Abortion Flashcards
What is abortion?
What is the period of viability in Ghana? US? UK?(in terms of completed weeks and in terms of birth weight)
Abortion is a ddx of bleeding in which case?
State three ways abortion can be classified
What is gestation
How many weeks is the first trimester?
Second?
Third?
Abortion—
⎯ Termination of pregnancy before the period of viability
• Period of viability—the gestational age at which the foetus is capable of independent existence. i.e., the GA at which if born it will have a reasonable chance of survival
• Period of viability-–depends on the country.
• WHO’s definition—foetal viability is possible after 20 weeks of foetal life (22 weeks of amenorrhea. i.e., 22 completed weeks from the date of the onset of the last menstrual period)
• It is a differential diagnosis of bleeding in early pregnancy. Other ddx include ectopic pregnancy,infections,endometriosis
• Period of viability in Ghana— was defined as
⎯ From 28 completed weeks from the LMP(beginning of the last time she had her period),or ⎯ Birthweight greater than or equal to 1000g
Classification of abortion
A. Spontaneous (miscarriage)
B. Induced
- Safe
- Unsafe
i. Septic
ii. Non-septic
For abortion ,you have to wait until the case has been sent and sat in by court before you can carry out the abortion in a rape patient
Viable for Ghana is 28 weeks
22 weeks in US
25 in UK
First Trimester: Begins 2 weeks after the last menstrual period (2 weeks gestation) and extends until 13 weeks plus 6 days. Second Trimester: Begins at 14 weeks gestation and extends until 27 weeks and 6 days. Third Trimester: Begins at 28 weeks gestation and extends until delivery.
What is unsafe abortion
Unsafe abortion may be septic
Unsafe abortion
⎯ A procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills, or in an environment lacking the minimal medical standards, or both. (WHO (1992))
⎯ A procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills, or in an environment lacking the minimal medical standards, or both, and which causes, or is likely to cause acute or chronic ill-health or impaired reproductive function, or even death.
State nine complications of abortion
What is Asherman syndrome?
State three risk factors of spontaneous abortion
COMPLICATIONS OF ABORTION
1. Haemorrhage
2. Pelvic infection
3. Tubal infertility
- Ectopic pregnancy from blockage and damage to tubes. PID is a leading cause of ectopic pregnancy cuz the infection causes inflammation which can cause scarring which leads to blockage
- Intrauterine synechiae as a result of infection or secondary to curettage (Asherman syndrome= intrauterine synechiae + amenorrhoea/oligomenorrhoea+ infertility)
- Rh-alloimunisation if woman is Rh negative and baby is Rh positive. Require Anti-D immunoglobulin by deep IM within 72hrs of onset of bleeding)
Pregnant Rhesys negative women can have problems even if they bleed slightly while pregnant. Make sure you check for antibodies when this happens to prevent problems or to give the required protection drug. - Utrine perforation
- Psychological problems
- Maternal death
Spontaneous abortion (miscarriage)
Risk factors
• Reproductive history (increasing parity, hx of previous miscarriages, etc)
• Maternal age—frequency of clinical miscarriage increases with increasing maternal age
• Paternal age—rate of clinical miscarriage increases with increase in paternal age
State four early trimester causes of miscarriage
Four second trimester causes of miscarriage
Four causes that can happen in both trimesters
Causes of miscarriages
• Clinically, miscarriage is categorised as early (first trimester) and late (second trimester)
• More than 80% of clinical miscarriage occur in first trimester, with majority of this occuring in the embryonic period (6-8 weeks)
Early trimester causes
1. Chromosomal
2. Smokingandalcohol-–theseareembryotoxins
- Insufficientlypreparedendometrium
⎯ Luteal phase defect before conception
⎯ Oligomenorrhoea
⎯ hCG-dependent progesterone deficiency after conception - LHhypersecretionduringfollicularphase
- Genetic(chromosomal)
- Immunological(alloimune)factors
- Hostileendometrium—endometriumcontainingahostileleukocyte population
Second trimester causes
i. Uterine anomalies [congenital and acquired such as bicornuate uterus, unicornuate uterus with rudimentary horn, severe septate uterus, submucous leiomyomata(Uterine leiomyomata (another plural form of “leiomyoma”) A benign smooth muscle tumor, usually in the uterus or gastrointestinal tract. Also called fibroid.) , intrauterine synechiae (adhesions), adenomyosis(when a viable endometrial tissue forms in the myometrium ,etc]
ii. cervical incompetence(repeated D&C can cause incompetence because the cervix keeps being forcefully opened and soon it loses its ability to close well)
iii. Endocrine factors (hypothyroidism, presence of anti-thyroid antibodies, poorly controlled Diabetes Mellitus)
iv. Thrombophylias(coagulationproblems)
Both trimester causes
A. Idiopathic causes
B. Antiphospholipid syndrome
C. Febral (pyrexial) illnesses—e.g., malaria, thyphoid
D. Lower genital tract infections specifically bacterial vaginosis
State the types of placenta previa
https://fpnotebook.com/mobile/ob/Bleed/PlcntPrv.htm
Look for shutter stock pictures of placenta praevia for better understanding
Type 1: Low Implantation
Lower placenta margin dips into lower uterine segment
Edge lies within 2 to 3.5 cm of internal cervical os
Type 2: Marginal Placenta
Placenta within 2 cm of internal os, does not cover
Type 3: Partial Previa
Placenta covers internal os when closed
Placenta does not cover os when fully dilated
Type 4: Complete Previa (Central Previa)
Placenta covers internal os even when fully dilated
What are the clinical categories of miscarriage
State the clinical features of each type of miscarriage
What is a sign of inevitable abortion
What is blighted ovum?
Internal os is used to diagnose miscarriage
Induced abortions usually come as incomplete miscarriages
CLINICAL CATEGORIES OF MISCARRIAGE (CLINICAL FEATURES)
Types of miscarriage
These are the clinical features :
Vaginal bleeding(Slight, moderate, severe)
Abdominal pain(Nil, mild, moderate, severe)
Cervical os Dilated?(Yes, No)
POC (products of conception) passed?(Yes, No)
Uterine size versus dates(Equal, smaller, larger)
So for Threatened abortion,
Vaginal bleeding is Slight,abdominal pain is Nil/mild,cervical os is not dilated,POC is not passed,uterine size vs the date is equal equal.
Inevitable abortion, Vaginal bleeding is Severe ,abdominal pain is Severe,cervical os is dilated,POC is not passed,uterine size vs the date is equal equal
Incomplete abortion,Vaginal bleeding is Severe ,abdominal pain is Severe,cervical os is dilated,POC is passed,uterine size vs the date is smaller
Complete abortion Vaginal bleeding is nil/slight,abdominal pain is nil or mild ,cervical os is not dilated,POC is passed,uterine size vs the date is smaller
Delayed (silent or missed) abortion Vaginal bleeding is mild,abdominal pain is nil or mild ,cervical os is not dilated,POC is not passed,uterine size vs the date is smaller
• Rupture of membranes with loss of amniotic fluid is a sign of inevitable abortion
• Blighted ovum (anembryonic gestation)—a gestational sac is present in the uterus but it is empty, even though it has reached a size at which it should contain a foetal pole. No bleeding, or slight bleeding. Pain is absent
State three investigations for miscarriage
How is it treated?
INVESTIGATIONS
• B-hCG (urine and quantitative)
• USG (transabdominal, transvaginal)
• Others, depending on the situation
TREATMENT
• Resuscitation
• Pain relief
• EOU-Evacuation of the Uterus for miscarriage treatment:
pregnancy tissue to be removed rather than wait for it to be expelled naturally
• Antibiotics
• Others depending on the situation
CONCLUSION
• Abortion is one of the causes of bleeding in early pregnancy
• Abortion is the termination of pregnancy before the period of viability
• Period of viability in Ghana— defined as
⎯ From 28 completed weeks from the LMP, or ⎯ Birthweight greater than or equal to 1000g
4-Feb-2022
