Abortion Flashcards
1
Q
Spontaneous Abortion
A
loss <20 wks w/o medical intervention (“miscarriage”)
2
Q
Early Pregnancy Loss (+ 3 types)
A
- Early Pregnancy Loss - spont abortion in first trimester
1- Anembryonic Gestation - develops w/o fetal pole
2- Embryonic Demise - embryo w/o cardiac activity < 10 wks
3- Fetal Demise - fetus w/o cardiac activity > 10 wks
3
Q
Missed Abortion
Threatened Abortion
Inevitable Abortion
Incomplete Abortion
A
- Missed Abortion - fetal death b/f 20 wks w/o expulsion of tissue for at least 8 wks
- Threatened Abortion - uterine bleeding from gestation < 20 wks gestation w/o cervical dilation
- Inevitable Abortion - uterine bleeding from a gestation less than 20 weeks with cervical dilation but no passage of pregnancy tissue through the cervix
- Incomplete abortion - passage of some, but not all, pregnancy tissue through the cervix before 20 weeks
4
Q
Pregnancy
A
refers to implantation of fertilized embryo (50-75% of fertilizations do not become pregnancy)
5
Q
7 Risks for ELP
A
- Advanced maternal age
- Advanced paternal age (less)
- Short inter-pregnancy interval (<3-6 mos)
- Prior spontaneous abortion
- Maternal diabetes
- Smoking (dose dependent)
- Maternal alcohol consumption
6
Q
Overview of Causes of ELP
A
- 50% are chromosomally abnormal
- Monosomy X (Turner’s syndrome)
- Trisomy 16 - always lethal
- Triploidy (69 XXX or 69 XXY)
- Morphological abnormality even if right chromosomes (genetics, chemicals, fever, lack of hCG)
- Medical conditions
- Poorly controlled DM
- Extreme BMIs
- Anti-thyroid antibodies
- Antiphospholipid antibody syndrome
- Hyperprolactinemia
- Luteal Phase Defect - inadequate progesterone by corpus luteum in first 6-7 wks
- Drugs / Toxins - tobacco, alcohol, caffeine (>200mg/day), radiation, NSAIDS, anesthetic gases, arsenic, heavy metals, & some solvents
- Infection (more common in 2nd trimester loss)
7
Q
Recurrent Pregnancy Loss (how is it defined and how does risk change?)
A
- Official Definition - 3 consecutive losses at < 20 wks
- Clinical Definition - by just 2 failed clinical pregnancies
- More rare that EPL - 2% chance of 2 consecutive losses and .4-1% chance of 2 consecutive losses
- BUT risk of subsequent pregnancy loss inc w/ ea successive loss
8
Q
Overview of Causes of RPL
A
- Unexplained: ~50-60%
- Antiphospholipid syndrome (APS): 15%
- Prolonged PTT that does not correct w/ mixing
- Prolonged viper venom time
- Anticardiolipin IgG antibodies
- Pathogenesis: likely clotting and infarction in early placenta and binding of antibodies to placental trophoblast antigens
- Other Thrombophilias - Factor V Leiden
- Hormonal/metabolic (diabetes, thyroid): 16%
- Luteal Phase Def - corpus luteum does not make enough progesterone
- Anatomic: 13%
- Bicornuate or septate uterus, scarring, leiomyomas and DES exposure can lead to poor implantation
- Chromosomal: 2-5%
- Balanced reciprocal tranlocations- 2 chromosomes mutually exchange broken off segments
- Robertsonian translocations - 2 acrocentric chromosomes lose short arms and join at centromere
- 13 to 15
- 21 to 22
9
Q
PA Abortion Law
A
- Mandatory 24 hour waiting period
- State-directed counseling
- Parental consent requirement for minors
- Ban on use of public funding to pay for abortion services
- Exception for threat to life, rape, incest
- Health plans offered in the state’s health exchange (established under the ACA) can only cover abortion in cases of threat to life, rape or incest, unless an optional rider is purchased at an additional cost
10
Q
1st Trimester Surgery
A
D&C
- MVA - manual vacuum aspirator (preferred b/c better maintains conceptus for viewing afterwards)
- EVA - electric vacuum aspirator (uses electric pump)
- Process
- Give abx (doxy)
- Speculum - pelvic exam
- Clean cervix
- Local anesthetic
- Tenaculum
- Cervical dilation
- Uterine evacuation (above suction methods)
- Examine conceptus
11
Q
1st Trimester Medications
A
- Mifepristone (anti-progestin) + misoprostol (synthetic PG)
- Alternative: methotrexate (anti-metabolite) + misoprostol OR misoprostol alone (last resort)
- Contraindications - severe anemia, allergies to meds, coagulopathy, women using blood thinner, suspected ectopic pregnancy (no progestin receptors in tubes so not effective)
- Complications - infection, heavy bleeding, failure to end pregnancy –> D&C
- Check US, hCG and phone follow up 1 wk later
12
Q
Misoprostol (mao and side effects)
A
- PG given vaginally or buccally 24-48 hrs after mifepristone for passage of pregnancy tissue
- Side effects - nausea, cramps, bleeding, vomiting, diarrhea, mild fever
13
Q
Mifepristone (mao and side effects)
A
- Block action of progesterone –> decidual necrosis, uterine contractions, cervical ripening (no quiescence)
- Side effects - nausea, cramps, light bleeding
14
Q
2nd Trimester Surgery
A
- D&E (dilation and evacuation)
1 - Cervical preparation - must be more dilated Misoprostol, Laminaria (seaweed), Dilapan (osmotic cervical dilator - expand as they absorb fluid from cervix
2 - Similar procedure but may use forceps for actual fetus in addition to aspirator for placenta / decidua
15
Q
2nd Trimester Medications
A
- Meds to induce labor - Pitocin, misoprostol or combo
- Can also give adjunctive mifepristone 24 hrs b/f to shorten duration of delivery period
- Misoprostol alone –> inc risk retained placenta and need for later D&C
