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Flashcards in Abortion Deck (50):
1

What is the definition of an abortion?

Loss of pregnancy prior to 20 weeks

2

What percent of all recognized pregnancy end with SAB?

20%

3

What is a threatened abortion? Is there cervical dilation and/or expulsion of the POC?

vaginal bleeding within the first 20 weeks of gestation, but NOT ending in a spontaneous abortion

No cervical dilation, or expulsion of the POC

4

What is an inevitable abortion? Is there cervical dilation and/or expulsion of the POC?

Vaginal bleeding with cervical dilation, but no passage of tissue--viable pregnancy unlikely

5

What is an incomplete abortion? Is there cervical dilation and/or expulsion of the POC?

Vaginal bleeding with cervical dilation and *partial* expulsion of POC

6

What is a complete abortion? Is there cervical dilation and/or expulsion of the POC?

Vaginal bleeding decreasing, all POC expelled

Cervix is close

7

What is a missed abortion? Is there cervical dilation and/or expulsion of the POC?

-Fetal death with or without spotting
-No cervical dilation
-Complete retention of POC
-Often proceed to complete SAB in 1-3 weeks

8

What is a septic abortion? Is there cervical dilation and/or expulsion of the POC?

Threatened, inevitable, or or incomplete abortion with signs of uterine infx

9

Chromosome abnormalities account for what percent of all SAB?

50%

10

Losses 2/2 aneuploidy occur when in gestation (early, middle, or late)?

early

11

What are the causes for spontaneous abortion, besides chromosomal abnormalities? (5)

-Teratogen exposure
-DM
-Trauma
-Anatomic ab
-Infx

12

True or false: the is often no obvious etiology for many abortions

True

13

What causes a septated uterus?

Failure of the obliteration of the septa between the paramesonephric ducts

14

What are the common signs of a miscarriage?

-Vaginal bleeding and cramping
-Decreased s/sx of pregnancy

15

How do you diagnose an abortion? (2)

-Quant hCG levels
-TVUS

16

Gestational sac can be seen at what hCG level? Fetal heart activity

1500

13000

17

Serum progesterone level below what value is indicative of a failed/abnormal pregnancy?

Less than 5 ng/dL

18

What are the basic hematological labs that should be obtained with a suspected abortion?

-CBC
-ABO and Rh status

19

What is implantation bleeding? Does this cause miscarriages?

Bleeding around the time of implantation--usually do not lead to miscarriages

20

What is the medical treatment for a suspected miscarriage?

-rhoGAM if Rh
-IV Abx

21

What is the surgical treatment for a miscarriage?

-D and C with suction
-d/c home with Rx for pain meds

22

What is the treatment for a threatened abortion?

-Pelvic rest (no sex)
-Minimal intervention

23

What is the treatment for inevitable and incomplete miscarriages? (surgical/medical)

-D and C
-Misoprostol

24

What is a D&E? When is it done?

dilation and evacuation--done after 14 weeks (2nd trimester)

25

How do you follow a complete abortion? (2)

-Follow quant hCG weekly until 0
-TVUS to r/o retained POC

26

What percent of inevitable and incomplete miscarriages will complete without intervention?

70%

27

What is the medical treatment for a missed abortion? Surgical?

-misoprostol
-D+C or D+E

28

What is the expectant management with missed abortions?

-Uterus Evacuated if profuse bleeding

29

What is the work up for septic abortions?

-Obtain vaginal cultures
-CXR
-Coag studies + usual sepsis procedure

30

What is the treatment for a septic abortion? (2)

-Prompt surgical evacuation
-IV abx and IVF

31

What is the most frequently performed gyn procedure? When in gestation is this performed? What is the major complication of this?

D+C
1st trimester
Uterine rupture

32

What is the medical management of abortions? When in gestation is this safe?

-Prostaglandin (misoprostol)
-Up to 49 days gestation

33

Which has a higher bleeding rate: abortions done through surgical means, or medical means?

Medical

34

In whom is medical abortion not appropriate for? Why?

Unsure f/u, d/t multiple visits, and protracted therapy

35

What is the definition of recurrent pregnancy loss?

3 or more losses prior to 20 weeks gestation

36

Do you include ectopic, molar, and biochemical pregnancies in the count of recurrent pregnancy loss?

No

37

Cause of recurrent pregnancy loss can be established in what fraction of women?

2/3

38

What are the two major immunologic causes of recurrent pregnancy losses (RPL)?

SLE and APLA

39

What are the anatomic causes of RPL? (3)

-Fibroids
-intrauterine adhesions
-Congential uterine malformations

40

Can inherited thrombophilias cause RPL?

Yes

41

What are the endocrine disorders that can cause RPL? (4)

-Thyroid disease
-DM
-PCOS
-Luteal phase defect

42

What is the trend in abortions?

Downward

43

What percent of abortions occur in women who were using a contraceptive method?

54%

44

What is the most effective contraceptive?

Implantables

45

What is the incidence of complications following an abortion?

0.3%

46

Risk of maternal death is (__)x more with childbirth than an abortion?

12x

47

Are there any adverse effect in future pregnancies with an abortion?

No

48

How early can ovulation occur post-abortion?

2 weeks

49

What is happening to the abortion rate in young women? Women aged 40+?

Adolescent abortions decreased

Increased in 40+

50

True or false: abortions should be performed ASAP d/t increased complications if performed later

True