66 Obstetrics and Gynecology Board Review •••
❍ What are the common intrapartum complications associated with cervical cerclage placement?
Cervical lacerations occurring in 3 to 13% of patients, and cervical stenosis secondary to scarring in approximately
5% of patients.
❍ What type of cervical cerclage is currently the most common?
McDonald.
❍ What cervical cerclage involves the dissection of the anterior cervicovaginal mucosa just distal to the bladder
refection?
Shirodkar.
❍ Define cervical incompetence.
A repetitive, acute, painless, second trimester evacuation of the uterus without associated bleeding or contractions.
❍ How does the stroma of the cervix differ from the uterine corpus?
There is a relative lack of smooth muscle compared with the amount of collagenous and elastic tissue.
❍ Specify at least one indication for cervical cone biopsy during pregnancy.
Suspected microinvasion on colposcopy or colposcopy directed biopsy, or persistent cytologic evidence of invasive
disease not explained by colposcopy or cervical biopsy or adenocarcinoma in situ.
❍ What is the current maternal mortality associated with legal abortion in the United States?
<1 in 100,000.
❍ Osmotic dilators used for dilating the cervix prior to abortion include laminaria tents. What are laminaria
tents derived from?
Dried seaweed of the Japonicum species.
❍ What four complications almost equally contribute to the mortality related to legal abortion?
Embolism, infection, hemorrhage, and anesthesia.
❍ What is the reported incidence of uterine perforation at abortion?
0.2 per 100. However, the real incidence may be higher because of asymptomatic and unsuspected perforations.
❍ What are the two most common causes of post abortal hemorrhage?
Uterine hypotonus and retained products of conception.
❍ What is the treatment of post abortal bleeding if uterine atony is suspected to be the cause?
General uterine massage and parenteral uterotonics (oxytocin, methylergonovine, and 15-methylprostaglandin
F2 alpha).
❍ What combination of medications is approved for the use of “medical abortion” in the United States?
A combination of mifepristone (RU-486) and misoprostol.