Abortions

Question 1

spontaneous abortion

Answer 1

termination of prego before 20 wks- most common in the first 1-7 wks

Question 2

what is “threatened” SA?

Answer 2

the only type that is associated with possible fetal viability

Question 3

what are some common causes of spontaneous abortions?

Answer 3

fetal chromosomal abnormalites (50%), maternal infections, uterine defects, endocrine abnormalities, malnutrtion, immunologic , trauma, smoking, drug use

Question 4

definition of a threatened SA?

Answer 4

Pregnancy may be viable & progress or abortion may follow
Most common cause of 1st trimester bleeding

Question 5

clinical manifestation of threatend SA

Answer 5

Bloody vaginal discharge
Spotting → Profuse
+ Contractions of uterus
Uterus size compatible with dates

Question 6

what is the managment of a threatened SA

Answer 6

Supportive → Rest @ home
Return to ER if sxs persist or passage of POC
Serial β-hCG to see if doubling
RhoGAM if indicated

Question 7

what does a cervix look like in threatened abortion?

Answer 7

closed and no products of conception is expelled from the uterus

Question 8

what is an inevitable abortion?

Answer 8

prego not salvageable

and no POC expelled

Question 9

what does a cervical os look like in an inevitable abortion?

Answer 9

Progressive cervical dilation >3 cm & effaced

+ rupture of membranes

Question 10

what are clinical manifestations of an inevitable abortion?

Answer 10

Moderate bleeding > 7 days
Mod-Severe uterus cramping
Uterus size compatible with dates

Question 11

treatment of an inevitable abortion?

Answer 11

2nd Trimester → Dilation & Evacuation (D&E )
1st Trimester → Suction curettage
RhoGAM if indicated

Question 12

what is an incomplete abortion?

Answer 12

prego not salvageable, some POC expelled, some retained

Question 13

what does a cervical os look like in an incomplete abortion?

Answer 13

dilated

Question 14

clinical manifestations of a incomplete abortions?

Answer 14

Heavy bleeding
Mod-Severe cramping
Retained tissue
Boggy uterus

Question 15

what is the tx for incompletel abortion?

Answer 15

May be allowed to finish
D&C in 1st → D&E after 1st
Pitocin
RhoGAM if indicated

Question 16

what is a complete abortion?

Answer 16

complete passage of all products

Question 17

what does a os look like in a complete abortion?

Answer 17

usually closed

Question 18

clinical manifestations of complete abortion?

Answer 18

Pain, cramps & bleeding that usually subsides

Pre-pregnancy size of uterus

Question 19

what is the tx of complete abortion

Answer 19

rhogam if indicated

Question 20

what is a missed abortion?

Answer 20

fetal demise, but still retained in uterus

no POC expeleed with closed uterus

Question 21

what are clinical manifestations of a missed abortion?

Answer 21

loss of prego sx

+/- brown d/c

Question 22

tx of missed abortion?

Answer 22

D&C or D&E

Misoprostol

Question 23

what is a septic abortion?

Answer 23

The retained POC becomes infected → Infection of uterus & organs

some POC expelled

Question 24

what is the cervical os look like in a septic abortion?

Answer 24

closed,

CMT

Question 25

what are the clinical manifestations of a septic abortion?

Answer 25

Foul brownish discharge, fever, chills
Uterine tenderness
Spotting → Heavy Bleed

Question 26

what are the management of septic abortions?

Answer 26

D&E to remove POC +Broad spectrum antibiotics

+ Hysterectomy if refractory

Question 27

what medications can be used for an elective abortion?

Answer 27

Mifepristone + Misoprostol 24-72 hrs after (Safe up to 9 weeks) OR Methotrexate + Misoprostol 3-7 days later (Safe up to 7 weeks)

Question 28

surgical abortions?

Answer 28

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