Abortion Flashcards
What is abortion?
Loss of pregnancy before 20 weeks
- either all or part of it
- with or without fetus (500gm)
In which trimester are abortions more common at?
First
Unrecognized 15% - biological 60%
What are etiologies of abortion?
- MC unknown
- defect (baby anomaly- mom anatomy)
- Malnutrition
- infection\ toxin
- endocrine\immunological
- trauma\ environmental
Name some anatomical defects that are associated with abortion?
Septate uterus - didelphys - bicornus
Name immunological factors associated with abortion
- Phospholipid disease
- protein S and C
- SLE
Name infection that is associated with abortion
Severe vaginits
What are the subtypes of spontaous abortions?
- missed
- threatened VS inevitable
- septic
- complete VS incomplete
What are the types of abortion
- spontanous
- induced
What is missed abortion?
Dead fetus (W\out contraction or bleeding)
What do we call missed abortion after 20 weeks
Still birth or IUFD
What is threatened abortion
- bleeding fresh red color
- contraction
- closed cervix
- pelvic & back pain
What is the risk for abortion in threatened abortion
50-50%
What is inevitable abortion?
- bleeding (fresh red blood)
- pelvic & back pain
- contractions
- cervix open
What is the difference between threatened & inevitable abortions?
The opening of the cervix in (inevitable abortion) and closed cervix in (threatened abortion)
Differentiate between complete and incomplete abortion:
- abortion of whole fetus
- part of the fetus (sac etc..) w\ dicidual part in uterus.
How does complete & incomplete abortions present
- bleeding
- passing of clot or tissue
How to differentiate clots from tissue in abortion
Clot: liver like
Tissue: chicken like
The passage of clot is indicative of:
Over-consumption fo coagulation factors
When should medical intervention occur
Complete or incomplete abortion
Incomplete, by evacuation
What is septic abortion
In incomplete abortion the ramining of dead tissue becomes necrotized, and colonized by normal flora»_space; ascending infection.
Where do we commonly see septic abortion?
In rural area and incomplete abortion
How do patients with septic abortion usually develop?
- abdominal pain
- fever
- bleeding
- tenderness
What are the investigations to order in abortion
1- CBC 2- blood group 3- Rh type 4- pregnancy test 5- US
Why would like to investigate Rh type?
Because mixing of blood can occur during abortion and she might develop anti-D antibodies
Why to order US in case of abortion?
- Sac, CRL, No. of gestations, fetal heart detected or no.
- rule out (ectopic - hydatiform mole)
What are the medical techniques for termination of pregnancy
- oxytocin
- prostaglandin
- misoprostol
- intra amniotic hyperosmotic solution
What is the mechanism by which oxytosin can induce abortion
induce uterine contractions
What is the mechanism by which Prostaglandin can induce abortion
Ripening of cervix and initiate contraction (given vaginally)
What is the role of intraminiotic hyperosmotic solution
Tachyarrythmia or hyperkalemia for the fetus to initiate death (Not used)
What are the surgical techniques of termination of pregnancy?
- D &C
- hysterotomy
How is hysteromtomy usually done
Similar to C\S: associated with extraction of fetus especially if risk on mother
If the mother preferred to wait for a spontanous abortion to occur, how long can you wait
Only one month, after that, there’s increase risk of DIC
If the mother decides to wait for spontanous abortion to occur, how do we follow her up?
PT or PTT weekly
What are the complications of surgical intervention for aboriton?
- triad (pain, bleeding, fever)
- retained product of conception\ septic\ DIC
- uterine\bladder\bowel injury
- cervical laceration and shock
- failed abortion
When does cervical shock and laceration usually occur?
Dilated >12mm
What is cervical shock?
Vasovagal response due to dilation
DIC is a complication of:
- missed abortion
- prolonged waiting period before medically interveniing
What are the indications for termination of pregnancy (maternal)
- maternal:
- president HD after cardiac decompensation
- HTN vascular disease (advanced)
- carcinoma of cervix (invasive)
- thrombocytopenia
What are the indications for termination of pregnancy (fetal)
incompatiable w\life (anencephaly, lung aplasia, renal agenesis)
Why is invasive carcinoma of the cervix is an indication for termination of pregnancy
If they delivery it will cause post-partum hemorrhage
Define recurrent miscarriage
2 or more consecutive pregnancy loss
- before 20 weeks of gestation
- fetus less than 500g
- non-ecotpic or molar
what are the Causes of recurrent miscarriage
Genetic, anatomic, thrombophilia, systemic diseases
Name systemic disease associated with recurrent miscarriage
Renal failure, SLE, hypOthyroidism, protein C & S, phospholipid syndrome
What is the most common cause of recurrent miscarriage
Unkown
Define cervical incompetence
PAINLESS cervical dilation followed by expulsion of product of conception
At which trimester is cervical incompetence most commonly associated
2nd trimester because of the baby weight
Funnling of cervix on US is indicative of:
Cervical incompetence
What are the causes of cervical incompetence
- Cervical abnormalities + in uteruo exposure to DES
- acquired: trauma, surgery, D&C
What are the temporary causes of cercvical cerclage?
Macdonald & modified macdonald suture
When is macdonald suture provided and when is removed
At 12-14 weeks
Removed at 37 weeks completed
What are the permanent cervical cerclage
Shirdokar suture and transabdominal
How do we do the macdonal cerclage
4 quadrant suture with small opening for the passage of fluid
What are indications for cervical cerclage
No
- abdominal pain
- vaginal bleeding
- infection
- fetal anomalies
- ruptured membrane
What if before 37 weeks, the patient with macdonald sutures present with labor pain, bleeding or rupture of membrane
Immidiatly remove suture to avoid rupture or tear of cervix and postpartum bleeding
