Clincal:Abortions Flashcards
Define abortion
unexpected, unplanned, sponatneous loss of pregnancy BEFORE fetus is sufficiently developed to survive extrautreo
up to how many weeks gestation defines it to be an abortion
Occur up to 20 weeks gestation
if the abortion is spontaneous and occurs AFTER 20 week but BEFORE 37 it is a …
Preterm birth
spontaneous abortion is aka
miscarriage
how many weeks gestation defines it to be intrauterine fetal demise (IUFD)
Fetal death after 20 weeks but BEFORE the onset of labor
IUFD is considered what type of abortion BEFORE 20 weeks
missed abortion
AFTER 20 weeks gestation, fetal death is considered … and no longer a missed abortion
IUFD
1% of pregnancies
abortion incidence of all preganancies
50%
abortion incidence of clinically recognizable pregnancies
10-15%
if the fetus makes it to … weeks gestation, the loss rate is reduced to (blank)% over the next 20 weeks
8 weeks gestation
3%
what is the loss rate over the next 20 weeks if mom is < 30 yrs old
2%
what is the loss rate over the next 20 weeks if mom is >40 yrs old
5-10%
at what age does the mom start going downhill in creating healthy babies
35 yrs old
worse if she’s 35 and smokes
define threatened abortion
vaginal bleeding BEFORE 20 weeks and the cervical os is CLOSED
what % of pregnant pt have some degree of bleeding in the 1st trimester
25%
of the 25% that have some degree of bleeding in the 1 trimester, how many result in loss of the pregnancy
25-50%
define inevitable abortion
vaginal bleeding with the cervix open to some degree
what symptom is frequently seen with inevitable abortion
cramping
define incomplete abortion
bleeding, Os OPEN, and passage of some products of conception
define complete abortion
bleed, Os CLOSED, and passage of ALL the productions of conception
define missed abortion
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
therapeutic or elective abortions
Elective termination of the pregnancy
define septic abortion
any spontaneous or therapeutic abortion with intrauterine infection
define recurrent abortion
3 successive abortions
-a work up should be done usually after the 2nd abortion
what could be causing recurrent abortions
usually bacteria/ infections/ viruses
what is the MOST common cause of spontaneous abortion
significant genetic abnormality of the conceptus –> im assuming another word for the fetus
what are some other etiologies
Infections Environmental Exposure Systemic disorders Increased maternal age Uterine abnormalities Fetal/Genetic abnormalites Immunologic
what are some examples of infections that can cause an abortion
Rubella, Listeria, Mycoplasma, Toxoplasma (cat feces)
what are examples of environmental exposures that can cause an abortion
smoking, alcohol, chemicals
what are examples of systemic disorders that can cause an abortion
Diabetes, hypothyroidism, SLE
How can increased maternal age affect abortions
the chromosomal factors
what are examples of uterine abnormalities
cervical incompetence
fibroids
septums
Asherman’s syndrome - endometrial lining adhering to each other
what can cause Asherman’s syndrome
scraping of the endometrial lining, D&E
Abortions effected by serum Ab, Rh, Kell & Duffy, etc… is what etiology
immunologic
Fetal/Genetic abnormalities:
what ratio of spontaneous 1st trimester abortions have significant CHROMOSOMAL abnormalities
2/3
of the 2/3 with chromosomal abnormalities, 1/2 is associated with what type of chromo abnl
Trisomies
What do you do for a threatened abortion
ultrasound
rest and reassurance
What do you do for an inevitable abortion
hospital admission analgesia possible D&C prostaglandins, cytotec
What do you do for a incomplete abortion
same as inevitable: hospital admission analgesia possible D&C prostaglandins, cytotec
D&C, Cytotec, prostaglandins, Laminaria manages which abortion type
Missed abortion
**if pt is Rh - , what must be given ***
Rhogram injection
what do you do for a complete abortion
supportive measures
I.V, antibiotics and evacuation
septic abortion
What do you need to do for recurrent abortions
workup with cultures, labs for Ab, and possibly chromosomal studies
What do you do for an elective abortion
counselling, D&C, D&E (done in the 2nd trimester), prostglandins or laminaria
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%
How do you diagnose IUFD
US
spalding’s sign
gas in the CV system
What does an ultrasound do for IUFD
it confirms lack of movement and absence of fetal heart tones
what is Spalding’s sign
the overlapping of the fetal skull bones on x-ray
- mostly due to liquefaction of the fetal brain
What is important to monitor for IUFD
coagulopathies
fibrinogen, fibrin split products, PT and PTT, CBC with Platelets
DIC
what needs to be done as a follow up for abortions
- work up pts for infections especially TORCH
- immune diseases
- uterine anomalies
- chromosome defects
What does TORCH stand for
T – Toxoplasmosis / Toxoplasma gondii
O – Other infections
R – Rubella
C – Cytomegalovirus
H – Herpes simplex virus-2 or neonatal herpes simplexDont 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.
Dont need to know, but who knows:
when does pitocin induction begin
after 28 weeks
Dont need to know, but who knows:
what is pitocin induction
high rate of uterine rupture with prostoglandins at the age
