Abortion - Mary Flashcards
definition of abortion
pregnancy termination prior to 20 wks or fetus born weight < 500 gm
when do more than 80% of spontaneous abortions of clinically recognized pregnancies occur?
within the 1st 12 weeks of pregnancy
what increases the risk for SAB?
increase with parity and maternal and paternal age
Most common cause of early pregnancy aneuploid abortions
45X
when are euploid abortions more likely to occur?
later in pregnancy
Rate of ____ and ____ are increased in women with insulin-dependent diabetes → risk is related to degree of metabolic control in early pregnancy
spontaneous abortion and major congenital malformation
Maternal risk factors that can cause SAB
infection chronic disease (Celiac dz) endocrine abnormalities (hypothyroid, DM)
Frequent alcohol use in ____ weeks of pregnany can cause SAB and fetal anomalies → dose dependent
first 8 weeks
In relation to caffeine use, increased risk of SAB is seen in women who consume ____
> 5 cups/day [500 mg caffeine]
what inherited thrombophilias put a woman at risk for SAB?
factor V leiden, prothrombin, antithrombin, proteins C and S
when is the best time to do abdominal or pelvic surgery in pregnancy?
2nd trimester if possibe → can do early if it is uncomplicated procedure
Early removal of ___ can increase the risk for SAB
corpus luteum cyst
if you remove a corpus luteum cyst before 10 weeks GA what is needed?
supplemental progesterone
acquired uterine defects that can cause SAB
leiomyomas and uterine synechiae
developmental uterine defects that can cause SAB
abnormal mullerian duct formation of fusion
vaginal bleeding with closed cervical ox
cramping/abdominal pain/low backache/pelvic pressure
threatened abortion
what percent of threatened abortions will abort?
50%
what is something important to rule out with threatened abortion?
ectopic pregnancy
90-96% of pregnancies with both _____ and _____ between 7-11 wk GA will result in continued pregnancy
fetal cardiac activity
vaginal bleeding
increasing vaginal bleeding, painful uterine cramps/contractions reach peak intensity, cervix is dilated
gestational tissue is felt or seen through internal cervical os
inevitable abortion
internal os is open and blood and tissue passes (fetus and placenta may remain inside entirely or extrude through dilated os
incomplete abortion
what will you see on US of incomplete abortion?
thickened endometrial stripe >15 mm
Management of incomplete abortion
conservative
medication (misoprostol)
surgical (D&C)
cervix is closed and all products of conception are expelled
complete abortion
in utero death of embryo or fetus prior to 20th week of gestation → retention of pregnancy for period of time
early pregnancy symptoms less (nausea, tender breast, etc)
vaginal bleeding may occur
closed cervix
missed abortion
how do you confirm missed abortion?
US → anembryonic gestation or embryonic death
management of missed abortion
conservative
medication (misoprostol)
surgical (D&C)
infection of prodcuts of conception in previable pregnancy
sx: fever, chills, malaise, abdominal pain, vaginal bleeding, sanguinopurulent discharge
septic abortion
physical exam findings in septic abortion
tachycardia, tachypnea, lower abdomen tenderness, boggy and tender uterus with dilated cervix
possible causes of a septic abortion
foreign bodies (IUD)
invasive procedure (amiocentesis, chorionic villus sampling)
maternal bacteremia
incomplete spontaneous or legally induced abortion
Pathogens most likely cause septic abortion
S. aureus, Gram (-) bacilli, Gram (+) cocci
Septic abortions can spread and lead to
salpingitis, peritonitis, septicemia
Management of septic abortion
IV antibiotics and evacuation of uterine cavity
what is the Expectant management of an abortion?
spontaneous completion in half cases of incomplete abortion
When do majority of expulsions occur?
first 2 weeks after diagnosis
what type of miscarriage is more likely to proceed to expulsion?
incomplete abortion > missed abortion
Medical management for incomplete or missed abortion
PGE1 (misoprostol) PO or vaginally
Preferred method of administration of misoprostol
vaginal → less s/e than buccally
what is the expulsion rate of misoprostol?
70-90%
Surgical management of abortion
D&C
D&C is the preferred lifesaving method in a patient who is
hemodynamically unstable
complications of D&C
uterine perforation, intrauterine adhesions, cervical trauma, infection
definition of recurrent abortion
three or more consecutive pregnancy losses @ 20 weeks or fetal weight <500 grams
when should you evaluate recurrent abortions?
after 2 consecutive losses
Preferred method for surgical abortion in 1st trimester
D&C
Preferred method for surgical abortion in 2nd trimester
D&E
What antibiotics can you give prophylactically prior to surgical abortion?
doxycycline or metronidazole
Complications of surgical abortion
pain, bleeding, infection, uterine perforation
Method for medical abortion
mifepristone (progesterone receptor antagonist)
misoprostol (24-48 hr after)
Side effects of medical abortion
bleeding, cramping, N/V/D
When is medical abortion most effective
before 9 weeks
If woman is Rh(-) and has miscarriage, what should she receive?
RhoGAM
