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Questions and Answers
What does a gush of vaginal fluid during the first half of pregnancy typically indicate?
What does a gush of vaginal fluid during the first half of pregnancy typically indicate?
- Serious consequences (correct)
- Inevitable abortion
- Possible infection
- Normal pregnancy progression
When is abortion considered inevitable according to the text?
When is abortion considered inevitable according to the text?
- Immediately after membrane rupture
- After 48 hours regardless of symptoms
- During the second half of pregnancy
- In the presence of bleeding, cramping, or fever (correct)
What is the next step if no additional amnionic fluid has escaped after 48 hours?
What is the next step if no additional amnionic fluid has escaped after 48 hours?
- Resume ambulation (correct)
- Begin exercise regimen
- Seek immediate medical attention
- Expect spontaneous expulsion
What typically accompanies the death of the conceptus in a first-trimester loss?
What typically accompanies the death of the conceptus in a first-trimester loss?
What does a rare collection of fluid between the amnion and chorion without associated symptoms indicate?
What does a rare collection of fluid between the amnion and chorion without associated symptoms indicate?
What does a woman need to do if bleeding, cramping, or fever is noted according to the text?
What does a woman need to do if bleeding, cramping, or fever is noted according to the text?
What term is used to describe partial or complete placental separation and dilation of the cervical os?
What term is used to describe partial or complete placental separation and dilation of the cervical os?
Which symptom is commonly associated with incomplete abortion?
Which symptom is commonly associated with incomplete abortion?
When does bleeding typically start in miscarriage?
When does bleeding typically start in miscarriage?
What management options are mentioned for incomplete abortion?
What management options are mentioned for incomplete abortion?
What is often done with the removed products of conception in cases of incomplete abortion?
What is often done with the removed products of conception in cases of incomplete abortion?
What may be necessary before suction curettage is performed in surgical therapy for incomplete abortion?
What may be necessary before suction curettage is performed in surgical therapy for incomplete abortion?
What is the purpose of sending the removed products of conception to pathology for standard histologic analysis?
What is the purpose of sending the removed products of conception to pathology for standard histologic analysis?
What was the outcome of the treatment with vacuum aspiration in Dao's study on first-trimester miscarriage?
What was the outcome of the treatment with vacuum aspiration in Dao's study on first-trimester miscarriage?
What is a decidual cast?
What is a decidual cast?
How is a complete abortion differentiated from a threatened abortion or ectopic pregnancy with sonography?
How is a complete abortion differentiated from a threatened abortion or ectopic pregnancy with sonography?
What is a common feature of patients who have experienced a complete abortion before presenting for care?
What is a common feature of patients who have experienced a complete abortion before presenting for care?
When is sonography typically performed to differentiate a complete abortion from other conditions?
When is sonography typically performed to differentiate a complete abortion from other conditions?
What is the significance of identifying a decidual cast in passed tissue?
What is the significance of identifying a decidual cast in passed tissue?
What is the diameter of the yolk sac typically seen within the gestational sac at around 5.5 weeks' gestation?
What is the diameter of the yolk sac typically seen within the gestational sac at around 5.5 weeks' gestation?
What is seen within the sac that can exclude the possibility of pseudosac when present?
What is seen within the sac that can exclude the possibility of pseudosac when present?
At what mean sac diameter (MSD) is the absence of an embryo in the sac considered suspicious for pregnancy failure?
At what mean sac diameter (MSD) is the absence of an embryo in the sac considered suspicious for pregnancy failure?
What structures surround the anechoic gestational sac in early pregnancy as shown in the sonogram in Figure 6-1?
What structures surround the anechoic gestational sac in early pregnancy as shown in the sonogram in Figure 6-1?
When can a 1- to 2-mm embryo adjacent to the yolk sac typically be found during pregnancy?
When can a 1- to 2-mm embryo adjacent to the yolk sac typically be found during pregnancy?
According to the American College of Obstetricians and Gynecologists (2018), what should be done cautiously if the yolk sac is not yet seen in a gestational sac?
According to the American College of Obstetricians and Gynecologists (2018), what should be done cautiously if the yolk sac is not yet seen in a gestational sac?
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Study Notes
Intrauterine Pregnancy
- A gestational sac may appear similar to other intrauterine fluid accumulations, such as a pseudogestational sac (pseudosac) present with ectopic pregnancy.
- A pseudosac can be excluded once a definite yolk sac or embryo is seen inside the sac.
Early Intrauterine Pregnancy
- The yolk sac is a circular, 3- to 5-mm-diameter anechoic structure typically seen within the gestational sac at approximately 5.5 weeks' gestation and with a mean sac diameter (MSD) ≥10 mm.
- At approximately 6 weeks' gestation, a 1- to 2-mm embryo adjacent to the yolk sac can be found.
- Absence of an embryo in a sac with a MSD of 16 to 24 mm is suspicious for pregnancy failure.
Inevitable Abortion
- Amnionic fluid leaking through a dilated cervix portends almost certain abortion, with sonography showing markedly diminished fluid volume.
- Following membrane rupture, either uterine contractions begin promptly or infection develops.
- A live fetus and normal fluid volume documented, diminished activity with observation is reasonable.
- After 48 hours, if no additional amnionic fluid has escaped and no bleeding, cramping, or fever is noted, a woman may resume ambulation.
Incomplete Abortion
- Death of the embryo or fetus nearly always precedes spontaneous expulsion, accompanied by hemorrhage into the decidua basalis.
- Incomplete abortion is characterized by partial or complete placental separation and dilation of the cervical os.
- Management options include curettage, medical abortion, or expectant management in clinically stable women.
Complete Abortion
- Expulsion of the entire pregnancy is completed before a patient presents for care, with a history of heavy bleeding, cramping, and tissue passage at home.
- On pelvic examination, the cervical os is closed, and patients are encouraged to bring in passed tissue, which may be a complete gestation, blood clots, or a decidual cast.
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