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RGU 2 > Abortion > Flashcards

Abortion Flashcards

1
Q

Are spontaneous abortions very very common?

A

YES

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2
Q

What is abortion?

A
  • TERMINATION of PREGNANCY either spontaneous “miscarriage” or intentionally before the fetus develops sufficiently to survive.
  • termination prior to 20 weeks gestation or less than 500 g.
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3
Q

What are the 2 important questions we need to consider in the first trimester?

A
  1. Location (where is it)= Ultrasound.

2. Quality (B-hCG…)

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4
Q

What is your dDx for first trimester bleeding?

A
  • extrauterine= ectopic
  • intrauterine= early intrauterine pregnancy (IUP), threatend spontaneous abortion (SAb), inevitable SAb, complete SAb, Missed SAb, or blighted ovum (anembryonic pregnancy).
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5
Q

What 2 things will tell you what is happening to your patient?

A
  • ultrasound

- B-hCG

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6
Q

What is the discriminatory zone?

A
  • B-hCG titer at which intrauterine gestational sac is reliably seen with transvaginal US (1,500-2,000 mIU/mL).
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7
Q

What B-hCG dynamic indicates a normal pregnancy?

A
  • doubling in 48 hours
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8
Q

What is the first anatomic structure that can be identified within the gestational sac?

A
  • yolk sac (spherical with echogenic periphery and sonolucent center).
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9
Q

** What is a COMPLETE spontaneous abortion “miscarriage”?

A
  • placenta detaches, bleeding, and expulsion of products of conception (POC), cervical os then closes.
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10
Q

** What is an INCOMPLETE spontaneous abortion “miscarriage”?

A
  • placenta detaches, os opens, bleeding, may pass some of POC, os remains OPEN.
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11
Q

** What is a THREATENED spontaneous abortion “miscarriage”?

A
  • bleeding but CERVIX is CLOSED, no expulsion of POC.

* sometimes this just goes away and everything is fine.

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12
Q

** What is an INEVITABLE spontaneous abortion “miscarriage”?

A
  • fluid leaking, bleeding and CERVIX is DILATED, no expulsion of POC.
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13
Q

** What is a MISSED spontaneous abortion “miscarriage”?

A
  • uterus retains the POC, no fetal heart tones (FHTs), os closed. No symptoms.
  • usually detected on ultrasound/doppler at prenatal visit.
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14
Q

** What is RECURRENT spontaneous abortion “miscarriage”? (also called “habitual aborter”)

A
  • 3 or more consecutive spontaneous abortions.

* must investigate as to why this happens. Usually chromosomal.

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15
Q

What major risk do mothers face with Missed Ab?

A
  • DIC after 4-5 weeks :(
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16
Q

What is the pathophysiology of abortion?

A
  • many different reasons, but hemorrhage begins into the decidua basilis followed by necrosis of the tissues adjacent to the bleeding.
  • the ovum detaches, uterine contractions begin, and POC expelled.
17
Q

When do 80% of most spontaneous abortions occur?

A
  • 1st twelve weeks of gestation.

* half are from chromosomal anomalies (usually trisomy).

18
Q

What increases incidence of abortion?

A
  • age
  • parity
  • conception within 3 months of a full term delivery.
19
Q

What are some causes of spontaneous abortion?

A
  • infections
  • hypothyroidism
  • progesterone deficiency
  • drugs and alcohol
  • autoimmune: antiphospholipid antibodies (lupus, anticardiolipin antibody)= placental infarctions and thrombosis.
  • thrombophilias
  • Asherman’s syndrome
  • insufficient cervix (habitual aborters).
20
Q

How do you evaluate for a spontaneous abortion?

A
  • focused PE:
  • vaginal exam to see where bleeding is coming from.
  • pelvic exam
  • ULTRASOUND
  • LABS
21
Q

What labs should you order if you suspect spontaneous abortion?

A
  • B-hCG
  • blood count
  • blood type (RHoGAM if indicated for Rh - status)
22
Q

How do you manage/treat?

A
  • observation
  • medical (misoprostol or methotrexate)
  • surgical (D&E)
  • laminaria (seaweed that dilates the cervix)
  • emotional support (don’t forget about dad)
  • follow B-hCG until reaches zero.
23
Q

What is elective and therapeutic termination/

A
  • medical or surgical termination of pregnancy before time of fetal viability.
  • THERAPEUTIC= if medically indicated (cervical cancer, heart disease, rape, incest, fetus with significant anatomical deformities not compatible with life).
  • ELECTIVE= voluntary interruption of pregnancy before viability at the woman’s request with no medical indication.
24
Q

On what is the termination procedure based?

A
  • gestational age
25
Q

How is termination performed?

A
  • D&C or D&E= dilation and curettage/evacuation. Cervix is dilated and uterine contents are removed (scraped/suctioned out with a curette).
  • Done up to 20 weeks in some states.
26
Q

How late can you offer medical abortion?

A
  • up to 49 days gestation (mioprostol +/- mifepristone)
27
Q

What is Mifepristone? (PICMONIC)

A
  • reverses the progesterone that acts by stabilizing the pregnancy and inhibiting contractions.
28
Q

What is Misoprostol? (PICMONIC)

A
  • prostaglandin that stimulates the myometrium to contract and expel POC.
29
Q

What is methotrexate? (PICMONIC)

A
  • antimetabolite that inhibits dihydrofolate reductase causing cell death.
30
Q

How are 2nd trimester terminations handled?

A
  • in the hospital with adequate IV access, surgery or medical. Consider pain control and beware of significant bleeding.
31
Q

What is septic abortion?

A
  • uterine infection during or immediately after a spontaneous abortion.
32
Q

How do you treat a septic abortion?

A
  • broad spectrum antibiotics

- evacuate any remaining POC and monitor for septicemia or DIC in hospital.

RGU 2 (24 decks)

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