Introduction to Abortion & its Management

Question 1

Abortion is _______________ by ______ or _________ before _____ weeks of gestation and the fetal weight is less than _____g.

Answer 1

termination of pregnancy

expulsion or extraction

28; 1000

Question 2

Abortion: can either be

_____________ (__________ ): 10%-15%

Or
_______/___________

Answer 2

Spontaneous ; Miscarriage

Artificial/ induced

Question 3

The early abortion occurs before _____weeks while late abortion occurs after ____weeks

Answer 3

12; 12

Question 4

5 aetiology of abortions

Answer 4

Aetiology
1.Hereditary
2.Uterine abnormalities
3.Infections
4.Endocrine disorders
5.Immunological factors

Question 5

HEREDITARY

Can either be _______ or _______

Answer 5

Numerical

Structural

Question 6

___________________ is the commonest cause of spontaneous abortion.

Answer 6

Chromosomal abnormality

Question 7

HEREDITARY

Numerical: ________, __________ I.e _________,_______

Structural –________ chromosomal abnormalities i.e., _________________

Answer 7

autosomal trisomies polyploidy i.e., Trisomy 16, monosomy X

Parental; balanced translocation

Question 8

monosomy X AKA ___________________

Answer 8

Turner’s syndrome

Question 9

50%~60% of early abortions are caused by _______________________

Answer 9

chromosomal abnormalities.

Question 10

Uterine abnormalities

•Congenital uterine deformity
__________ uterus
______________uterus
_____________________________

•Acquired
________________

________________

Answer 10

Double; Hypoplastic; Longitudinal uterine septum

Cervical incompetence; pelvic tumor

Question 11

Infections

Systemic (_________,________) or Local ( _____,________ )

•Bacteria, toxins and viruses get into fetal blood circulation via the ______________.

Answer 11

malaria, pyelonephritis

Bacterial Vaginosis , UTI

placenta

Question 12

Endocrine disorders

•Hyper- or hypo___________
•Hypofunction of ______________ (luteal phase dysfunction)

Answer 12

thyroidism

corpus luteum

Question 13

Immunological factors

•____________ _______________ (APS)

•Blood type incompatibility between mother and fetus – incompatibility due to ABO, Rh

Answer 13

Antiphospholipid syndrome

Question 14

Types of abortion

List 6

Answer 14

Complete Abortion
Recurrent Abortion
Inevitable abortion
Incomplete Abortion
Missed Abortion
Threatened abortion

Question 15

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.

Answer 15

vaginal bleeding; 28th

Closed cervix

Question 16

Pain is always a prominent feature of threatened abortion

T/F

Answer 16

F

Pain may not be a prominent feature of threatened abortion, although a lower abdominal dull ache sometimes accompanies the bleeding.

Question 17

Inevitable abortion
•Occurs when a clinical pregnancy is complicated by ____________________________.

•Vaginal examination reveals that _____________________________, attesting to the inevitability of the process.

Answer 17

both vaginal bleeding and cramp-like lower abdominal pain

The cervix is frequently partially dilated

Question 18

Incomplete Abortion
•In addition to _________________ , an incomplete abortion involves the _________________________________, often described by the women as looking like _________ or ________.

Answer 18

vaginal bleeding, cramp- like pain, and cervical dilatation

passage of products of conception

pieces of skin or liver

Question 19

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.

Answer 19

the passage of all the products of conception

uterine contractions and bleeding

closes; smaller; amenorrhoea

Question 20

Missed Abortion

•The term missed abortion is used when ___________ but ———————————-.

•It manifests by —————————— and a ________________.

Answer 20

the fetus has died

is retained in the uterus, usually for some weeks

loss of symptoms of pregnancy ; decrease in uterine size

Question 21

Missed abortion

Risk of ____ – _________ levels should be checked weekly until the fetus and placenta are expelled.

Answer 21

DIC

Fibrinogen

Question 22

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.

Answer 22

three consecutive spontaneous abortions

Question 23

Causes of Early abortion

List 3

Answer 23

•Hypofunction of corpus luteum •Chromosomal abnormalities •Antiphospholipid syndrome

Question 24

CaUses of Late abortion

List 4

Answer 24

•Cervical incompetence
•Congenital anomalies of the uterus •Myomas of the uterus
•Blood type incompatibility between mother and fetus

Question 25

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.

Answer 25

decidua basalis

Necrosis and inflammation; implantation

Detachment; foreign body

Uterine contractions and dilatation of the cervix

Question 26

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)

Answer 26

bedrest ; 2 days after blood loss has ceased

Intercourse; USS

Question 27

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 – ___________________________

Answer 27

strict aseptic

manual vacuum aspiration (MVA).

Question 28

Management Of Incomplete Abortion

•Patients will require admission to the hospital.
•Treatment is aimed at preventing ___________,__________, and ___________ the uterus (medical or surgical).

Answer 28

preventing infection, controlling bleeding and evacuating

Question 29

evacuation of uterus

Medical – ___________/____________
Surgical – _________________

Answer 29

Mifepristone/Misoprostol

manual vacuum aspiration (MVA)

Question 30

The chief risks associated with retained products in incomplete abortion are ________ and __________

Answer 30

haemorrhage and sepsis.

Question 31

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?).

Answer 31

uterus should be emptied.

suction evacuation (MVA).

Good

Uncommon

Question 32

Septic abortion
•The principle of treatment:

oTreat infection with _______________
antibiotics
oThen ___________________

Answer 32

broad-spectrum

Surgical evacuation (MVA)