Abortion Flashcards
Discriminatory zone
- hCG titer at which intrauterine gestational sac reliably seen w/ TVUS
Types of spontaneous abortions
Spontaneous = w/o medical or mechanical intervention
“Miscarriage”
- Complete = placenta detaches, bleeding and expulsion of products of conception (POC), cervical os then closes
- Incomplete = placenta detaches, os opens, bleeding, may pass some of POC, os remains open
- Threatened = bleeding but cervix is closed, no expulsion of poc
- Inevitable = fluid leaking, bleeding and cervix is dilated, no expulsion of poc
- Missed = uterus retains the POC, no fetal heart tones (FHTs), os closed, no symptoms
*usually deteached on US/Doppler at prenatal visit
- Recurrent = 3 or more consecutive spontaneous abortions
*recurrent pregnancy loss is classically defined as the occurrence of 3 or more consecutive pregnancy loss; however, the American Society of Reproductive Medicine (ASRM) has recently redefined recurrent pregnancy loss as 2 or more pregnancy losses
*must investigae as to why this happens
Threatened SAb
- Vaginal bleeding <20wks
- +/- pain
- Cervix closed
- 25-50% pregnancy loss
Inevitable SAb
- Vaginal bleedin <20wks
- Cramping pain
- Cervix partially dilated
- POC not passed yet
Incomplete SAb
- Vaginal bleeding <20wks
- Cramping pain
- Cervix dilated
- POC passed
Complete SAb
- Vaginal bleeding <20wks stopped
- Cramping pain stopped
- Cervix closed
- All POC passed
- Uterus involutes
- No Sx of pregnancy
- Neg. pregnancy test
Anembryonic pregnancy or blighted ovum
- Empty gestational sac
*differentiate pseudogestational sac (ectopic)
- Large size w/o embryo or yok sac
- Distorted shape
- Irregular contour
- Absence double decidual sac
- Abnormal position
Missed Ab
- Refers to fetal death <20wks and retention of products of conception in uterus w/ closed cervical os
- Products usually retained greater than 8wks
- Risk DIC after 4-5wks
SAb pathophysiology
- 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
- Later in the pregnancy the fetus undergoes maceration, the amniotic fluid is absorbed and the fetus is compressed
SAb incidence
- 80% occurs in the first 12wks of gestation
- 50% are from chromosomal anomalies
*most common chromosomal abnormality = trisomy
- Incidence increases w/:
*age
*parity
*conception w/ in 3 months of a full term delivery
Management/treatment of abortions
Offer pts options
- Observation
- Medical (misoprostol, methotrexate, mifepristone)
- Surgical (D and E)
- LaminariA (seaweed stick that can expand the cervix when absorbing water)
- Birth control if appropriate
- Follow bhcg weekly until it reaches zero
- Serial exams and US as indicated
Medical vs Surgical Aborition chart
