Introduction to Abortion & its Management Flashcards
Abortion is _______________ by ______ or _________ before _____ weeks of gestation and the fetal weight is less than _____g.
termination of pregnancy
expulsion or extraction
28; 1000
Abortion: can either be
_____________ (__________ ): 10%-15%
Or
_______/___________
Spontaneous ; Miscarriage
Artificial/ induced
The early abortion occurs before _____weeks while late abortion occurs after ____weeks
12; 12
5 aetiology of abortions
Aetiology
1.Hereditary
2.Uterine abnormalities
3.Infections
4.Endocrine disorders
5.Immunological factors
HEREDITARY
Can either be _______ or _______
Numerical
Structural
___________________ is the commonest cause of spontaneous abortion.
Chromosomal abnormality
HEREDITARY
Numerical: ________, __________ I.e _________,_______
Structural –________ chromosomal abnormalities i.e., _________________
autosomal trisomies polyploidy i.e., Trisomy 16, monosomy X
Parental; balanced translocation
monosomy X AKA ___________________
Turner’s syndrome
50%~60% of early abortions are caused by _______________________
chromosomal abnormalities.
Uterine abnormalities
•Congenital uterine deformity
__________ uterus
______________uterus
_____________________________
•Acquired
________________
________________
Double; Hypoplastic; Longitudinal uterine septum
Cervical incompetence; pelvic tumor
Infections
Systemic (_________,________) or Local ( _____,________ )
•Bacteria, toxins and viruses get into fetal blood circulation via the ______________.
malaria, pyelonephritis
Bacterial Vaginosis , UTI
placenta
Endocrine disorders
•Hyper- or hypo___________
•Hypofunction of ______________ (luteal phase dysfunction)
thyroidism
corpus luteum
Immunological factors
•____________ _______________ (APS)
•Blood type incompatibility between mother and fetus – incompatibility due to ABO, Rh
Antiphospholipid syndrome
Types of abortion
List 6
Complete Abortion
Recurrent Abortion
Inevitable abortion
Incomplete Abortion
Missed Abortion
Threatened abortion
Threatened Abortion
The term threatened abortion is used when a pregnancy is complicated by ___________ before the ______ week.
•Vaginal examination at this stage usually reveals a ___________
•25-50% of threatened abortions eventually result in pregnancy loss.
vaginal bleeding; 28th
Closed cervix
Pain is always a prominent feature of threatened abortion
T/F
F
Pain may not be a prominent feature of threatened abortion, although a lower abdominal dull ache sometimes accompanies the bleeding.
Inevitable abortion
•Occurs when a clinical pregnancy is complicated by ____________________________.
•Vaginal examination reveals that _____________________________, attesting to the inevitability of the process.
both vaginal bleeding and cramp-like lower abdominal pain
The cervix is frequently partially dilated
Incomplete Abortion
•In addition to _________________ , an incomplete abortion involves the _________________________________, often described by the women as looking like _________ or ________.
vaginal bleeding, cramp- like pain, and cervical dilatation
passage of products of conception
pieces of skin or liver
Complete Abortion
•Occurs after ______________________
The _________ and ___________ abate, the cervix ________, and the uterus is ______ than the period of ______ would suggest.
In addition, the symptoms of pregnancy are no longer present, and the pregnancy test becomes negative.
the passage of all the products of conception
uterine contractions and bleeding
closes; smaller; amenorrhoea
Missed Abortion
•The term missed abortion is used when ___________ but ———————————-.
•It manifests by —————————— and a ________________.
the fetus has died
is retained in the uterus, usually for some weeks
loss of symptoms of pregnancy ; decrease in uterine size
Missed abortion
Risk of ____ – _________ levels should be checked weekly until the fetus and placenta are expelled.
DIC
Fibrinogen
Recurrent Abortion
•Recurrent, or habitual abortion refers to any case in which there have been _____________________________.
•Every abortion may or may not occur at the same month of pregnancy.
three consecutive spontaneous abortions
Causes of Early abortion
List 3
•Hypofunction of corpus luteum •Chromosomal abnormalities •Antiphospholipid syndrome
CaUses of Late abortion
List 4
•Cervical incompetence
•Congenital anomalies of the uterus •Myomas of the uterus
•Blood type incompatibility between mother and fetus
Pathology – Spontaneous abortion
•Embryo or fetus is compromised •Hemorrhage into the ______________.
• __________ and ___________ appear in the region of _____________.
•___________ of conceptus (seen as a ________ in the uterus)
•_____________ and _______________ result in the expulsion of partial or all the products of conception.
decidua basalis
Necrosis and inflammation; implantation
Detachment; foreign body
Uterine contractions and dilatation of the cervix
Management of Threatened Abortion
•The patient is kept on _______ until ___________
• __________ is avoided
•As soon as the initial bleeding has stopped, ______ is performed to reveal whether the pregnancy is still intact
•Drugs
Folic acid 5mg TID
Progesterone – Dydrogesterone (10-20mg BD) PO OR
Cyclogest pessaries (400mg OD)
bedrest ; 2 days after blood loss has ceased
Intercourse; USS
Management Of Inevitable Abortion
•The uterus usually expels its contents unaided, and examination must be made with a __________ technique.
•If the abortion is not quickly completed, or if haemorrhage becomes severe, the contents of the uterus are removed via a surgical evacuation – ___________________________
strict aseptic
manual vacuum aspiration (MVA).
Management Of Incomplete Abortion
•Patients will require admission to the hospital.
•Treatment is aimed at preventing ___________,__________, and ___________ the uterus (medical or surgical).
preventing infection, controlling bleeding and evacuating
evacuation of uterus
Medical – ___________/____________
Surgical – _________________
Mifepristone/Misoprostol
manual vacuum aspiration (MVA)
The chief risks associated with retained products in incomplete abortion are ________ and __________
haemorrhage and sepsis.
Management Of Missed Abortion
•Once the diagnosis has been made the ________________.
•Early in gestation evacuation of the uterus is usually accomplished by ________________.
•The prognosis for the mother is (good or bad?) .
•Serious complications are (common or uncommon?).
uterus should be emptied.
suction evacuation (MVA).
Good
Uncommon
Septic abortion
•The principle of treatment:
oTreat infection with _______________
antibiotics
oThen ___________________
broad-spectrum
Surgical evacuation (MVA)
