Master the board step 3

Obstetrics
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Medical abortion through the use of oral mifepristone (Mifeprex, a progesterone
antagonist) and oral misoprostol (Cytotec, prostaglandin E1) is
an alternative to surgical abortion. It may only be used in the first 63 days
of amenorrhea. Approximately 2 percent abort incompletely and require
D&C. Clostridium sordellii sepsis can occur in rare cases.
Spontaneous Abortion/Fetal Demise
Death of an embryo or fetus has various different terms based on the gestational
age or weight at the time of in utero death.
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Spontaneous abortion is the expulsion of an embryo/fetus < 500 g or < 20
weeks’ gestation. It most commonly initially presents with uterine pain and
vaginal bleeding.
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Fetal demise is the in utero death of a fetus after 20 weeks’ gestation. The
most common symptom is a loss of fetal movements.
Spontaneous Abortion
Type Ultrasound Finding Treatment
Complete
Incomplete
Inevitable
Threatened
Missed
No products of conception;
cervix closed
Some products of conception
present; cervix closed
Products of conception
present; intrauterine
bleeding; dilation of cervix
Products of conception
present; intrauterine
bleeding; no dilation of
cervix
Fetus is dead but remains in
uterus
Follow up with β-hCG
Dilation and curettage (D&C)
Medical induction or D&C
Bed rest
Medical induction or D&C
Septic Infection of the uterus D&C and IV levofloxacin and
metronidazole
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