Hemorrhagic Disorders/Abortions Flashcards
Threatened Abortion
Vaginal spotting early in gestation. No passage embryonic or fetal tissue
Abdominal cramping
Cervix is closed
Management of Threatened Abortion
Possible mild activity restriction w/ bedrest 24-48 hrs, sedation
Avoid stimulation of sexual intercourse and orgasm for 2 wks
Inevitable Abortion
Pregnancy loss that cannot be prevented
Bleeding may be moderate/heavy
Cervix is dilated w/ tissue in cervix
Management of Inevitable Abortion
D & C (dilation and curettage) performed, vacuum curettage or administration of prostaglandin analog to evacuate the uterus
Incomplete Abortion
Pass of some of the products of conception. Ultrasound reveals retained material in the uterus. Cervix is open
Management of Incomplete Abortion
Cervix is open but may require additional dilation before curettage
Curettage
Scraping of a cavity or lesion
Complete Abortion
All fetal tissue and products of conception passed in bleeding. US reveals an empty uterus
Management of Complete Abortion
No further intervention may be needed if uterine contractions adequate to prevent hemorrhage and there is no infection. No need for treatment but follow up care to discuss related issues.
Septic Abortion
Fever
abdominal pain and tenderness
Bleeding from scant to heavy usually malodorous
Cervix is usually dilated
Septic Abortion Management
Termination of pregnancy
Culture and sensitivity studies to initiate appropriate antibiotic therapy
Missed Abortion
Retained nonviable embryo or fetus for 6 wks or more
Fetus has died and the placenta atrophied but the products of conception retained
Cervix is closed
Missed Abortion Management
Blood clotting factors are monitored
DIC w/ hemorrhage develops in case of fetal death after wk 12
Habitual or recurrent abortion
3 or more consecutive losses before 20 weeks of gestation
Cervix open
Habitual or Recurrent Abortion management
Identification and treatment of the underlying cause
Prophylactic cerclage if related to cervical insufficiency
Cervical insufficiency or short cervis
Cervical Internal OS opening or prolapsed fetal membranes
Management Cervical insufficiency
Cerclage: closing of the cervix w/ a purse-string stitch
Ectopic Pregnancy (Tubal pregnancy)
Abdominal pain
Spotting
+ pregnancy test
verified by US
Signs of shoulder pain (ruptured tube)
signs of shock
Ectopic Pregnancy Management
Tubal ligation and Methotrexate (nausea)
What should be avoid with Ectopic Pregnancy
folic acid, sun exposure, sexual intercourse
Why would you avoid these factors during ectopic pregnancy
Because they would cause NV and gastric discomfort
Hydatidiform Mole (Molar pregnancy
True or False pregnancy?
False pregnancy; its a gestational trophoblast disease
Hydatidiform Mole diagnosis
Transvaginal US and serum hCG
Management of Hydatidiform Mole
Dilation and Currettage
