Abortion – clinical classification, causes, diagnosis and treatment Flashcards
define abortion
Spontaneous or induced expulsion of the products of conception from the uterus before 20 weeks
gestation or if fetal weight is <500g
when is an abortion early
before 12 wks
when is abortion late
after 12 wks
factors causing abortionn
maternal
foetal
placental
Idiopathic
maternal factors
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.
Foetal factors
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
Placental factors
Placental abruption
Placental praevia
history in dg of abortion
- Amenorrhea (preg)
- Abdominal pain
- Vaginal bleeding
- Expulsion of products of gestation
Clinical classification of abortion
Induced abortion
Spontaneous abortion
Septic abortion
types of
Spontaneous abortion
Threatened abortion Inevitable abortion Incomplete abortion Complete abortion Missed abortion Habitual abortion
pain in threatened abortion
slight / or absent pain
internal os in threatened abortion
Cervix closed
US in threatened abortion
Living foetus
Clinical picture in inevitable abortion
Excessive vaginal bleeding
Accompanied w/ clots
Rupture of membranes
btwn 12-20 weeks
Clinical picture in Threatened
abortion
Vaginal spotting
Pain in inevitable abortion
Pain in
suprapubic region radiating to
the back
Internal os in inevitable abortion
Cervix is dilated
and products of
conception may
be felt
clinical picture in incomplete
Continuous bleeding
Uterus large in size
internal os Incomplete abortion
Cervix is opened
Incomplete abortion US
Retained contents
clinical picture in complete abortion
Bleeding slight
Uterus large in size
pain in complete abortion
Ceases
internal os in complete abortion
Empty cavity
clinical pic in missed abortion
Regression of pregnancy
symptoms
Foetal movements not felt
Dark brown vaginal
discharge
Uterus fails to grow
internal os in missed abortion
closed cervix
US in missed abortion
Ultrasound shows either
- smaller gestational sac,
- absent foetal heart movement
- absent foetal heart sounds
rx of threatened abortion
protect the fetus
pt at bed rest
spasmolytic therapy: bucolysin
progesterone
magnesium
specific spasmolytic therapy for threatened abortion
NO SPA?
buscolysin
spasmalgon
specific progesterone rx for threatened abortion
Utrogestan caps
Duphaston tab
specific mg rx for threatened abortion
Magnerot tab
Magnerich tab Cormagnesin amp. for i.v.
define habitual abortion
3+ spontaneous abortions
Etiology of habitual abortion
genetic factors, endocrine fx, anatomic causes such as congenital abnormalities , infectious causes immunological problems
Septic abortion
any type of abortion complicated by infection.
physical exam in septic abortion
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.
rx of septic abortion
isolate pt
bed rest
cervico-vaginal swab for culture
antibiotic therapy
fluid therapy
how are 1st trimester surgical abortions done
vacuum aspiration
how is vacuum aspiration performed
cervix is dilated by expanding rods inserted into cervical opening
When dilated
tube attached to suction pump inserted
Contents of uterus suctioned out
aka’s for vacuum dilation
dilation and evacuation
suction dilation
vacuum curettage
suction curettage
Medical abortions
non invasive
- no surgical instuments used
- no anaesthesia
- drugs – per os / injection
3 meds used used im medical abortion
3M’s for misscarriage
o Antiprogestin mifeprostone
o Antimetabolite methotrexate
o Prostaglandin misoprostol
which drugs can cause miscarriage
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.
immunological causes of Miscarriage
– SLE
– Antiphospholipid syndrome Abs that are directed against platelets and vascular
endothelium leading to thrombosis, placental destruction and
abortion.
– Thrombophilia
how does magnesium help in threatened abortion
reduce fetal growth restriction and preeclampsia as well as increase birth weight.
why are spas contraindicated in threatened abortion
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
