Abortion Flashcards
Spontaneous or induced termination of pregnancy before fetal viability
Abortion
Pregnancy termination before 20 weeks gestation
With a fetus born weighing <500 g (520)
Abortion
Distiguishes between clinical vs chemical pregnancy
UTZ
B HCG
Presumptive signs and symptoms of pregnancy and with evidence of ultrasound
Clinical abortion
Pregnancy test is +
Patient will bleed
Will turn out pregnancy test -
Very early pregnancy losses
Chemical abortion
Pregnancy wherein you have signs of pregnancy and + pregnancy test but when UTZ is done, no intrauterine or extrauterine pregnancy is identified
SERIAL B HCG and UTZ
Pregnancy of unknown location
First trimester abortions more common
Within the first 12 weeks (First Trimester)
80% spontaneous
Death of embryo precedes the expulsion
Death is accompanied by hemorrhage in decidua basalis followed by adjacent tissue necrosis stimulating uterine contractions and expulsion
Early abortion
Abortion after 12 weeks (Post First trimester)
Fetus is expelled alive / fetus does not die before expulsion
Late abortion
Early abortions
subdivided:
Embryonic 50% - developmental abnormality of zygote, embryo, fetus or placenta
Anembryonic (blighted ovum) 50%
Half of emrbyonic early abortions are
Euploid
Aneuploid
Most common aneuploidy (22-32)
Autosomal trisomy
Down syndrome
From isolated nondysjunction
Single most frequent specific chromosomal abnormality
Monosomy
45 XO Turner
Aneuploid abortion in third trimester
Still birth
Because fetus is already big
Abortion rates and chromosomal anomalies decrease with advancing gestational age
Contain normal chromosomal complement
Late abortions
Peaks at 13 weeks or immediately after 1st trimester
Incidence increases dramatically after maternal age exceeds 35 years
Euploid abortion
Maternal factors that cause Euploid abortion in late first tri
Infections Medical disorders Cancer treatment Uncontrolled DM Thyroid disorders Immunologic factors Surgical procedures Nutrition
Infection found to be present in 4% abortuses
Chlamydia trachomatis
Linked to 2-4 fold increase risk for abortions
Polymicrobial infection from periodontal disease
Infection with an association between 2nd trimester but not 1st
Bacterial vaginosis
Medical disorder that causes recurrent abortions and male and female infertility
Celiac disease
Medical conditions that increase risk for abortion
Unrepaired cyanotic heart disease
Inflammatory bowel disease
SLE
Women vascular disease who have miscarriages are more likely to suffer MI
Has effect on subfertility, preterm delivery, fetal growth restriction
Eating disorder
Does not confer significant risk for abortion
Chronic hypertension
Increased risk for septic abortion
IUD
Uncontrolled DM increases risk for
Spontaneous abortion
Major congenital malformations
Recurrent or repetitive abortion (overt DM within first tri)
Associated with recurrent abortion
Thyroid disorders Severe iodine deficiency Overt hypothyroidism Uncontrolled DM Hashimoto’s thyroiditis
Marker for increased miscarriage
Abnormally high serum antibodies to thyroid peroxidase TPO
Antibodies to thyroglobulin
Most potent immune-mediated disorder directed against binding proteins in plasma
Associated with repetitive, recurrent miscarriage
Treat with aspirin
Anti-phospholipid Antibody Syndrome APAS
Surgical procedures that induce abortion
Manipulation of female genitalia in removal of ovarian cyst
Early removal of corpus luteum or ovary
<10 weeks AOG give progesterone
Abdominal trauma
Uncontested risk factor for abortion and subfertility
Obesity
Alcohol and abortion
Increased only if regular and heavy consumption
Low does not but causes fetal malformations
Cigarettes and abortion
Increase
Excessive caffeine consumption
Increase
5 cups/day 500 mg caffeine
<200 mg does not
Arsenic Lead Formaldehyde Benzene Ethylene oxide DDT-containing insecticides Cytotoxic antineoplastic chemotherapeutic agents
Increase risk
Thrombophilia and abortion
No r
Uterine defects and abortikn
Early and late recurrent abortions
Bloody vaginal discharge + closed cervical os during the first 20 weeks
Bleeding
cramping abdominal pain
Tx
Threatened abortion
Tocolytics
Isoxuprine, Progesterone to resolve contraction
Bed rest
Gross rupture of membrane + Cervical dilatation
Uterine contraction or infection
Tx
Inevitable abortion
Expectant
If without fever, pain, bleeding or amniotic fluid escape, ambulation and pelvic rest.
Passage of meaty tissues
Partial or complete placental separation + dilatation of cervical os + bleeding
Before 10 weeks expelled together
Tx
Incomplete abortion
Complete curettage
History of passage of meaty tissues
Expulsion of entire pregnancy + CLOSED cervix upon examination
> 20 weeks gestation
Tx
Complete abortion
Expectant
On UTZ a complete abortion will look
Minimally thickened endometrium without a gestational sac
Dead products of conception that were retained for days to months in the uterus with a closed cervical os
Tx
Missed abortion
Early pregnancy loss
Early fetal wastage
Suction Curettage
Early pregnancy loss or wastage with mean death-to-abortion interval of 6 weeks
Current missed abortion
Results from women with threated or incomplete abortion develop a pelvic infection or sepsis syn
Tx
Septic abortion
Bacteria gain uterine entry from a premature rupture usually due to non-sterile instruments -> colonized dead products -> invade myometrium -> parametritis -> peritonitis -> septicemia -> endocarditis -> severe sepsis syndrome with ARDS, AKI, DIC
Broad-spectrum antibiotics and curettage
If no response remove whole organ
> /= 3 consecutive pregnancy losses at = 20 weeks or with a fetal weight <500
It has to be consecutive
Recurrent miscarriage
Recurrent spontaneous abortion
Causes of recurrent abortion
Parental chromosomal abnormality (2-4%)
Anatomical factors - acquired or congenital
Immunologic factors
Endocrine factors (8-12) - progestone deficiency caused by luteal-phase defect and polycystic ovarian syndrome
Timing - early embryonic loss
Autoimmune or anatomic abnormalities - 2nd trimester
Can cause recurrent miscarriage because it impinges upon the uterine cavity causing contractions and early abortion
Submucous myoma
History of previous dilatation and curettage
Limited uterine cavity causing the recurrent miscarriage
Synechiae
Destruction of large areas of endometrium
Follow uterine curettage or ablative procedure
Treatment directed hysteroscopic lysis of adehsions
Asherman syndrome
Uterine anomalies causing miscarriage
Didelphys Bicornuate uterus Septate uterus (congenital)
Painless cervical dilatation in second trimester
Followed by prolapse and ballooning of membranes into the vagina and ultimately expulsion of immature fetus
When pregnancy becomes heavy, the tendency of the cervix is to open, at 16-22 weeks and usually happens in cases of recurrent abortion
Cervical insufficiency
Cervical insufficiency Dx
And look for
TVS at 14 weeks or earlier
Funneling
Cervical length shorter than 2.5cm
Ballooning of the membranes into a dilated internal cervical os, but with a closed external os
Funneling
Risk factors for cervical insufficiency
History of D&C
Conization
Cauterization
Amputation
surgically reinforces weak cervix by suturing (purse-string)
Cerclage
Elective - 12-14 weeks if previously diagnosed with insufficiency
Emergent - 20 weeks with cervical dilatation and bag of water already prolapsing
