Short Quiz on Abortion-Types & Diagnosis
Instruction
2. There is 1 Mark for each correct Answer
Recurrent abortion in 1st trimester, investigation of choice is:
Ans.A. i.e. Karyotyping
In cases of recurrent abortions, IOC is parental Karyotyping.
Recommendation for the testing of the couple presenting with recurrent miscarriage (≥3 miscarriages).
1. Basic investigations
- Obstetric and family history, age, BMI, organic solvents, alcohol, mercury, lead, caffeine, hyperthermia, smoking.
- Full blood count (blood sugar level and thyroid function tests).
- Antiphospholipid antibodies (LAC and ALC).
- Parental karyotype.
- Pelvic ultrasound (SIS) and/or hysterosalpingogram and hysteroscopy and laparoscopy in case of inconclusive findings.
2. Research investigations within the context of a trial
- Feto-placental karyotypes
- Testing of uterine and/or peripheral blood NK cells
- Mannan-binding lectin (MBL) level
- Luteal phase endometrial biopsy
- Homocysteine/folic acid level
- Thrombophilia screening
Ans. is A. Threatened Abortion
- Mifepristone is an antiprogestin which binds to the progesterone receptors and thus prevents the action of progesterone.
- The administration of mifepristone is usually followed by a synthetic prostaglandin analogue thus effectively brings about abortion.
- Threatened abortion is a condition diagnosed clinically by the bleeding occurring in the early pregnancy and by the presence of a definite heart sound and a hematoma (sub-chorionic/marginal sinus/retroplacental) ultrasonographically.
- Every attempt must be taken to preserve the pregnancy in threatened abortion by applying expectant management.
- The use of an abortifacient is not included in the management of threatened abortion.
Ans. is D. i.e. TORCH infection screening
Recurrent miscarriage is defined as a sequence of three or more consecutive spontaneous abortion before 20 weeks.
Investigations:
1) Blood glucose (fasting and postprandial), VDRL, thyroid function test, ABO and Rh grouping (husband and wife), toxoplasma antibodies IgG&IgM
2) Autoimmune screening – lupus anticoagulant and anticardiolipin antibodies
3) Serum LH on D2/D3 of the cycle
4) Ultrasonography – to detect congenital malformations of the uterus, polycystic ovaries, and uterine fibroid
5) Hysterosalpingography in the secretory phase
6) Laryngoscopy
7) Karyotyping (husband and wife)
8) Endocervical swab to detect chlamydia, mycoplasma, and bacterial vaginosis
A pregnant lady in her first trimester presents with vaginal bleeding. On examination, the os is closed and the uterine size corresponds to the period of amenorrhoea. The condition could be:
Ans. D: Threatened Abortion
- Estimates report that up to 50% of all fertilized eggs abort spontaneously, usually before the woman knows she is pregnant. Among known pregnancies, the rate is approximately 10%.
- These usually occur between 7 and 12 weeks of gestation.
- The increased risk is associated with women over age 35, women with systemic disease (such as diabetes or thyroid dysfunction), and those with a history of 3 or more prior spontaneous abortions
- Threatened abortion-The process of abortion has started but has not progressed to a state from which recovery is impossible. It presents with painless, slight bleeding per vaginum. Digital examination reveals a closed external os. Uterine size corresponds to the period of amenorrhea.
- Inevitable abortion- The process of abortion has started and has progressed to a state where recovery is impossible. It presents with painful, increased bleeding per vaginum. Digital examination reveals a dilated internal os.
- Complete abortion- It presents with painless, slight bleeding per vaginum. Digital examination reveals a closed external os. Uterine size is smaller than the period of amenorrhea.
- Septic abortion presents with clinical evidence of infection of the uterus and its contents.
Ans A. i.e. Threatened abortion
The pregnancy test is positive in case of threatened abortion.
Threatened abortion
- Complaint- Spotting +/-, abdominal pain
- P/A- Height of uterus = period of gestation
- Internal OS- closed
- Diagnosis- USG- Live intrauterine pregnancy
- Management- Reassurance, Avoid intercourse
- Value of Bed rest and progesterone uncertain.
Ans. is C. i.e. Disproportionate increase
Threatened abortion:
- Persistence of dark-colored vaginal bleeding with the mistaken date showing a disproportionate increase in the size of the uterus is quite confusing on clinical examination.
- Bleeding may be only slight spotting, or it can be heavy.
- Pain and cramping are in the lower abdomen. They may be on one side, both sides, or in the middle. The pain can go into the lower back, buttocks, and genitals.
Ans. is A. i.e. First half of pregnancy
Threatened Abortion
- The clinical diagnosis of threatened abortion is presumed when bloody vaginal discharge or bleeding appears through a closed cervical os during the first 20 weeks.
- Bleeding in early pregnancy must be differentiated from implantation bleeding, which some women have at the time of the expected menses.
- Almost a fourth of women develop clinically significant bleeding during early gestation that may persist for days or weeks.
20 weeks pregnant woman present with per vaginal bleeding. On speculum examination, the os is open but no product is coming out. The most likely diagnosis is:
Ans. is C. i.e. Inevitable abortion
Inevitable abortion
- Complaint- Bleeding + Pain in abdomen
- P/A- Height of uterus = period of gestation
- Internal OS- open
- Diagnosis- USG-Live/Dead fetus
- Management- Insert vaginal misoprostol to complete the process
A female comes to gynae OPD for pre-conceptual counseling, with a history of two-second trimester abortions. What is the next investigation you will advise?
Ans. is A. i.e. TVS ( transvaginal sonography)
- The most common cause of second-trimester abortion is cervical uterine abnormalities.
- The next step would be to do an ultrasound and look for any structural uterine anomaly.
- Chromosomal abnormalities are a common cause of abortions in the first trimester.
In which type of abortion the gestational age corresponds to the uterine size?
Ans. A.Threatened
In Threatened abortion, the gestational age corresponds to the uterine size.
Threatened abortion
- Complaint- Spotting +/-, abdominal pain
- P/A- Height of uterus = period of gestation
- Internal OS- closed
- Diagnosis- USG- Live intrauterine pregnancy
- Management- Reassurance, Avoid intercourse
- Value of Bed rest and progesterone uncertain.
In a case of recurrent spontaneous abortion, the following investigation is unwanted ‑
Ans. is C. i.e. Testing for TORCH infections
Recommendation for the testing of couple presenting with recurrent miscarriage (≥3 miscarriages)
1. Basic investigations
- Obstetric and family history, age, BMI, organic solvents, alcohol, mercury, lead, caffeine, hyperthermia, smoking
- Full blood count (blood sugar level and thyroid function tests)
- Antiphospholipid antibodies (LAC and aLC)
- Parental karyotype
- Pelvic ultrasound (SIS) and/or hysterosalpingogram and hysteroscopy and laparoscopy in case of inconclusive findings
2. Research investigations within the context of a trial
- Feto-placental karyotypes
- Testing of uterine and/or peripheral blood NK cells
- Mannan-binding lectin (MBL) level
- Luteal phase endometrial biopsy
- Homocysteine/folic acid level
- Thrombophilia screening
Dilatation & evacuation is done for all except ‑
Ans. C. Threatened abortion
In a threatened abortion fetus is viable and hence Dilatation & evacuation are not to be done.
Threatened abortion
Complaint- Spotting +/- abdominal pain
P/A- Height of uterus = period of gestation
Internal OS- closed
Diagnosis- USG- Live intrauterine pregnancy
Management- Reassurance, Avoid intercourse.
Value of Bed rest and progesterone uncertain.
-Inevitable abortion means the process of expulsion of products of conception has become irreversible.
-The expulsion of products of conception has not occurred but it is bound to happen and nothing can be done to stop this process.
-When the entire products are not expelled, part of it is left inside the uterine cavity, it is called an incomplete abortion.