Abortion

Question 1

Who definition of Abortion?

Answer 1

Termination of a pregnancy under 20 weeks gestation with expulsion of a fetus under 500gr

Question 2

Classification of Abortion?

Answer 2

Induced Abortion - Elective, Therapeutic Abortion
Spontaneous Abortion - Threatened, inevitable, incomplete, complete, missed
Septic Abortion - infection
Habitual Abortion - more than 3 consecutive abortions

Question 3

Causes of Spontaneous Abortion?

Answer 3

Maternal - Infections, Trauma, Endocrine, maternal malnutrition
Fetal - chromosomal abnormalities (70%), faulty implantation of the embryo
Placental - Previa, Abruption

Question 4

Types of Abortion according to time?

Answer 4

<12 weeks - Early Abortion - Elective and therapeutic
>12 weeks - late Abortion - only Therapeutic
>20 weeks - Stillbirth

Question 5

Types of induced Abortion?

Answer 5

1. Elective - <12 weeks, at request of patient. NOT due to maternal risk. BEFORE Fetal viability
2. Therapeutic - if mothers life is at risk. Rape/incest. If risk of child with severe physical deformities

Question 6

Spontaneous Abortion - Threatened Abortion. CP. Treatment

Answer 6

Vaginal bleeding in first half of pregnancy 
50% -> normal pregnancy 
50% -> inevitable Abortion 
CP 
Vaginal bleeding 
Closed cervix
US - Viable fetus with heartbeat 
Treatment - Bed rest + Progesterone and Magnesium

Question 7

Spontaneous Abortion - Inevitable Abortion. CP. Treatment

Answer 7

Rupture of membranes -> pregnancy no longer viable 
CP
Excessive bleeding
Dilated cervix
No passage of POC 
US - Gestational sac seen, no heartbeat 
Treatment - D&C

Question 8

Spontaneous Abortion. Incomplete. CP. Treatment

Answer 8

Retention of some POC 
CP
Bleeding 
Dilated cervic 
Some POC delivered, some not 
US - some contents remain
Treatment - D&C

Question 9

Spontaneous Abortion. Complete. CP. Treatment

Answer 9

All POC expelled. 
CP
Slight bleeding, gradually diminishes 
Closed cervix
US - empty cavity
No treatment

Question 10

Spontaneous Abortion. Missed Abortion

Answer 10

Death of fetus without the onset of Labour. Retention of POC
CP
No vaginal bleeding
Closed cervical OS 
Regression of pregnancy symptoms 
No Fetal movements
US - no heartbeat

Question 11

What happens of the gestation after missed Abortion?

Answer 11

1. Carneous mole - mass of blood clots

2. Macerated fetus - collapses skull bones, blood in abdomen, degenerated organs

Question 12

Treatment of missed Abortion?

Answer 12

Most cases - spontaneous expulsion

If not - Surgical Abortion

Question 13

Causes of Septic Abortion. CP. Treatment

Answer 13

Pathogens from vaginal + bowel flora 
Usually due to criminal Abortion 
CP
Pyrexia, malaise, sweating. 
POC may be retained - oxytocin given - > expulsion of remaining contents. 
Treatment - Abx, fluids, bed rest

Question 14

What are the complications of Abortion?

Answer 14

Immediate (<3 hours) - bleeding, cervical injury, uterine perforations
Delayed (>3 hours) - Infection, Ashermans syndrome (scarring of uterine cavity - leads to menstrual abnormalities and infertilisation), Rh sensitization

Question 15

D&C

Answer 15

First trimester abortions

1. Dilation
2. Currete used to cut fetus into pieces
3. Scrape contents into basin

Question 16

Suction Aspiration

Answer 16

First trimester
Dilation
Suction catcher with knife tip inserted and contents are suctioned.
99% effective

Question 17

Dilation and Evacuation

Answer 17

2nd and 3rd trimester
Dilation of cervic
Baby dismembered in utero and removed peice by peice
Baby resembled by nurse to make sure the cavity is empty

Question 18

Which drugs are used for medical Abortion?

Answer 18

1. Methotrexate
2. Misoprostol
3. Mifipristone