic pregnancies are more common in what type of pregnancies?

A

if in vitro or other assisted technologies used

42
Q

ectopic pregnancy surgery

A
  • tube ressected or tied

* if you just take out the ectopic, it can scar down the tube and happen again

43
Q

in what part of the tube are most ectopic pregnancies?

A

ampulla of the fallopian tube

44
Q

what is the most common cause of maternal death in the 1st trimester?

A

ectopic pregnancy

45
Q

there has been an ____ incidence in ectopic pregnancies but a _____ mortality in the past 10 years

A

increasing incidence

decreasing mortality

46
Q

are chromosomal problems a reason for ectopic pregnancy?

A

NO!

47
Q

3 possible clinical presentations of ectopic

A
  • acutely ruptured
  • probable ectopic in symptomatic women
  • possible ectopic
48
Q

symptoms of ectopic

A

amenorrhea, vaginal bleeding, lower abd pain

49
Q

acutely ruptured ectopic: presentation and Txt

A

intraperitoneal hemorrhage
severe abd pain and dizzy
positive HCG
*surgical emergency, large bore IV

50
Q

ectopic pregnancy can result in what possible fates?

A
  • tubal rupture and hemorrhage
  • pregnancy resorption
  • tubal abortion into peritoneal cavity
  • abd pregnancy (very rare)
51
Q

probable ectopic Dx

A

US: no intrauterine pregnancy BUT they have significant HCG
txt: surgical eval and therapy

52
Q

what is the discriminatory zone of HCG?

A

quantitative HCG level above which viable IUPs are visible by ultrasound (about 2000 mIU/mL)

53
Q

possible ectopic

A

pt is seen multiple times before anyone realizes what it is!

54
Q

txt/management of ectopic: unstable vs stable

A

unstable: laparotomy (large incision to view)
stable: laparoscopy (small incision with camera)
- salpingectomy
- salpingotomy/salpingostomy

55
Q

salpingectomy

A

txt for ectopic: removal of fallopian tube if damaged, will be <6cm of tube left

56
Q

salpingotomy/salpingostomy

A

txt for ectopic: incision along axis, POC removed

57
Q

medical management of ectopic

A

methotrexate and monitor HCG (follow to zero)

58
Q

when would you do expectant management for ectopic pregnancy?

A 
stable undiagnosed (as ectopic) pts 
- reliable hCG levels less than 200 and declining
59
Q

two types of induced abortion: surgical

A

D&C : earlier in pregnancy (<12 wks)

Dilation and evacuation: 13+ wks (vacuum & forceps use)

60
Q

induced medical abortions can be done up to __ wks

A

9

61
Q

3 types of medication used for induced abortion

A

misoprostol- dilates cervix and triggers contractions
mifepristone- blocks progesterone
methotrexate (with misoprostol) - interferes with placenta growth

62
Q

90% of medical-abortions are complete within __ hrs

A

24

63
Q

induced abortion: hypertonic saline or urea

A

later in pregnancy (16-24 wks )
injected directly into amniotic cavity
(* not really done anymore, risk injecting Vascular system)

64
Q

induced abortion complications

A

retained tissue- can cause thrombotic events

65
Q

what is acute hematometra?

A

complication of induced abortion: collection of blood in uterine cavity

Clin Med- P (124 decks)

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