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Clincal:Abortions Flashcards

1
Q

Define abortion

A

unexpected, unplanned, sponatneous loss of pregnancy BEFORE fetus is sufficiently developed to survive extrautreo

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2
Q

up to how many weeks gestation defines it to be an abortion

A

Occur up to 20 weeks gestation

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3
Q

if the abortion is spontaneous and occurs AFTER 20 week but BEFORE 37 it is a …

A

Preterm birth

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4
Q

spontaneous abortion is aka

A

miscarriage

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5
Q

how many weeks gestation defines it to be intrauterine fetal demise (IUFD)

A

Fetal death after 20 weeks but BEFORE the onset of labor

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6
Q

IUFD is considered what type of abortion BEFORE 20 weeks

A

missed abortion

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7
Q

AFTER 20 weeks gestation, fetal death is considered … and no longer a missed abortion

A

IUFD

1% of pregnancies

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8
Q

abortion incidence of all preganancies

A

50%

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9
Q

abortion incidence of clinically recognizable pregnancies

A

10-15%

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10
Q

if the fetus makes it to … weeks gestation, the loss rate is reduced to (blank)% over the next 20 weeks

A

8 weeks gestation

3%

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11
Q

what is the loss rate over the next 20 weeks if mom is < 30 yrs old

A

2%

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12
Q

what is the loss rate over the next 20 weeks if mom is >40 yrs old

A

5-10%

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13
Q

at what age does the mom start going downhill in creating healthy babies

A

35 yrs old

worse if she’s 35 and smokes

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14
Q

define threatened abortion

A

vaginal bleeding BEFORE 20 weeks and the cervical os is CLOSED

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15
Q

what % of pregnant pt have some degree of bleeding in the 1st trimester

A

25%

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16
Q

of the 25% that have some degree of bleeding in the 1 trimester, how many result in loss of the pregnancy

A

25-50%

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17
Q

define inevitable abortion

A

vaginal bleeding with the cervix open to some degree

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18
Q

what symptom is frequently seen with inevitable abortion

A

cramping

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19
Q

define incomplete abortion

A

bleeding, Os OPEN, and passage of some products of conception

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20
Q

define complete abortion

A

bleed, Os CLOSED, and passage of ALL the productions of conception

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21
Q

define missed abortion

A

fetus died and is retained in the uterus
there’s usually no bleeding and usually no symptoms
-basically the body “missed” the fact that the fetus is dead and hasn’t elicited any symptoms

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22
Q

therapeutic or elective abortions

A

Elective termination of the pregnancy

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23
Q

define septic abortion

A

any spontaneous or therapeutic abortion with intrauterine infection

24
Q

define recurrent abortion

A

3 successive abortions

-a work up should be done usually after the 2nd abortion

25
what could be causing recurrent abortions
usually bacteria/ infections/ viruses
26
***what is the MOST common cause of spontaneous abortion***
significant genetic abnormality of the conceptus --> im assuming another word for the fetus
27
what are some other etiologies
``` Infections Environmental Exposure Systemic disorders Increased maternal age Uterine abnormalities Fetal/Genetic abnormalites Immunologic ```
28
what are some examples of infections that can cause an abortion
Rubella, Listeria, Mycoplasma, Toxoplasma (cat feces)
29
what are examples of environmental exposures that can cause an abortion
smoking, alcohol, chemicals
30
what are examples of systemic disorders that can cause an abortion
Diabetes, hypothyroidism, SLE
31
How can increased maternal age affect abortions
the chromosomal factors
32
what are examples of uterine abnormalities
cervical incompetence fibroids septums Asherman's syndrome - endometrial lining adhering to each other
33
what can cause Asherman's syndrome
scraping of the endometrial lining, D&E
34
Abortions effected by serum Ab, Rh, Kell & Duffy, etc... is what etiology
immunologic
35
Fetal/Genetic abnormalities: | what ratio of spontaneous 1st trimester abortions have significant CHROMOSOMAL abnormalities
2/3
36
of the 2/3 with chromosomal abnormalities, 1/2 is associated with what type of chromo abnl
Trisomies
37
What do you do for a threatened abortion
ultrasound | rest and reassurance
38
What do you do for an inevitable abortion
``` hospital admission analgesia possible D&C prostaglandins, cytotec ```
39
What do you do for a incomplete abortion
``` same as inevitable: hospital admission analgesia possible D&C prostaglandins, cytotec ```
40
D&C, Cytotec, prostaglandins, Laminaria manages which abortion type
Missed abortion
41
**if pt is Rh - , what must be given ***
Rhogram injection
42
what do you do for a complete abortion
supportive measures
43
I.V, antibiotics and evacuation
septic abortion
44
What do you need to do for recurrent abortions
workup with cultures, labs for Ab, and possibly chromosomal studies
45
What do you do for an elective abortion
counselling, D&C, D&E (done in the 2nd trimester), prostglandins or laminaria
46
**what are the causes and their respective % for fetal death***
``` placental and cord - 10-20% HTN - 5-20& Med complications - 5-10% Infections - 5-10% Congential anomalies - 5-10% unknown - >50% ```
47
How do you diagnose IUFD
US spalding's sign gas in the CV system
48
What does an ultrasound do for IUFD
it confirms lack of movement and absence of fetal heart tones
49
what is Spalding's sign
the overlapping of the fetal skull bones on x-ray | - mostly due to liquefaction of the fetal brain
50
What is important to monitor for IUFD
coagulopathies
51
fibrinogen, fibrin split products, PT and PTT, CBC with Platelets
DIC
52
what needs to be done as a follow up for abortions
- work up pts for infections especially TORCH - immune diseases - uterine anomalies - chromosome defects
53
What does TORCH stand for
``` T – Toxoplasmosis / Toxoplasma gondii O – Other infections R – Rubella C – Cytomegalovirus H – Herpes simplex virus-2 or neonatal herpes simplex ```
54
Dont need to know, but who knows: | how do you manage IUFD
13 to 28 weeks- either watchful expectancy or induction of labor. 80%- spontaneous labor in 2-3 weeks. Induction with prostaglandins 12-28 weeks. D&E.
55
Dont need to know, but who knows: | when does pitocin induction begin
after 28 weeks
56
Dont need to know, but who knows: | what is pitocin induction
high rate of uterine rupture with prostoglandins at the age

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