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clinical aspects of abortion Flashcards

1
Q

what is an abortion ?

A

the termination of a pregnancy before viability which is 24 weeks

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2
Q

difference between abortion vs miscarriage ?

A

abortion is deliberate
miscarriage is spontaneous
both happening before viability

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3
Q

what is the mechanism of abortion in the first 8 weeks ?

A

seperation of the decidua basalis and the ovum is expelled with the decidua

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4
Q

what is the mechanism of abortion between 8-12 weeks ?

A

rupture of the decidua capsularis and the embryo is expelled through the decidua

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5
Q

what is the mechanism of abortion after 12 weeks ?

A

abortion at this point happens like a miniature labour, where uterine contractions happen and result in cervical dilatation followed by fetal and placental expulsion

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6
Q

what is a threatened abortion ?

A

refers to mild vaginal bleeding that occurs before 2o weeks of gestation without cervical dilatation or effacement

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7
Q

what is the management for a threatened abortion ?

A

bed rest
hormonal support:
. HCG 1000 IU twice weekly
. natural progesterone in cases of deficiency
. Anti D injections after 12 weeks of gestation

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8
Q

what is an inevitable abortion ?

A

refers to excessive uterine bleeding prior to 20 weeks of gestation that is accompanied with uterine contractions and cervical dilatation without expulsion of the fetus or the placenta

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9
Q

what is most likely to be seen on ultrasonography of an inevitable abortion ?

A

fetus is most likely to be dead
placenta is partially or completely separated
internal cervical os is dilated

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10
Q

what is the management for a case of inevitable abortion ?

A

if below 12 weeks then evacuation of the contents of the uterus
if above 12-14 weeks then oxytocin and ergometrin is given along with antibiotics and anti D ( opt for medical evacuation )

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11
Q

if medical induction fails , cervix is not fully dilated and the bleeding is very severe what is the next best step in management ?

A

abdominal hysterotomy

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12
Q

what is ann incomplete abortion ?

A

parts of the fetus are expelled whilst others are still retained in the uterus

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13
Q

how can we make a clinnical diagnosis of ann incomplete abortion ?

A

signs are those of an inevitable abortion ( excessive bleeding, supra pubic pain ) however with a smaller uterine size ( inevitable the size of the uterus is almost the same as gestational age )

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14
Q

how are incomplete abortions managed ?

A

by medical or surgical evacuation along with proper administration of antibiotics

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15
Q

what is a complete abortion ?

A

all products of conception have been expelled from the uterus, pain has stopped, bleeding has stopped

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16
Q

what is a missed abortion ?

A

death of the foetus before viability but with prolonged retention of the foetus and placenta for several weeks

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17
Q

what are the two types of missed abortions ?

A

first and second trimesteric

18
Q

what is the clinical picture of a first trimesteric missed abortion ?

A

. recurrent attacks of mild vaginal bleeding ]bleeding is
. dark brown in colour with minimal or no pain
. uterus is a normal size or SGA
. cervix is formed and closed

19
Q

what is the expectant management of a missed abortion ?

A

spontaneous expulsion will happen within 2 weeks

20
Q

what will ultrasound reveal in cases of missed abortion ?

A
  1. anembryonic sac ( no embryonic echo)
  2. a dead embryo with no evidence of pulsation
  3. a dead foetus with no movements or cardiac pulsations
21
Q

what is the surgical management for cases of missed abortion ?

A

if below the age of 7 weeks suction evacuation is performed

if between 7-12 weeks then a surgical evacuation is performed

22
Q

what is the result of a second trimesteric missed abortion ?

A

intra uterine fetal death

23
Q

what are the complications of prolonged IUFD ?

A

intrauterine infection
severe bleeding
hypofibrinogenaemia and DIC

24
Q

what is a septic abortion ?

A

any abortion that has been complicated by infection

25
Q

what are septic abortions commonly associated with ?

A

pregnancy on top of IUCD

criminal abortions

26
Q

what is the management for septic abortions ?

A

isolation of the patient
administration of antibiotics
observations of vital signs
analgesics and anti-pyretics

27
Q

when do we perform a hysterectomy inn cases of septic abortions?

A

if the causative organism is clostridium welchii leading to gangrene that is not responding to treatment

28
Q

what is a therapeutic abortion ?

A

termination of a pregnancy for a medical reason such as chronic hypertension

29
Q

what are recurrent abortions defined as ?

A

loss of 3 or more fetus consecutively

30
Q

how are pregnant women with antiphospholipid syndrome managed ?

A

they are given low dose aspirin daily

31
Q

what is isthmic incompetence ?

A

it is the inability of the cervix to retain the conceptus past the first trimester

32
Q

what are the causes of isthmic incompetence ?

A

trauma is the most common cause

anatomic defects

33
Q

how is isthmic incompetence mainly treated ?

A

cervical cerclage performed between 12-14 weeks

mcdonalds operation

34
Q

what is the presentation associated with a threatened abortion ?

A

mild vaginal bleeding before 20 weeks
uterus size corresponds to gestational age
ultrasound is normal
cervical os is closed

35
Q

what is the prognosis of a threatened abortion ?

A

50% chance will become either an inevitable abortion

or missed abortion

36
Q

what is the clinical presentation associated with inevitable abortion ?

A

severe vaginal bleeding
suprapibic pain is always present and radiating to the back
the cervix is dilated

37
Q

what does the ultrasound scan of an incomplete abortion show ?

A

parts of the conception are still in the uterus with a slightly dilated cervix

38
Q

what is the medical treatment for a missed abortion ?

A

oral antiprogesterone

misoprostol ( synthetic prostaglandins )

39
Q

how is the medical induction of abortion initiated ?

A

oral or vaginal misoprostol

iv oxytocin infusion

40
Q

what is important to administer in an abortion occuring before 12 weeks ?

A

Anti-D

41
Q

what is usually a diagnostic method for the identification of isthmic incompetence ?

A

easy passage of no.8 hegar dilator
funneling of the cervix
widened internal os in relation to gestational age

WH (68 decks)

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