Abortions Flashcards
spontaneous abortion
termination of prego before 20 wks- most common in the first 1-7 wks
what is “threatened” SA?
the only type that is associated with possible fetal viability
what are some common causes of spontaneous abortions?
fetal chromosomal abnormalites (50%), maternal infections, uterine defects, endocrine abnormalities, malnutrtion, immunologic , trauma, smoking, drug use
definition of a threatened SA?
Pregnancy may be viable & progress or abortion may follow
Most common cause of 1st trimester bleeding
clinical manifestation of threatend SA
Bloody vaginal discharge
Spotting → Profuse
+ Contractions of uterus
Uterus size compatible with dates
what is the managment of a threatened SA
Supportive → Rest @ home
Return to ER if sxs persist or passage of POC
Serial β-hCG to see if doubling
RhoGAM if indicated
what does a cervix look like in threatened abortion?
closed and no products of conception is expelled from the uterus
what is an inevitable abortion?
prego not salvageable
and no POC expelled
what does a cervical os look like in an inevitable abortion?
Progressive cervical dilation >3 cm & effaced
+ rupture of membranes
what are clinical manifestations of an inevitable abortion?
Moderate bleeding > 7 days
Mod-Severe uterus cramping
Uterus size compatible with dates
treatment of an inevitable abortion?
2nd Trimester → Dilation & Evacuation (D&E )
1st Trimester → Suction curettage
RhoGAM if indicated
what is an incomplete abortion?
prego not salvageable, some POC expelled, some retained
what does a cervical os look like in an incomplete abortion?
dilated
clinical manifestations of a incomplete abortions?
Heavy bleeding
Mod-Severe cramping
Retained tissue
Boggy uterus
what is the tx for incompletel abortion?
May be allowed to finish
D&C in 1st → D&E after 1st
Pitocin
RhoGAM if indicated
what is a complete abortion?
complete passage of all products
what does a os look like in a complete abortion?
usually closed
clinical manifestations of complete abortion?
Pain, cramps & bleeding that usually subsides
Pre-pregnancy size of uterus
what is the tx of complete abortion
rhogam if indicated
what is a missed abortion?
fetal demise, but still retained in uterus
no POC expeleed with closed uterus
what are clinical manifestations of a missed abortion?
loss of prego sx
+/- brown d/c
tx of missed abortion?
D&C or D&E
Misoprostol
what is a septic abortion?
The retained POC becomes infected → Infection of uterus & organs
some POC expelled
what is the cervical os look like in a septic abortion?
closed,
CMT
what are the clinical manifestations of a septic abortion?
Foul brownish discharge, fever, chills
Uterine tenderness
Spotting → Heavy Bleed
what are the management of septic abortions?
D&E to remove POC +Broad spectrum antibiotics
+ Hysterectomy if refractory
what medications can be used for an elective abortion?
Mifepristone + Misoprostol 24-72 hrs after (Safe up to 9 weeks) OR Methotrexate + Misoprostol 3-7 days later (Safe up to 7 weeks)
surgical abortions?
Can be performed up to 24 weeks from LMP
D & C → Dilation & Curettage → Including suction curettage → Used during first 4-12 weeks gestation
D & E → Dilation & Evacuation → > 12 weeks gestation
