ABORTION Flashcards
Abortion
Spontaneous or induced termination of pregnancy before fetal viability
Abortion
pregnancy termination before 20 weeks’ gestation
OR
fetus born weighing < 500 g
Spontaneous Abortion
threatened inevitable incomplete complete missed abortion
> 80 % of spontaneous abortions occur within the
first 12 weeks
No identifiable embryonic elements
anembryonic miscarriage
Often display a developmental abnormality of the embryo, fetus, yolk sac, and, at times, the placenta
embryonic miscarriages
75 % of chromosomally abnormal abortions occurred by
8 weeks’ gestation
Most frequently identified chromosomal anomaly in the 1st trimester
Autosomal Trisomy
trisomies of chromosomes 13, 16, 18, 21 , and 22 - most common
Single most frequent specific chromosomal abnormality
Monosomy X (45,X) (Turner Syndrome)
Associated with hydropic or molar pregnancy
Triploidy
Presumed when bloody vaginal discharge or bleeding appears through a closed cervical os during the first 20 weeks
Threatened Abortion
The most predictive risk factor for pregnancy loss
Bleeding
serum progesterone concentrations that suggest a dying pregnancy
< 5 ng/mL
Used to locate the pregnancy and determine viability
Transvaginal sonography
Bleeding that follows partial or complete placental separation and dilation of the cervical os
Incomplete Abortion
History of heavy bleeding, cramping, and passage of tissue or a fetus
During examination – closed cervical os
Complete Abortion
Describes dead products of conception that were retained for days, weeks, or even months in the uterus with a closed cervical os
Missed Abortion
Nonviable pregnancy without vaginal bleeding, uterine cramping or cervical dilation
Missed Abortion
Recurrent Abortion
≥ 3 losses at < 20 weeks OR with a fetal weight < 500 grams
American Society for Reproductive Medicine (2008)
≥ 2 failed clinical pregnancies confirmed by either sonographic or histopathological examination
Refers to multiple losses in a woman who has never delivered a live born
Primary RPL
Refers to multiple pregnancy losses in a patient with a prior live birth
Secondary RPL
Midtrimester Abortion
Extends from the end of the 1st trimester until the fetus weighs ≥ 500 g or gestational age reaches 20 wks
Risk Factors For Second-Trimester Abortion
race
ethnicity
prior poor obstetrical outcomes
extremes of maternal age
Recommended for women with prior preterm birth
Cervical length screening
Funneling
Ballooning of the membranes into a dilated internal os but with a closed external os
Contraindications to Cerclage
bleeding
contractions
ruptured membranes
Simpler procedure and most commonly used vaginal cerclage
McDonald
Complications of Cerclage
membrane rupture
preterm labor
hemorrhage
infection
Medical or surgical termination of pregnancy before the time of fetal viability
Induced Abortion
number of abortions per 1000 live births
abortion ratio
number of abortions per 1000 women aged 15 to 44 years
abortion rate
Medical And Surgical Disorders That Are Indication For Termination Of Pregnancy
persistent cardiac decompensation (with field pulmonary hypertension)
advanced hypertensive vascular disease or diabetes
malignancy
to prevent birth of a fetus with a significant
anatomical, metabolic, or mental deformity - THE MOST FREQUENT INDICATION CURRENTLY
hygroscopic dilators (osmotic dilators)
Devices that draw water from surrounding tissues and expand to gradually dilate the endocervical canal
For ripening
Side effects of Misoprostol
fever
bleeding
gastrointestinal side effects
Antiprogestin; effective cervical-ripening agent
Mifepristone
Prevent postabortal infection after a first- or second-trimester surgical evacuation
prophylactic Doxycycline
Transcervical approach to surgical abortion
cervix is first dilated and then products of conception are evacuated
Vacuum Aspiration
sharp dilation and curettage (DC)
Contents are mechanically scraped out solely by a sharp curette
currently NOT recommended for pregnancy evacuation due to greater blood loss, pain, and procedural time
Lies within connective tissue lateral to the uterosacral and cardinal ligaments and supply cervix, vagina, and uterus
Frankenhauser plexus
Risk factors for abortion complication
operator inexperience prior cervical surgery or anomaly adolescence multiparity advanced gestational age
3 Medications Used Alone Or In Combination in Medical Abortion
Mifepristone – augments uterine contractility by reversing progesterone-induced myometrial quiescence
Methotrexate - acts on trophoblast and halts implantation
Misoprostol - directly stimulates the myometrium
Symptoms following Misoprostol (common w/n 3 hrs)
vomiting
diarrhea
fever
chill
bleeding and cramping
Indications for uterine evacuation in the 2nd trimester
fetal anomaly or death
maternal health complications
inevitable abortion
desired termination
