AIIMS Raipur NO - 2017 (Shift-1)
Obstetrics & Gynaecology
Easy
The active management of patient with missed abortion at 12 weeks of gestation includes?
Appeared in: AIIMS Raipur NO - 2017 (Shift-1)
Explanation
- Suction evacuation, also known as vacuum aspiration or suction curettage, is the standard surgical procedure for uterine evacuation in the first trimester (up to 12-14 weeks).
- At 12 weeks, the fetal and placental tissues are soft and small enough to be effectively removed by suction through a cannula inserted into the uterus.
- This method is considered safer and more effective than medical management or sharp curettage alone for first-trimester missed abortions, with lower rates of incomplete evacuation and complications.
Why Other Options Were Wrong
- Option A: This term is too general. While suction evacuation is a form of vaginal evacuation, it is not the most specific or precise term for the standard procedure.
- Option B: The myometrium in the first trimester has a low concentration of oxytocin receptors, making it relatively insensitive to oxytocin. Therefore, an oxytocin drip is ineffective for inducing uterine contractions at 12 weeks.
- Option C: Laminaria tents are used for cervical ripening, which is a preparatory step performed hours or a day before the surgical evacuation. It is not the active procedure of evacuation itself.
Related Visual
- Visual 1: Diagram - Illustration of a suction evacuation procedure, showing the cannula inserted through the cervix into the uterus and connected to a suction source.
- Visual 2: Infographic - Comparison table of management options for first-trimester abortion (Expectant, Medical, Surgical), highlighting the efficacy, time to completion, and potential complications of each.
Clinical Relevance
- Nursing practice connection: Use the key finding related to Management of first-trimester missed abortion to guide bedside assessment, documentation, and the next nursing action.
- Nurses must be knowledgeable about the different methods of managing pregnancy loss to provide accurate patient education, prepare patients for procedures, and manage post-procedural care.
- A critical nursing responsibility is to administer Rhₒ(D) immune globulin to Rh-negative patients after any type of abortion to prevent Rh isoimmunization, which can affect future pregnancies.
- What if? - If the patient was at 16 weeks of gestation (second trimester), the procedure would be a Dilation and Evacuation (D&E), which requires more extensive cervical preparation (often with laminaria over 1-2 days) and the use of forceps to remove larger fetal parts, in addition to suction. Medical induction with agents like misoprostol would also be a primary option.
How to Approach the Question
- First, identify the key clinical parameters in the question: 'active management', 'missed abortion', and '12 weeks of gestation'.
- Recognize that 12 weeks falls at the end of the first trimester. Management strategies for abortion differ significantly between the first and second trimesters.
- Evaluate the options based on first-trimester protocols. 'Active management' implies an intervention to empty the uterus.
- Analyze 'Suction evacuation'. This is the standard surgical procedure for the first trimester.
- Analyze 'Oxytocin drip'. Recall that uterine sensitivity to oxytocin is low in the first trimester.
- Analyze 'Laminaria tent'. Identify this as a method for cervical preparation, a step before the main procedure, not the evacuation itself.
Concept Tested & Keywords
- Concept Tested: Management of first-trimester missed abortion.
- Stem keywords: active management, missed abortion, 12 weeks of gestation
- Lead-in keywords: BEST, MOST RELEVANT CLUE
- Clinical cues: Gestational age of 12 weeks is a key cue, indicating a first-trimester pregnancy, which dictates the appropriate management method.
Question ID
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Practise the full AIIMS Raipur NO - 2017 (Shift-1)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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