Abortion Flashcards
Mention causes of bleeding in early pregnancy ?
★obstetric cause
1.abortion
2.ectopic pregnancy
3.gestational trophoblastic diseases
4.Hartman sign dt implantation and blood vessels erosion
5.decidual shedding before fusion bt decidua capsularis and decidua vara
★non obstetric causes
1.General:liver diseases and htn
2.Local: trauma,vaginitis, polyps,cervical erosion & carcinoma
Mention risk factors of spontaneous abortion
1.Advancing maternal age
2.Extremes of maternal weight
3.Low plasma folate levels
4.Previous spontaneous abortion
What are the fetal causes of spontaneous abortion?
★Chromosomal abnormalities most common cause
Aneuploidy 85% increases by increasing maternal age *autosomal trisomy 16 mc *monosomy turner
*Triploidy 10% tetraploidy 4.2%
★ congenital malformation caused by
1.Chromosomal and genetic abnormalities
2.Amniotic bands
3.Teratogens
*Teratogenic drugs isotretinoin
*Maternal diseases:uncontroled dm
*Physical stress: fever
*Environmental chemicals: mercury
Mention maternal causes of spontaneous abortion?
★Uterine and endometrial anomaly
1)Congenital uterine anomalies septate and bicornuate uterus .
2)Uterine fibroid submucous myomas
3)Uterine polyps
4)Intrauterine synechiae ashermann syndrome
5)Cervical insufficiency
★Endocrinopathy
1)Dm: first trimesteric abortion and fetal congenital malformation.
2)Progesterone deficiency in early pregnancy luteal phase defect
3)Thyroid dysfunction, Cushing S hyperprolactinemia&pcos.
★Immunological disorders: SLE&thrombophilia
*Hypercoagulable state antiphospholipid s
*allogenic factors
★Maternal infections cause 2nd trimesteric abortion than 1st trimesteric
*Fever causes release of prostaglandin that causes Uterine contraction
*Malaria may obstruct the blood vessels
★diseases: chronic htn cardiac or respiratory diseases.
Causes of spontaneous abortion are..
★Maternal causes
★Fetal causes
★Severe trauma : aminocentes , chorionic villus sampling external trauma
★Drugs and toxins
Chemo methotrexate
Prostaglandin misoprostol
Antiprogesterone mifeprodtone
NSAIDs around the time of conception
Large doses of caffeine,alcohol ,toxic gases ,some anaesthetic are rare causes
★Unexplained
Complete
Second trimesteric abortion occurs bt …,….of gestation
13_24 weeks
Mention causes of second trimesteric abortion
Early second trimesteric abortion (13-16 wks)
Similar to first trimesteric abortion chromosomal abnormalities,structural anomalies &endocrinal disorders .
Late second trimesteric abortion (18-24wks)
1)Placental separation
2)Ascending genital Infection
3)Cervical incompetence
Explain the pathology of
1)1st trimesteric abortion
2)2nd trimesteric abortion
3)Missed abortion
4)Chromosomal anomalies
1)Partial or complete separation of placenta with expulsion of the ovum or the embryo through dilated cervix
2)Uterine contractions occurs spontaneously or after rupture of membranes leading to cervical dilatation and expulsion of the fetus followed by the placenta
3)Reorganization of the hematoma and keep on viable placenta
4)Hydropic villous degeneration
What are the complications of abortion?
Bleeding
Prolonged bleeding dt incomplete evacuation
Severe bleeding in late first or 2nd trimesteric abortion
Postoperative bleeding dt: injury uterine perforation,cervical injury
Incomplete evacaution, infection, choriocarcinoma
Infection
Immediate complications
Septic shock ,renal failure &ARDS,DIC ,pelvic abcess pelvic thrombosis, septic emboli
Late complications
Intrauterine synechiae ashermann s tubal, peritoneal adhesion, chronic pelvic paIn infertility .
Traumatic complications of SEuterine perforation and cervical laceration
Hypofibrogenemia and DIC dt releasing thromboplastin like substance from ovum or placenta in case of missed abortion
Infection dt release of inflammatory cytokines and endotoxins
RH iso imunization if Rh -vr & didn’t receive anti D
Psychological trauma in PG
Maternal mortality dt infection, bleeding , thromboembolism, anaesthetic complications in case of SE
Management of spontaneous abortion
(Diagnosis+ttt)
Woman may present with menstrual Delay, symptoms of early pregnancy,vaginal bleeding and pelvic pain
Ist investigation is pelvic US then according to the type of abortion
1)Define threatened abortion
2)Mention symptoms and signs of threatened abortion
1)★it ia an attempt of the uterus to expel fertilized ovum.★ patial separation of fertilized ovum from uterine wall with minimal bleeding in choriodecidual space
★The Patient continues pregnancy in 70-80%of cases
2)symptoms. Minimal or mild vaginal bleeding with no blood clots.
Dull aching pelvic pain and heaviness
Signs
Uterine size corresponds to gestational age by LMP
Cervix is closed
mention investigations done in threatened abortion
1.B HCG levels correlates with pregnancy duratin 2.Tvs &TAs will show intact pregnancy with cardiac pulsation if >7weeks
Mild choriodecidual separation and Intrauterine bleeding in some cases
Mention ttt of threatened abortion
Expectant management untill symptoms resolve or it may progress
Active management
*Progesterone IM, oral &vaginl is routinely used with no sufficient evidance except in LPD
*Bed rest
Ant D in RH -ve women
Define missed abortion
Mention symptoms and signs of missed abortion
Definition:Retention of non viable products of conception dt viable placenta or exogenous progesterone .
Symptoms
1.Brownish vaginal discharge
2.Recurrant vaginal bleeding dark in colour
3.Breast milk discharge
4.Symptoms of early pregnancy become less pronounced
5.Pain is absent
Signs
Uterus size is smaller than gestational age
Cervix is closed
What are the investigations needed for Missed abortion?
Ultrasonography
Gestational sac≥ 25 mm that doesn’t contain a yolk sac or embryo
An embryo with a crown rump length≥7mm that doesn’t have cardiac activity
Coagulation profile to exclude DIC
