25 Questions
What does a gush of vaginal fluid during the first half of pregnancy typically indicate?
Serious consequences
When is abortion considered inevitable according to the text?
In the presence of bleeding, cramping, or fever
What is the next step if no additional amnionic fluid has escaped after 48 hours?
Resume ambulation
What typically accompanies the death of the conceptus in a first-trimester loss?
Hemorrhage into the decidua basalis
What does a rare collection of fluid between the amnion and chorion without associated symptoms indicate?
Normal pregnancy development
What does a woman need to do if bleeding, cramping, or fever is noted according to the text?
Seek immediate medical attention
What term is used to describe partial or complete placental separation and dilation of the cervical os?
Incomplete abortion
Which symptom is commonly associated with incomplete abortion?
Persistent low backache with pelvic pressure
When does bleeding typically start in miscarriage?
Before cramping begins
What management options are mentioned for incomplete abortion?
Expectant management and medical abortion
What is often done with the removed products of conception in cases of incomplete abortion?
Send them for standard histologic analysis
What may be necessary before suction curettage is performed in surgical therapy for incomplete abortion?
Additional cervical dilation
What is the purpose of sending the removed products of conception to pathology for standard histologic analysis?
To confirm the products of conception.
What was the outcome of the treatment with vacuum aspiration in Dao's study on first-trimester miscarriage?
100% completed
What is a decidual cast?
A layer of uterine lining sloughed off in the shape of the uterine cavity
How is a complete abortion differentiated from a threatened abortion or ectopic pregnancy with sonography?
By observing a thickened endometrium without a gestational sac
What is a common feature of patients who have experienced a complete abortion before presenting for care?
Cervical os is closed on pelvic examination
When is sonography typically performed to differentiate a complete abortion from other conditions?
If a gestational sac is not identified grossly in the expelled specimen
What is the significance of identifying a decidual cast in passed tissue?
Suggests an incomplete abortion
What is the diameter of the yolk sac typically seen within the gestational sac at around 5.5 weeks' gestation?
3-5 mm
What is seen within the sac that can exclude the possibility of pseudosac when present?
Definite yolk sac or embryo
At what mean sac diameter (MSD) is the absence of an embryo in the sac considered suspicious for pregnancy failure?
22-26 mm
What structures surround the anechoic gestational sac in early pregnancy as shown in the sonogram in Figure 6-1?
Decidua capsularis and decidua parietalis
When can a 1- to 2-mm embryo adjacent to the yolk sac typically be found during pregnancy?
Around 6 weeks' gestation
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?
Make the diagnosis of an intrauterine pregnancy
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.
Learn about the symptoms and terminology associated with miscarriages, including bleeding, cramping, backache, pelvic pressure, and suprapubic discomfort. Understand the difference between complete and incomplete abortion.
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