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Obstetrics and Gynecology > Abortion > Flashcards

Abortion Flashcards

(54 cards)

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1
Q

Spontaneous or induced termination of pregnancy before fetal viability

A

Abortion

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2
Q

Pregnancy termination before 20 weeks gestation

With a fetus born weighing <500 g (520)

A

Abortion

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3
Q

Distiguishes between clinical vs chemical pregnancy

A

UTZ

B HCG

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4
Q

Presumptive signs and symptoms of pregnancy and with evidence of ultrasound

A

Clinical abortion

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5
Q

Pregnancy test is +
Patient will bleed
Will turn out pregnancy test -
Very early pregnancy losses

A

Chemical abortion

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6
Q

Pregnancy wherein you have signs of pregnancy and + pregnancy test but when UTZ is done, no intrauterine or extrauterine pregnancy is identified

SERIAL B HCG and UTZ

A

Pregnancy of unknown location

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7
Q

First trimester abortions more common
Within the first 12 weeks (First Trimester)

80% spontaneous

Death of embryo precedes the expulsion
Death is accompanied by hemorrhage in decidua basalis followed by adjacent tissue necrosis stimulating uterine contractions and expulsion

A

Early abortion

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8
Q

Abortion after 12 weeks (Post First trimester)

Fetus is expelled alive / fetus does not die before expulsion

A

Late abortion

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9
Q

Early abortions

subdivided:

A

Embryonic 50% - developmental abnormality of zygote, embryo, fetus or placenta
Anembryonic (blighted ovum) 50%

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10
Q

Half of emrbyonic early abortions are

A

Euploid

Aneuploid

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11
Q

Most common aneuploidy (22-32)

A

Autosomal trisomy
Down syndrome

From isolated nondysjunction

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12
Q

Single most frequent specific chromosomal abnormality

A

Monosomy

45 XO Turner

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13
Q

Aneuploid abortion in third trimester

A

Still birth
Because fetus is already big
Abortion rates and chromosomal anomalies decrease with advancing gestational age

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14
Q

Contain normal chromosomal complement
Late abortions
Peaks at 13 weeks or immediately after 1st trimester

Incidence increases dramatically after maternal age exceeds 35 years

A

Euploid abortion

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15
Q

Maternal factors that cause Euploid abortion in late first tri

A 
Infections
Medical disorders
Cancer treatment
Uncontrolled DM
Thyroid disorders
Immunologic factors
Surgical procedures 
Nutrition
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16
Q

Infection found to be present in 4% abortuses

A

Chlamydia trachomatis

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17
Q

Linked to 2-4 fold increase risk for abortions

A

Polymicrobial infection from periodontal disease

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18
Q

Infection with an association between 2nd trimester but not 1st

A

Bacterial vaginosis

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19
Q

Medical disorder that causes recurrent abortions and male and female infertility

A

Celiac disease

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20
Q

Medical conditions that increase risk for abortion

A

Unrepaired cyanotic heart disease
Inflammatory bowel disease
SLE

Women vascular disease who have miscarriages are more likely to suffer MI

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21
Q

Has effect on subfertility, preterm delivery, fetal growth restriction

A

Eating disorder

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22
Q

Does not confer significant risk for abortion

Study These Flashcards
A

Chronic hypertension

23
Q

Increased risk for septic abortion

24
Q

Uncontrolled DM increases risk for

Study These Flashcards
A

Spontaneous abortion
Major congenital malformations
Recurrent or repetitive abortion (overt DM within first tri)

25
Associated with recurrent abortion
``` Thyroid disorders Severe iodine deficiency Overt hypothyroidism Uncontrolled DM Hashimoto’s thyroiditis ```
26
Marker for increased miscarriage
Abnormally high serum antibodies to thyroid peroxidase TPO | Antibodies to thyroglobulin
27
Most potent immune-mediated disorder directed against binding proteins in plasma Associated with repetitive, recurrent miscarriage Treat with aspirin
Anti-phospholipid Antibody Syndrome APAS
28
Surgical procedures that induce abortion
Manipulation of female genitalia in removal of ovarian cyst Early removal of corpus luteum or ovary <10 weeks AOG give progesterone Abdominal trauma
29
Uncontested risk factor for abortion and subfertility
Obesity
30
Alcohol and abortion
Increased only if regular and heavy consumption | Low does not but causes fetal malformations
31
Cigarettes and abortion
Increase
32
Excessive caffeine consumption
Increase 5 cups/day 500 mg caffeine <200 mg does not
33
``` Arsenic Lead Formaldehyde Benzene Ethylene oxide DDT-containing insecticides Cytotoxic antineoplastic chemotherapeutic agents ```
Increase risk
34
Thrombophilia and abortion
No r
35
Uterine defects and abortikn
Early and late recurrent abortions
36
Bloody vaginal discharge + closed cervical os during the first 20 weeks Bleeding cramping abdominal pain Tx
Threatened abortion Tocolytics Isoxuprine, Progesterone to resolve contraction Bed rest
37
Gross rupture of membrane + Cervical dilatation Uterine contraction or infection Tx
Inevitable abortion Expectant If without fever, pain, bleeding or amniotic fluid escape, ambulation and pelvic rest.
38
Passage of meaty tissues Partial or complete placental separation + dilatation of cervical os + bleeding Before 10 weeks expelled together Tx
Incomplete abortion Complete curettage
39
History of passage of meaty tissues Expulsion of entire pregnancy + CLOSED cervix upon examination >20 weeks gestation Tx
Complete abortion Expectant
40
On UTZ a complete abortion will look
Minimally thickened endometrium without a gestational sac
41
Dead products of conception that were retained for days to months in the uterus with a closed cervical os Tx
Missed abortion Early pregnancy loss Early fetal wastage Suction Curettage
42
Early pregnancy loss or wastage with mean death-to-abortion interval of 6 weeks
Current missed abortion
43
Results from women with threated or incomplete abortion develop a pelvic infection or sepsis syn Tx
Septic abortion Bacteria gain uterine entry from a premature rupture usually due to non-sterile instruments -> colonized dead products -> invade myometrium -> parametritis -> peritonitis -> septicemia -> endocarditis -> severe sepsis syndrome with ARDS, AKI, DIC Broad-spectrum antibiotics and curettage If no response remove whole organ
44
>/= 3 consecutive pregnancy losses at = 20 weeks or with a fetal weight <500 It has to be consecutive
Recurrent miscarriage | Recurrent spontaneous abortion
45
Causes of recurrent abortion
Parental chromosomal abnormality (2-4%) Anatomical factors - acquired or congenital Immunologic factors Endocrine factors (8-12) - progestone deficiency caused by luteal-phase defect and polycystic ovarian syndrome Timing - early embryonic loss Autoimmune or anatomic abnormalities - 2nd trimester
46
Can cause recurrent miscarriage because it impinges upon the uterine cavity causing contractions and early abortion
Submucous myoma
47
History of previous dilatation and curettage Limited uterine cavity causing the recurrent miscarriage
Synechiae
48
Destruction of large areas of endometrium Follow uterine curettage or ablative procedure Treatment directed hysteroscopic lysis of adehsions
Asherman syndrome
49
Uterine anomalies causing miscarriage
``` Didelphys Bicornuate uterus Septate uterus (congenital) ```
50
Painless cervical dilatation in second trimester Followed by prolapse and ballooning of membranes into the vagina and ultimately expulsion of immature fetus When pregnancy becomes heavy, the tendency of the cervix is to open, at 16-22 weeks and usually happens in cases of recurrent abortion
Cervical insufficiency
51
Cervical insufficiency Dx And look for
TVS at 14 weeks or earlier Funneling Cervical length shorter than 2.5cm
52
Ballooning of the membranes into a dilated internal cervical os, but with a closed external os
Funneling
53
Risk factors for cervical insufficiency
History of D&C Conization Cauterization Amputation
54
surgically reinforces weak cervix by suturing (purse-string)
Cerclage Elective - 12-14 weeks if previously diagnosed with insufficiency Emergent - 20 weeks with cervical dilatation and bag of water already prolapsing

Obstetrics and Gynecology (18 decks)

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