Threatened Abortion
| A | Minimal vaginal bleeding | |
| B |
Pain follows bleeding |
|
| C |
Uterine size corresponds to gestational age |
|
| D |
Manifests at an early age |
Ectopic pregnancy differs from threatened abortion by :
| A |
Minimal vaginal bleeding |
|
| B |
Pain follows bleeding |
|
| C |
Uterine size corresponds to gestational age |
|
| D |
Manifests at an early age |
Ans. D. i.e. Manifests at an early age
This is a tough one : as it is quite difficult to differentiate between Ectopic pregnancy and threatened abortion on the clinical grounds.
|
Ectopic pregnancy
|
Abortion (Threatened)
|
In ectopic pregnancy as well as threatened absorption – amount of bleeding is slight.
| A | Antibiotic Prophylaxis even with unruptured membranes | |
| B |
Metronidazole if asymptomatic but significant bacterial vaginosis |
|
| C |
Antibiotics if asymptomatic but significant bacteremia |
|
| D |
Antibiotics for Preterm Premature Rupture of Membranes |
- The lady in the question at 32weeks of gestation with features of threatened abortion such as closed cervical os, intact membranes and without expulsion of products of conception is in preterm labor.
- Since threatened abortion is said to occur before 22weeks of gestation.
- There is no benefit from the use of antibiotics for the prevention of preterm labor in women with an intact membrane.
- Antibiotics along with other measures are used to prevent and treat preterm labor, especially in the setting of chorioamnionitis which occurs in the case of the ruptured membrane.
Mifepristone may be used for all of the following, EXCEPT:
| A |
Threatened Abortion |
|
| B |
Ectopic pregnancy |
|
| C |
Fibroids |
|
| D |
Molar Pregnancy |
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.
| A | ||
| B |
Ectopic Abortion |
|
| C |
Both |
|
| D |
None |
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.
| A |
Smaller than expected |
|
| B |
Unchanged |
|
| C |
Disproportionate increase |
|
| D |
None of the above |
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.
| A |
The first half of pregnancy |
|
| B |
The second half of pregnancy |
|
| C |
Third trimester |
|
| D |
All |
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.
