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Abortion and Recurrent Pregnancy Loss
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1
Question
What is the medical definition of abortion?
Page 1
Answer
Expulsion of the products of conception before 20 weeks of gestation or fetal weight less than 500 grams.
2
Question
Distinguish between spontaneous and induced abortion.
Page 1
Answer
Spontaneous abortion is natural expulsion without intervention; induced abortion is deliberate termination by medical or surgical means.
3
Question
What are the main types of spontaneous abortion?
Page 2
Answer
Threatened, inevitable, incomplete, and complete.
4
Question
Define threatened abortion.
Page 2
Answer
Vaginal bleeding in early pregnancy with closed cervical os, viable fetus, and no passage of tissue.
5
Question
What characterizes inevitable abortion?
Page 2
Answer
Vaginal bleeding with cervical dilatation, but products of conception not yet expelled.
6
Question
Define incomplete abortion.
Page 2
Answer
Partial expulsion of products of conception, with some retained in the uterus.
7
Question
What is complete abortion?
Page 2
Answer
Complete expulsion of products of conception from the uterus.
8
Question
Classify induced abortion.
Page 2
Answer
Therapeutic (medically indicated) and criminal (illegal or non-medical).
9
Question
List common causes of spontaneous abortion.
Page 3
Answer
Chromosomal abnormalities, maternal infections (TORCH), endocrine disorders, anatomical issues, immunological factors.
10
Question
What infections are associated with spontaneous abortion via TORCH?
Page 3
Answer
Toxoplasmosis, Other (syphilis, etc.), Rubella, Cytomegalovirus, Herpes simplex.
11
Question
Describe signs of threatened abortion.
Page 3
Answer
Vaginal spotting or bleeding, mild abdominal cramps, closed cervix, viable pregnancy on ultrasound.
12
Question
What lab findings suggest miscarriage in threatened abortion?
Page 3
Answer
Decreasing beta-hCG levels or non-viable fetal cardiac activity on ultrasound.
13
Question
Define recurrent pregnancy loss (RPL).
Page 4
Answer
Three or more consecutive spontaneous abortions before 20 weeks.
14
Question
What genetic causes contribute to recurrent pregnancy loss?
Page 4
Answer
Parental balanced translocations, aneuploidy in products of conception.
15
Question
List endocrine causes of recurrent pregnancy loss.
Page 4
Answer
Luteal phase defect, thyroid dysfunction, diabetes, polycystic ovary syndrome.
16
Question
What anatomical factors lead to recurrent pregnancy loss?
Page 4
Answer
Uterine septum, bicornuate uterus, cervical incompetence.
17
Question
Describe infectious causes of recurrent pregnancy loss.
Page 4
Answer
Chronic endometritis, bacterial vaginosis, subclinical infections.
18
Question
What thrombophilias are linked to recurrent pregnancy loss?
Page 4
Answer
Antiphospholipid syndrome, factor V Leiden, prothrombin mutation.
19
Question
What investigations are recommended for recurrent pregnancy loss?
Page 5
Answer
Parental karyotyping, uterine cavity evaluation (HSG/HS), thyroid function tests, antiphospholipid antibodies.
20
Question
How is luteal phase defect diagnosed in RPL?
Page 5
Answer
Endometrial biopsy showing out-of-phase endometrium or short luteal phase on progesterone levels.
21
Question
What is the role of hysteroscopy in RPL evaluation?
Page 5
Answer
Direct visualization and correction of intrauterine abnormalities like polyps or septum.
22
Question
Management of threatened abortion includes what?
Page 6
Answer
Bed rest, avoid intercourse, serial beta-hCG and ultrasound monitoring, progesterone supplementation if indicated.
23
Question
What is the prognosis for threatened abortion?
Page 6
Answer
About 50% progress to viable pregnancy if bleeding stops and fetal heart is seen.
24
Question
In recurrent pregnancy loss with luteal phase defect, what treatment?
Page 6
Answer
Progesterone supplementation from ovulation to 12 weeks.
25
Question
How to manage anatomical causes of RPL like uterine septum?
Page 6
Answer
Surgical correction via hysteroscopic metroplasty.
26
Question
What is unexplained recurrent pregnancy loss?
Page 7
Answer
RPL after full evaluation with no identifiable cause.
27
Question
Congenital anomalies associated with RPL include what?
Page 7
Answer
Mullerian malformations like bicornuate or septate uterus.
28
Question
What is cervical incompetence?
Page 7
Answer
Painless cervical dilatation leading to mid-trimester loss.
29
Question
Investigations for cervical causes of RPL?
Page 7
Answer
History of second-trimester losses, transvaginal ultrasound for cervical length.
30
Question
What is Asherman's syndrome and its relation to RPL?
Page 7
Answer
Intrauterine adhesions causing infertility or recurrent loss; treated by hysteroscopic adhesiolysis.