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Gyne > Abortion > Flashcards

Abortion Flashcards

1
Q

What is abortion?

A

Loss of pregnancy before 20 weeks

  • either all or part of it
  • with or without fetus (500gm)
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2
Q

In which trimester are abortions more common at?

A

First

Unrecognized 15% - biological 60%

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3
Q

What are etiologies of abortion?

A
  • MC unknown
  • defect (baby anomaly- mom anatomy)
  • Malnutrition
  • infection\ toxin
  • endocrine\immunological
  • trauma\ environmental
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4
Q

Name some anatomical defects that are associated with abortion?

A

Septate uterus - didelphys - bicornus

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5
Q

Name immunological factors associated with abortion

A
  • Phospholipid disease
  • protein S and C
  • SLE
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6
Q

Name infection that is associated with abortion

A

Severe vaginits

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7
Q

What are the subtypes of spontaous abortions?

A
  • missed
  • threatened VS inevitable
  • septic
  • complete VS incomplete
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8
Q

What are the types of abortion

A
  • spontanous

- induced

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9
Q

What is missed abortion?

A

Dead fetus (W\out contraction or bleeding)

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10
Q

What do we call missed abortion after 20 weeks

A

Still birth or IUFD

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11
Q

What is threatened abortion

A
  • bleeding fresh red color
  • contraction
  • closed cervix
  • pelvic & back pain
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12
Q

What is the risk for abortion in threatened abortion

A

50-50%

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13
Q

What is inevitable abortion?

A
  • bleeding (fresh red blood)
  • pelvic & back pain
  • contractions
  • cervix open
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14
Q

What is the difference between threatened & inevitable abortions?

A

The opening of the cervix in (inevitable abortion) and closed cervix in (threatened abortion)

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15
Q

Differentiate between complete and incomplete abortion:

A
  • abortion of whole fetus

- part of the fetus (sac etc..) w\ dicidual part in uterus.

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16
Q

How does complete & incomplete abortions present

A
  • bleeding

- passing of clot or tissue

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17
Q

How to differentiate clots from tissue in abortion

A

Clot: liver like
Tissue: chicken like

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18
Q

The passage of clot is indicative of:

A

Over-consumption fo coagulation factors

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19
Q

When should medical intervention occur

Complete or incomplete abortion

A

Incomplete, by evacuation

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20
Q

What is septic abortion

A

In incomplete abortion the ramining of dead tissue becomes necrotized, and colonized by normal flora&raquo_space; ascending infection.

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21
Q

Where do we commonly see septic abortion?

A

In rural area and incomplete abortion

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22
Q

How do patients with septic abortion usually develop?

A
  • abdominal pain
  • fever
  • bleeding
  • tenderness
23
Q

What are the investigations to order in abortion

A 
1- CBC 
2- blood group
3- Rh type 
4- pregnancy test 
5- US
24
Q

Why would like to investigate Rh type?

A

Because mixing of blood can occur during abortion and she might develop anti-D antibodies

25
Q

Why to order US in case of abortion?

A
  • Sac, CRL, No. of gestations, fetal heart detected or no.

- rule out (ectopic - hydatiform mole)

26
Q

What are the medical techniques for termination of pregnancy

A
  • oxytocin
  • prostaglandin
  • misoprostol
  • intra amniotic hyperosmotic solution
27
Q

What is the mechanism by which oxytosin can induce abortion

A

induce uterine contractions

28
Q

What is the mechanism by which Prostaglandin can induce abortion

A

Ripening of cervix and initiate contraction (given vaginally)

29
Q

What is the role of intraminiotic hyperosmotic solution

A

Tachyarrythmia or hyperkalemia for the fetus to initiate death (Not used)

30
Q

What are the surgical techniques of termination of pregnancy?

A
  • D &C

- hysterotomy

31
Q

How is hysteromtomy usually done

A

Similar to C\S: associated with extraction of fetus especially if risk on mother

32
Q

If the mother preferred to wait for a spontanous abortion to occur, how long can you wait

A

Only one month, after that, there’s increase risk of DIC

33
Q

If the mother decides to wait for spontanous abortion to occur, how do we follow her up?

A

PT or PTT weekly

34
Q

What are the complications of surgical intervention for aboriton?

A
  • triad (pain, bleeding, fever)
  • retained product of conception\ septic\ DIC
  • uterine\bladder\bowel injury
  • cervical laceration and shock
  • failed abortion
35
Q

When does cervical shock and laceration usually occur?

A

Dilated >12mm

36
Q

What is cervical shock?

A

Vasovagal response due to dilation

37
Q

DIC is a complication of:

A
  • missed abortion

- prolonged waiting period before medically interveniing

38
Q

What are the indications for termination of pregnancy (maternal)

A
  • maternal:
  • president HD after cardiac decompensation
  • HTN vascular disease (advanced)
  • carcinoma of cervix (invasive)
  • thrombocytopenia
39
Q

What are the indications for termination of pregnancy (fetal)

A

incompatiable w\life (anencephaly, lung aplasia, renal agenesis)

40
Q

Why is invasive carcinoma of the cervix is an indication for termination of pregnancy

A

If they delivery it will cause post-partum hemorrhage

41
Q

Define recurrent miscarriage

A

2 or more consecutive pregnancy loss

  • before 20 weeks of gestation
  • fetus less than 500g
  • non-ecotpic or molar
42
Q

what are the Causes of recurrent miscarriage

A

Genetic, anatomic, thrombophilia, systemic diseases

43
Q

Name systemic disease associated with recurrent miscarriage

A

Renal failure, SLE, hypOthyroidism, protein C & S, phospholipid syndrome

44
Q

What is the most common cause of recurrent miscarriage

A

Unkown

45
Q

Define cervical incompetence

A

PAINLESS cervical dilation followed by expulsion of product of conception

46
Q

At which trimester is cervical incompetence most commonly associated

A

2nd trimester because of the baby weight

47
Q

Funnling of cervix on US is indicative of:

A

Cervical incompetence

48
Q

What are the causes of cervical incompetence

A
  • Cervical abnormalities + in uteruo exposure to DES

- acquired: trauma, surgery, D&C

49
Q

What are the temporary causes of cercvical cerclage?

A

Macdonald & modified macdonald suture

50
Q

When is macdonald suture provided and when is removed

A

At 12-14 weeks

Removed at 37 weeks completed

51
Q

What are the permanent cervical cerclage

A

Shirdokar suture and transabdominal

52
Q

How do we do the macdonal cerclage

A

4 quadrant suture with small opening for the passage of fluid

53
Q

What are indications for cervical cerclage

A

No

  • abdominal pain
  • vaginal bleeding
  • infection
  • fetal anomalies
  • ruptured membrane
54
Q

What if before 37 weeks, the patient with macdonald sutures present with labor pain, bleeding or rupture of membrane

A

Immidiatly remove suture to avoid rupture or tear of cervix and postpartum bleeding

Gyne (18 decks)

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