Abortion and Medical Termination of Pregnancy MCQs

The purpose of the Lash and Lash operation is to correct the defect in the cervical wall and restore competence to the cervix, thereby allowing gestation to proceed to term. Lash and Lash operation is a pervaginal procedure done in non pregnant females Benson Durfee is an abdominal cerclage procedure that can be done oin bothe pregnant as well as non pregnant females. Wurms cerclage is an emergency cerclage procedure done during pregnancy Still, Laparoscopic cerclage is the most preferred operative procedure in non pregnant females.

Setting standards of emergency obstetrics and newborn care: Basic emergency obstetric and newborn care provided in health centres, large or small include the facilities for: Administration of antibiotics, oxytocics and anticonvulsants. Manual removal of the placenta. Removal of retained products following miscarriage or abortion. Assisted vaginal delivery preferably with vacuum extractor. Comprehensive emergency obstetric and newborn care, typically delivered in district hospital, includes all basic functions above, plus cesarean section, safe blood transfusion and care to sick and low birth weight newborns including resuscitation. It is recommended that for every 5,00,000 people there should be 4 facilities offering comprehensive essential obstetric care. Reference: KDT 6/e, p 251,484,488,Dutta Obs 7/e, p 288

Explanation: Maternal mortality refers to the death of a woman during pregnancy or within 6 weeks (42 days) after its termination. WHO Definition: Maternal mortality is defined as the annual number of deaths of women from causes related to or worsened by pregnancy or its management (excluding accidental or incidental causes), occurring during pregnancy or within 42 days of its end, regardless of the pregnancy's duration or location. Late Maternal Death: This refers to the death of a woman from direct or indirect obstetric causes occurring more than 42 days but less than one year after the end of pregnancy. Options A, B, and C are incorrect. Reference: https://www.who.int/data/gho/indicator-metadata-registry/imr-details/4622 https://sciencedirect.com/topics/medicine-and-dentistry/maternal-mortality

Explanation: Autosomal recessive inheritance is the single largest category of Mendelian disorders. They have following features: The trait does not usually affect the parents but siblings may show the disease (Option "c" is correct). Siblings have one chance in four of being affected (i.e. recurrence risk is 25% for each birth). Consanguineous marriage may be the cause ( Option "a" is correct). The expression of the defect tends to be more uniform than in autosomal dominant disorders. Complete penetration is common (Option "b" is correct). Onset is frequently early in life. In the question the lady has recurrent abortions and H/o autosomal recessive disorder in the family, therefore all features of autosomal recessive disorders apply to her.

Normal FSH values range from 5 to 20 mzU/mL. in the question, FSH levels are 6 mzU/mL, that means this is a case of secondary amenorrhea with normal FSH values. In case of pituitary failure - as is evident from the flow diagram ® values of FSH should be lower than the normal values. So Option 'd' is ruled out Incase of ovarian failure → estrogen is deficient so negative feedback on FSH will be absent, thus values of FSH will be more than normal. In case of ovarian failure/menopause, FSH is above 40 m IU/mL so option a is also ruled out. Normal FSH and amenorrhea point towards uterine pathology. The patient had a spontaneous abortion following which a curettage is generally required which would be responsible for intrauterine synechiae (Asherman's Syndrome). Thus, the most probable diagnosis is uterine synechiae. Reference : Leon speroff 7 th /ed, pg no: 415-425.

Clinical features and diagnosis of different types of Abortions In the question, os is open, size of uterus corresponds to period of amenorrhea and product of conception cannot be seen coming out from os.Thus, it indicates inevitable abortion. Reference: Dutta Obs 7/e, p 161, 162

Dead fetuses, if retained for more than 4 to 5 weeks, release thromboplastin which leads to DIC (consumptive coagulopathy). In the question, the fetus has been dead and has been retained for five weeks so there are increased chances of DIC. Reference: : Dutta Obs. 7/e, p 325

As discussed in previous question TORCH infection do not lead to recurrent abortion. SLE is an established cause for recurrent abortion SLE is associated with antiphospholipid syndrome (anti-cardiolipin antibodies) and is known to cause recurrent abortions. RH incompatibility is a known cause for spontaneous abortion and may lead to recurrent abortions if it remains unrecognized. Syphillis also does not lead to recurrent abortions but if you have to rule out one option between TORCH infection and syphilis go for TORCH infection. Reference: 'Pre-test' Obstetrics and Gynaecology 11/e, p 68.