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O&G > Abortion – clinical classification, causes, diagnosis and treatment > Flashcards

Abortion – clinical classification, causes, diagnosis and treatment Flashcards

1
Q

define abortion

A

Spontaneous or induced expulsion of the products of conception from the uterus before 20 weeks
gestation or if fetal weight is <500g

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2
Q

when is an abortion early

A

before 12 wks

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3
Q

when is abortion late

A

after 12 wks

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4
Q

factors causing abortionn

A

maternal

foetal

placental

Idiopathic

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5
Q

maternal factors

A

Maternal infections
-human immunodeficiency virus, Chlamydia, Toxoplasmosis

Trauma

Endocrine causes

  • progesterone deficiency=> can’t maintain preg
  • DM
  • hyperthyroidism

Drugs

Environmental causes

Immunological causes:

Ageing sperm or ovum.
Uterine defects
- Septum, Asherman’s syndrome (intrauterine adhesions).

Nervous and psychological conditions.

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6
Q

Foetal factors

A

Chromosomal abnormalities: cause at least 50% of early abortions e.g.

trisomy.
Blighted ovum (gestational sac w/o an embryo).

Faulty implantation of the fertilized ovum

Failure of the endometrium to accept the fertilized ovum

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7
Q

Placental factors

A

Placental abruption

Placental praevia

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8
Q

history in dg of abortion

A
  • Amenorrhea (preg)
  • Abdominal pain
  • Vaginal bleeding
  • Expulsion of products of gestation
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9
Q

Clinical classification of abortion

A

 Induced abortion
 Spontaneous abortion
 Septic abortion

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10
Q

types of

Spontaneous abortion

A 
 Threatened abortion
 Inevitable abortion
 Incomplete abortion
 Complete abortion
 Missed abortion
 Habitual abortion
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11
Q

pain in threatened abortion

A

slight / or absent pain

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12
Q

internal os in threatened abortion

A

Cervix closed

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13
Q

US in threatened abortion

A

Living foetus

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14
Q

Clinical picture in inevitable abortion

A

Excessive vaginal bleeding
Accompanied w/ clots
Rupture of membranes
btwn 12-20 weeks

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15
Q

Clinical picture in Threatened

abortion

A

Vaginal spotting

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16
Q

Pain in inevitable abortion

A

Pain in
suprapubic region radiating to
the back

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17
Q

Internal os in inevitable abortion

A

Cervix is dilated
and products of
conception may
be felt

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18
Q

clinical picture in incomplete

A

Continuous bleeding

Uterus large in size

19
Q

internal os Incomplete abortion

A

Cervix is opened

20
Q

Incomplete abortion US

A

Retained contents

21
Q

clinical picture in complete abortion

A

Bleeding slight

Uterus large in size

22
Q

pain in complete abortion

A

Ceases

23
Q

internal os in complete abortion

A

Empty cavity

24
Q

clinical pic in missed abortion

A

Regression of pregnancy
symptoms
Foetal movements not felt

Dark brown vaginal
discharge

Uterus fails to grow

25
Q

internal os in missed abortion

A

closed cervix

26
Q

US in missed abortion

A

Ultrasound shows either

  • smaller gestational sac,
  • absent foetal heart movement
  • absent foetal heart sounds
27
Q

rx of threatened abortion

A

protect the fetus

pt at bed rest

spasmolytic therapy: bucolysin
progesterone
magnesium

28
Q

specific spasmolytic therapy for threatened abortion

A

NO SPA?

buscolysin

spasmalgon

29
Q

specific progesterone rx for threatened abortion

A

Utrogestan caps

Duphaston tab

30
Q

specific mg rx for threatened abortion

A

Magnerot tab

Magnerich tab Cormagnesin amp. for i.v.

31
Q

define habitual abortion

A

3+ spontaneous abortions

32
Q

Etiology of habitual abortion

A 
genetic factors, 
endocrine fx, 
anatomic causes such as congenital abnormalities , infectious
causes 
immunological problems
33
Q

Septic abortion

A

any type of abortion complicated by infection.

34
Q

physical exam in septic abortion

A

Pyrexia and tachycardia.

Rigors = bacteraemia.

Jaundice or hematouria – haemolytic
infection indicated

A subnormal temperature w/ tachycardia
is ominous + mostly seen with gas forming
organisms.

Malaise, sweating, headache, and joint
pain.

35
Q

rx of septic abortion

A

isolate pt

bed rest

cervico-vaginal swab for culture

antibiotic therapy

fluid therapy

36
Q

how are 1st trimester surgical abortions done

A

vacuum aspiration

37
Q

how is vacuum aspiration performed

A

cervix is dilated by expanding rods inserted into cervical opening

When dilated
tube attached to suction pump inserted

Contents of uterus suctioned out

38
Q

aka’s for vacuum dilation

A

dilation and evacuation

suction dilation

vacuum curettage

suction curettage

39
Q

Medical abortions

A

non invasive

  • no surgical instuments used
  • no anaesthesia
  • drugs – per os / injection
40
Q

3 meds used used im medical abortion

3M’s for misscarriage

A

o Antiprogestin mifeprostone

o Antimetabolite methotrexate

o Prostaglandin misoprostol

41
Q

which drugs can cause miscarriage

A

misoprostol – used for conditions such as rheumatoid arthritis.

retinoids – used for eczema and acne.

methotrexate – used for conditions such as rheumatoid arthritis.

non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen; these are used for pain and inflammation.

42
Q

immunological causes of Miscarriage

A

– SLE
– Antiphospholipid syndrome Abs that are directed against platelets and vascular
endothelium leading to thrombosis, placental destruction and
abortion.
– Thrombophilia

43
Q

how does magnesium help in threatened abortion

A

reduce fetal growth restriction and preeclampsia as well as increase birth weight.

44
Q

why are spas contraindicated in threatened abortion

A

Spending more than 10 minutes in a hot tub can raise your body temperature higher than 101 F (38.3 C).

small increased risk of neural tube defects — serious abnormalities of the brain or spinal cord — in the babies of women who have fevers during early pregnancy

O&G (43 decks)

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