Abortions - William Flashcards
What is the definition of abortion?
termination of the pregnancy before 20 weeks or fetus bor weighing less than 500 gms
When do most spontaneous abortions (SAB’s)happen?
in the 1st 12 weeks
What are most SAB’s due to?
chromosomal abnormalities
SAB’s increase with?
maternal and paternal age. Also women <20 and >40
What are the fetal factors of SAB?
Aneupold abortions (45X) and Euploid abortions
What are some maternal risk factors for abortions?
infections, chronic disease, endocrine (Hypothyrodism and Diabetes), maternal age, Drug use (Tobacco, alcohol, caffeine, infection from an IUD) and enviornment (radiation, enviornmental toxins), inherited thrombophilias, maternal surgery, uterine defects (acquired or developmental)
What are the types of abortions?
Threatened, inevitable incomplete, missed, septic, therapeutic, elective
What is a threatened abortion?
vaginal bleeding with a closed cervical os
What are some s&s of threatened abortion?
vaginal bleeding, cramping, abd. Pain, low backache, pelvic pressure
What percentage of threatened abortions will actually abort?
50%
What must be ruled out if you suspect a threatened abortion?
ectopic pregnancy
What is an inevitable abortion?
the abortion is iminent
What are the charactersitics of an inevitable abortion?
increased bleeding, painful uterine cramps/contractions, dilated cervix
can the gestational tissue be visualized in an inevitable abortion?
yes
What is an incomplete abortion?
internal cervical os is opened that allows passage of blood and tissue, but the fetus may remaine inside the uterus or partially extrude
What dx imaging do you want to use for an incomplete abortion?
U/S
How do you tx an incomplete abortion?
conservative, Medical (misoprostol), or surgical (D&C)
What is a complete abortion?
all producst have been expelled and the cervix is closed
What is a missed abortion?
in utero death of the fetus prior to 20 wks, with retention of the pregnancy for a prolonged period of time
What are the symptoms of a missed abortion?
N/V, breast tenderned, abated feeling, vaginal bleeding, closed cervix
What will U/S show with a missed abortion?
confirmation of anembryonic gestation or embryonic death
How do you tx a missed abortion?
conservative, Medical (misoprostol), or surgical (D&C)
What is a septic abortion?
infection of the products of conception in a previable pregnancy
What are some things that can cause a septic abortion?
foreign bodies, invasive procedures, maternal bacteremia, incomplete spontaneous or legally induced abortion
What are some s&s of a septic abortion?
feverm chills, malaise, abd. Pains. Sanguinopurulent discharge
What will PE show with a septic abortion?
tachycardia, tachypnea, lower abdominal tendernedd, boggy tender uterus with a dilated cervix
What is the management of a septic abortion?
IV abx and evacuation of the uterine cavity
What is an expectant?
natural expulsion of the products of gestation
What is expectant highly associated with?
incomplete abortion
What is the medical management for an incomplete or missed abortion?
Misoprostol (PGE1)
What is the surgical method for abortion in the 1st trimester?
D&C
What is the surgical method for abortion in the 2nd trimester?
D&E
What is given prophylactically for a surgical abortion?
abx (doxycycline or metronidazole)
What medications can be given for an elective abortion?
Mifepristone or Misoprostol
does an Rh- woman need anti-D immunoglobulin following a miscarriage or any bleeding during pregnancy?
yes
