Williams Gynecology, Second Edition (Schorge,Williams Gynecology), 2nd Edition

CHAPTER 6
First-Trimester Abortion

6–1. More than 80 percent of spontaneous abortions occur in the first 12 weeks of pregnancy. What percent of these result from chromosomal anomalies?

a. 25

b. 35

c. 50

d. 75

6–2. Although most early pregnancy losses are clinically silent, approximately what percentage of all pregnancies are reportedly lost after implantation?

a. 11

b. 21

c. 31

d. 41

6–3. Which of the following chromosomal anomalies is most frequently identified with first-trimester abortion?

a. Triploidy

b. Monosomy X (45,X)

c. Autosomal trisomy

d. Balanced Robertsonian translocation

6–4. Maternal factors that contribute to euploid abortion include all EXCEPT which of the following?

a. Frequent alcohol use

b. Daily tobacco smoking

c. Dietary nutrient deficiency

d. Poorly controlled diabetes mellitus

6–5. Although moderate caffeine consumption is unlikely to cause spontaneous abortion, studies consistently warn that use above what daily amount of caffeine increases the risk for miscarriage?

a. 200 mg (2 cups of coffee)

b. 300 mg (3 cups of coffee)

c. 400 mg (4 cups of coffee)

d. 500 mg (5 cups of coffee)

6–6. Up to what percentage of women experience vaginal spotting or bleeding during early gestation?

a. 15

b. 25

c. 35

d. 45

6–7. Approximately what percentage of pregnancies abort in women experiencing early gestational bleeding?

a. 5

b. 20

c. 50

d. 60

6–8. A proven, effective therapy for threatened abortion includes which of the following?

a. Bed rest

b. Daily morning acetaminophen (Tylenol)

c. Increased oral fluid intake

d. None of the above

6–9. Which of the following should always be considered in the differential diagnosis of threatened abortion?

a. Paternal factors

b. Ectopic pregnancy

c. Minor maternal trauma

d. Oral contraceptive use

6–10. Your patient presents with complaints of vaginal spotting and a last menstrual period 6 weeks ago. Transvaginal sonography reveals the following, and fetal heart motion is seen. Your diagnosis is which of the following?

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a. Missed abortion

b. Incomplete abortion

c. Threatened abortion

d. All of the above

6–11. The same patient in Question 6–10 represents 2 weeks later with light bleeding and strong cramps. Her blood pressure is 132/78, pulse is 72, and she is afebrile. Her hematocrit is 40. Transvaginal sonography reveals the following. Appropriate management includes which of the following?

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a. Await spontaneous miscarriage

b. Excise cesarean scar pregnancy

c. Perform emergent cerclage placement

d. Administer intramuscular injection of methotrexate

6–12. While in your emergency department, the patient in Question 6–11 passes the tissue shown here. Her bleeding and pain have now subsided significantly. Your diagnosis is which of the following?

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a. Missed abortion

b. Complete abortion

c. Threatened abortion

d. None of the above

6–13. Appropriate management of this patient now includes which of the following?

a. Transvaginal sonography

b. Dilatation and curettage

c. Administration of Rho [D] immunoglobulin, if the patient is Rh negative

d. All of the above

6–14. To correctly define an incomplete abortion, which of the following must be present?

a. Abdominal cramping

b. Heavy vaginal bleeding

c. Dilated external cervical os

d. Dilated internal cervical os

6–15. The transvaginal sonogram shown below displays which of the following?

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a. Cervical pregnancy

b. Cesarean scar pregnancy

c. Intrauterine anembryonic gestation

d. None of the above

6–16. In 2005, the Centers for Disease Control and Prevention reported four septic abortion deaths following medical abortion. The deaths were all caused by toxic shock syndrome from which of the following bacterial infections?

a. Gonorrhea

b. Clostridium sordellii

c. Staphylococcus aureus

d. Streptococcus pyogenes

6–17. In women experiencing a spontaneous incomplete abortion without dangerous hemorrhage or infection, expectant management results in spontaneous completion in what percent?

a. 10

b. 30

c. 50

d. 80

6–18. Recurrent spontaneous abortion or recurrent miscarriage is formally defined by which of the following?

a. Two pregnancy losses in 10 years at 20 weeks’ gestation or less

b. Two consecutive pregnancy losses at 20 weeks’ gestation or less

c. Three or more consecutive pregnancy losses at 20 weeks’ gestation or less

d. Two consecutive pregnancy losses with fetal weights more than 500 grams

6–19. Which of the following is more likely to result in recurrent second-trimester losses?

a. Genetic factors

b. Infection

c. Autoimmune or anatomic factors

d. All of the above

6–20. Acquired defects that may lead to recurrent miscarriage include which of the following?

a. Leiomyoma

b. Asherman syndrome

c. Cervical incompetence

d. All of the above

6–21. Of müllerian defects, which has the lowest associated risk of recurrent miscarriage and is shown here in this three-dimensional sonographic image?

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a. Septate uterus

b. Arcuate uterus

c. Uterus didelphys

d. Unicornuate uterus

6–22. What percent of women with recurrent miscarriage have recognized autoimmune factors?

a. 5

b. 15

c. 30

d. 45

6–23. Early pregnancy loss is more common in women with which of the following?

a. Well-controlled type 2 diabetes mellitus

b. Human immunodeficiency virus (HIV) infection

c. Systemic lupus erythematosus with antiphospholipid antibodies

d. Marfan syndrome

6–24. Antiphospholipid antibodies can be correlated with adverse pregnancy outcome. Clinical and laboratory criteria include which of the following?

a. Serial detection of lupus anticoagulant

b. Three or more consecutive spontaneous abortion before 10 weeks’ gestation

c. Moderate to high levels of immunoglobulin G (IgG) or immunoglobulin M (IgM) anticardiolipin antibodies

d. All of the above

6–25. There are treatment regimens for antiphospholipid syndrome that increase live birth rates. A regimen proposed by the American College of Obstetricians and Gynecologists includes which of the following?

a. Low-dose aspirin daily

b. 5000 units vitamin D daily

c. Unfractionated heparin twice daily

d. Both low-dose aspirin daily along with unfractionated heparin twice daily

6–26. In asymptomatic women with recurrent miscarriage, screening for which of the following infections is indicated to find an underlying etiology?

a. Gonorrhea

b. Human immunodeficiency virus (HIV) infection

c. Chlamydia trachomatis infection

d. None of the above

6–27. An initial scheme for the evaluation of women with recurrent miscarriage includes all EXCEPT which of the following?

a. Partner karyotyping

b. Diagnostic laparoscopy

c. Uterine cavity evaluation

d. Antiphospholipid antibody syndrome testing

6–28. In the United States, how many pregnancies are electively (voluntary) terminated for every four live births?

a. 1

b. 2

c. 3

d. 4

6–29. Common complications of this method of first-trimester pregnancy termination include all EXCEPT which of the following?

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Reproduced, with permission, from Word L: Surgeries for benign gynecologic conditions. In Hoffman BL, Schorge JO, Schaffer JI, et al (eds): Williams Gynecology, 2nd ed. New York, McGraw-Hill, 2012, Figure 41-16.8.

a. Infection

b. Hemorrhage

c. Asherman syndrome

d. Incomplete abortion

6–30. Prior to surgical pregnancy termination, the device shown here is placed in preparation for pregnancy termination at 14 weeks’ gestation. The next day your patient chooses NOT to proceed with the abortion. You remove the laminaria and counsel her on which of the following?

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Reproduced, with permission, from Cunningham FG, Leveno KL, Bloom SL, et al: Abortion. In Williams Obstetrics, 23rd ed. New York, McGraw-Hill, 2010, Figure 9-6A.

a. Observation is recommended.

b. Abortion will spontaneously occur in most cases.

c. Oral antimicrobials are required to prevent infection.

d. Cerclage placement is required to sustain the pregnancy.

Reference

Centers for Disease Control and Prevention: Clostridium sordellii toxic shock syndrome after medical abortion with mifepristone and intravaginal misoprostol—United States and Canada, 2001–2005. MMWR 54(29):724, 2005

Chapter 6 ANSWER KEY

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