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OBGYN > 16. spontaneous abortion > Flashcards

16. spontaneous abortion Flashcards

1
Q

what is considered spontaneous abortion (miscarriage)?

A

a pregnancy that ends before 20 weeks gestation

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2
Q

what is the most common type of spontaneous abortion?

A

Early pregnancy loss, which occurs in the first trimester (first 12 weeks),

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3
Q

how many pregnancies end in spontaneous abortion?

A

15-25% of all pregnancies

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4
Q

what is Biochemical pregnancy (subclinical abortion)?

A

the presence of β-hCG in blood of a women 7-10 days after ovulation, but menstruation occurs when expected. Conception has occurred, but spontaneous loss of gestation took place without prolongation of the menstrual cycle

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5
Q

are signs or pregnancy seen in an US of a biochemical pregnancy (subclinical abortion)?

A

no

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6
Q

60-80% of all SAB during the first trimester are associated with ?

A

abnormal chromosomes

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7
Q

risk factors for spontaneous abortion (other than abnormal chromosomes)

A
  1. Abnormalities of the reproductive tract: septate uterus, leiomyoma, uterine adhesions/scarring, cervical incompetence
  2. Systemic diseases: diabetes, hypercoagulability, thyroid disorders, SLE, APS
  3. Environmental factors: maternal toxin exposure, maternal smoking and alcohol consumption
  4. Increased maternal age
  5. Trauma
  6. Infection with mycoplasma, toxoplasma, listeria
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8
Q

how are spontaneous abortions classified?

A

whether any or all of the products of conception (POC) have passed, and whether or not the cervix is dilated.

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9
Q

what is threatened abortion?

A

Any vaginal bleeding before 20 weeks, without
dilation of the cervix or expulsion of any POC
(normal pregnancy with bleeding).

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10
Q

what is inevitable abortion?

A

No expulsion of products, but vaginal bleeding
and cervical dilation such that a viable pregnancy
is unlikely.

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11
Q

what is incomplete abortion?

A

Partial expulsion of some but not all POC before
20 weeks gestation.

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12
Q

what can be seen on the US of an incomplete abortion?

A

retained POC

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13
Q

what is a complete abortion?

A

Complete expulsion of all POC before 20 weeks
gestation.
*cervix is closed

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14
Q

what is missed abortion?

A

Death of the embryo or fetus before 20 weeks
gestation with complete retention of all POC.

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15
Q

what work up should be done in case of a suspected spontaneous abortion?

A
  1. Pelvic examination- in all cases of vaginal bleeding.
  2. Labs β-hCG, CBC, blood typing.
  3. Pelvic US is used to evaluate fetal viability and normal placentation.
  4. TVUS should be considered when there is an abnormal fetal cardiac activity or confirmed uterine bleeding.
  5. Consider work-up for recurrent pregnancy losses.
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16
Q

management for threatened abortion?

A
  1. Expectant management (pelvic rest, nothing per vagina); vaginal bleeding may resolve spontaneously
  2. F/U weekly with pelvic US
17
Q

management for incomplete, inevitable, or missed abortion

A
  1. incomplete- maybe expectant management
  2. Medical evacuation (use before 6 w’ gestation)
    *Misoprostol (PGE1 analog) induces cervical dilation, uterine contractions, and expulsion of POC
    * Mifepristone (progesterone antagonist) given 24-48 h’ before misoprostol
    *Oxytocin
  3. Surgical evacuation (use if 0-12 w’ gestation)
    D&C; preferred method in septic abortion or if there is heavy bleeding or significant maternal disease.
18
Q

what are the complications to consider in case of surgical evacuation (D&C)?

A

uterine perforation, bleeding, endometritis, intrauterine adhesions

19
Q

management for complete abortion?

A

No treatment needed
F/U for recurrent bleeding and/or signs of infection

20
Q

complications of spontaneous abortion

A
  1. endometritis +/- sepsis → retained POC become infected.
  2. Asherman syndrome → the presence of intrauterine synechiae or adhesions (scar tissue), secondary to intrauterine surgery (D&C) or infection
  3. Rh-alloimmunization
21
Q

treatment in case of endometritis +/- sepsis from an abortion?

A

broad-spectrum antibiotics, surgical evacuation of the uterine cavity
*Retained products of conception may result in the release of thromboplastin into the systemic circulation → DIC

OBGYN (60 decks)

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