Obstetrics Complications: Spontaneous Abortion

Questions and Answers

Which treatment option is appropriate for an unruptured ectopic pregnancy measuring less than or equal to 3.5 cm?

Immediate vaginal delivery

Methotrexate IM or IV (correct)

Fresh frozen plasma administration

Laparoscopic salpingectomy

What is a significant risk factor for fetomaternal hemorrhage?

Maternal obesity

Placental tumors (correct)

Prior cesarean delivery

Third trimester ultrasound

What is the primary symptom associated with placenta previa?

Painless vaginal bleeding after the 20th week (correct)

Intense uterine contractions

Nausea and vomiting

Severe abdominal pain

Which diagnostic method is used to confirm the presence of fetomaternal hemorrhage?

Kleihauer-Betke (KB) test Signup and view all the answers

In the context of abruptio placentae, which condition is commonly associated with severe bleeding and total detachment?

Maternal hypertension Signup and view all the answers

What is the defining characteristic of a threatened abortion?

Vaginal bleeding occurs without cervical dilatation. Signup and view all the answers

Which diagnostic test is NOT commonly used in evaluating suspected ectopic pregnancy?

Pelvic ultrasound for uterine abnormalities Signup and view all the answers

What treatment is indicated for incomplete abortion?

Suctioning of the vaginal vault Signup and view all the answers

In a case of ectopic pregnancy, which hormone's lower levels help rule out the condition?

Progesterone Signup and view all the answers

Which symptom is typically associated with the rupture of an ectopic pregnancy?

One-sided or generalized abdominal pain Signup and view all the answers

What is one of the most dangerous complications of DIC in pregnant women?

Death of the mother and fetus Signup and view all the answers

What initiates the coagulation cascade in the development of DIC?

Tissue factor entering circulation Signup and view all the answers

Which laboratory finding is NOT typically associated with DIC?

Increased platelet count Signup and view all the answers

Which of the following causes could trigger DIC?

Shock due to hypovolemia Signup and view all the answers

What happens to clotting factors during the progression of DIC?

They become depleted Signup and view all the answers

What might a patient with DIC present with in terms of bleeding?

Bleeding from surgical or venous puncture sites Signup and view all the answers

Which of the following treatments aims to improve fibrinogen levels in a DIC patient?

Cryoprecipitate Signup and view all the answers

Which symptom is likely to occur due to ischemia as a result of DIC?

Petechiae and purpura Signup and view all the answers

What is a defining characteristic of severe preeclampsia?

BP ≥ 160/110 Signup and view all the answers

Which of the following statements about eclampsia is true?

Eclampsia can occur anytime from the 20th week of gestation to one month postpartum Signup and view all the answers

What constitutes hypertension in pregnancy according to the provided criteria?

BP > 140/90 or a 20-mm Hg increase in systolic pressure Signup and view all the answers

What is the weight gain criterion associated with preeclampsia?

Weight gain of ≥ 5 pounds in one week after the 20th week of gestation Signup and view all the answers

Which of the following is a criterion for diagnosing HELLP syndrome?

Low platelet count alongside elevated liver enzymes Signup and view all the answers

In which scenario is transient hypertension diagnosed during pregnancy?

When there are no accompanying symptoms of preeclampsia or eclampsia Signup and view all the answers

What is the typical result for fibrinogen in a DIC panel?

Decreased Signup and view all the answers

Which test shows increased time most consistently in a DIC panel?

Activated partial thromboplastin time Signup and view all the answers

What is the common finding for D-Dimer in a DIC panel?

Increased Signup and view all the answers

In a DIC panel, what percentage of patients typically show an increased prothrombin time?

75% Signup and view all the answers

Which of the following tests shows increased time in approximately 50-60% of DIC cases?

Partial thromboplastin time Signup and view all the answers

What is the variability associated with prothrombin time in DIC?

May be increased, normal, or shortened Signup and view all the answers

Which of the following is typically decreased in a patient with DIC?

Fibrinogen Signup and view all the answers

What does an increased thrombin time indicate in the context of DIC?

Fibrinogen deficiency Signup and view all the answers

Which of the following tests is least likely to indicate a direct change in clotting factors in DIC?

D-Dimer Signup and view all the answers

Which test would give the most reliable indication of fibrinolysis in a DIC panel?

D-Dimer Signup and view all the answers

What condition is characterized by an umbilical cord that becomes entrapped by the descending fetus during labor?

Prolapsed umbilical cord Signup and view all the answers

Which complication is most likely to occur in a neonate as a result of precipitous labor?

Intracranial injury Signup and view all the answers

Which of the following best describes the nature of PROM?

Amniotic sac breaks prior to labor onset Signup and view all the answers

What is a common risk associated with twin-twin transfusion syndrome?

Macrosomia Signup and view all the answers

What may occur if pressure on the umbilical cord is not relieved during a prolapsed cord situation?

Neurological damage or death to the fetus Signup and view all the answers

Which term describes a woman who is pregnant for the first time?

Primigravida Signup and view all the answers

What is the term for a woman who has never experienced a pregnancy?

Nulligravida Signup and view all the answers

Which term refers to a woman who has given birth at least twice after 20 weeks of gestation?

Multipara Signup and view all the answers

What does the term 'gestation' specifically refer to?

Weeks since the first day of the last menstrual period Signup and view all the answers

Which condition is NOT associated with polyhydramnios?

Molar pregnancy Signup and view all the answers

What is the definition of 'nullipara'?

A woman who has never given birth after 20 weeks Signup and view all the answers

Which term describes the delivery of a live or stillborn fetus after 20 weeks of gestation?

Para Signup and view all the answers

What is considered the term for a pregnancy lasting between 38 and 48 weeks?

Term Signup and view all the answers

Which of the following best defines 'grand multipara'?

A woman who has given birth 25 or more times Signup and view all the answers

Which statement is true regarding the risks associated with polyhydramnios?

It is linked to an elevated perinatal mortality rate Signup and view all the answers

Study Notes

Spontaneous Abortion

Vaginal bleeding in the first trimester may suggest spontaneous abortion, ectopic pregnancy, or infection.
Classifications of abortion include:
- Threatened: Bleeding without cervical dilation.
- Inevitable: Bleeding with cervical dilation.
- Incomplete: Partial loss of pregnancy products, typically between 6-14 weeks.
- Complete: Full loss before 20 weeks.
- Missed: Fetal death without loss of conception products for 4 weeks.
- Septic: Infection accompanying the abortion.
Diagnostic tests involve pelvic exams, CBC, ultrasound, and quantitative serum B-hCG levels.
Treatment includes suctioning with pathological examination, evacuation for incomplete abortions, and RhoGAM administration for unsensitized Rh-negative women.

Ectopic Pregnancy

Occurs when a fertilized ovum implants outside the uterus, most commonly in the fallopian tube.
Diagnosis uses vaginal exams, hCG titers, and transvaginal sonography.
Early symptoms include amenorrhea, breast tenderness, and signs of pregnancy.
Symptoms of rupture involve unilateral abdominal pain, decreased hemoglobin, and hypotension.
Treatment can involve Methotrexate for unruptured cases or laparoscopic procedures if necessary.

Fetomaternal Hemorrhage (FMH)

FMH can be asymptomatic or present with fetal blood entering the maternal circulation.
Massive FMH (over 30 ml) can cause significant stillbirth risk.
Risk factors include maternal trauma, placental abruption, and twin pregnancies.
Diagnosis often utilizes the Kleihauer-Betke test to check for fetal hemoglobin in maternal blood.

Abruptio Placentae

Premature detachment of the placenta can result in severe bleeding.
Risk factors encompass maternal hypertension, cocaine use, and coagulopathy.
Symptoms include vaginal bleeding, a tender uterus, abdominal pain, and potential fetal distress.
Diagnosis involves ultrasound and blood studies.
Treatment varies from monitoring and bedrest to immediate delivery based on severity.

Placenta Previa

Condition where the placenta implants over or near the cervical opening.
Symptoms frequently present as painless bleeding after 20 weeks gestation.
Diagnosis is performed via ultrasound; vaginal exams should be avoided to prevent hemorrhage.

Hypertensive Disorders of Pregnancy

Includes essential hypertension, preeclampsia, eclampsia, and HELLP syndrome.
Preeclampsia is characterized by hypertension with proteinuria and may progress to seizures (eclampsia).

Disseminated Intravascular Coagulation (DIC)

A serious condition often triggered by abruptio placentae, uterine rupture, or severe infection.
Symptoms manifest as bleeding, shock, and laboratory signs of coagulopathy.
Treatment focuses on addressing the underlying cause, blood products, and potentially anticoagulants.

Pregnancy Terminology

Gravida: Total number of pregnancies.
Nulligravida: Woman who has never been pregnant.
Primigravida: First-time pregnant woman.
Multipara: Woman who has given birth multiple times.
Term: Full term pregnancy lasts 38-48 weeks.

Fetal and Neonatal Complications

Conditions leading to fetal anomalies include chromosomal abnormalities and central nervous system issues.
Increased risk of complications with multiple gestations and certain prenatal conditions.

Precipitous Labor

Characterized by labor lasting ≤3 hours, potentially resulting in trauma or low Apgar scores.
Increased risks include meconium aspiration and intracranial injury for the neonate.

Prolapsed Umbilical Cord

Occurs when the cord precedes the fetus in labor, requiring prompt management to prevent fetal hypoxia.
Management includes changing the maternal position and preparing for immediate delivery if necessary.

Induction of Labor

Induction may be conducted for various medical conditions but contraindicated in certain fetal and maternal situations.
Common methods include membrane stripping and oxytocin administration.

Cesarean Section

Indicated for risks such as fetal distress, dystocia, and placenta previa.
Regional anesthesia preferred due to fewer complications compared to general anesthesia.

Cephalopelvic Disproportion

Diagnosed when labor does not progress, often related to pelvic size or fetal position.
Cesarean delivery may be necessary in cases of disproportion or severe fetal malpresentation.

Delivery Management

Effective pushing techniques are crucial during the expulsive period of labor.
Perineal considerations may lead to the need for episiotomy to assist delivery.

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Description

This quiz covers the various classifications and implications of spontaneous abortion during the first trimester. It discusses symptoms, assessments, and key considerations for women experiencing vaginal bleeding in early pregnancy. Test your knowledge on this critical aspect of obstetrics.