L8: Abortion Flashcards
Def of Abortion
types of Abortion
- Spontaneous abortion (miscarriage or early pregnancy loss).
- Induced abortion: See induction of abortion.
Def of Spontaneous Abortion
- Interruption or termination of pregnancy before fetal viability through natural passage without any mechanical or medical intervention
Incidence of Spontaneous Abortion
10-15% of clinical pregnancies.
Etiology of Spontaneous Abortion
- Fetal Causes
- Maternal Causes
- Paternal Causes
- Abnormalities in Placenta & AVF
- Idiopathic
Etiology of Spontaneous Abortion
- fetal Causes
- Fetal Causes
- Chromosomal abnormalitie
What is the most common Causes of Etiology of Spontaneous Abortion?
Chromosomal abnormalities
Types of Chromosomal abnormalites resulting in spontaneous abortion
Numerical disorders (monosomy & trisomy) or structural disorders.
Effects of Chromosomal abnormalites on spontaneous Abortion
Non formation of embryo (blighted ovum) or congenital malformation of embryo.
Etiology of Spontaneous Abortion
- Maternal Causes
Etiology of Spontaneous Abortion
- Anatomical Congenital Causes
Etiology of Spontaneous Abortion
- Anatomical Acquired Causes
Etiology of Spontaneous Abortion
- Endocrinal Causes
LPD, DM or thyroid disorders.
Etiology of Spontaneous Abortion
- Infection Causes
STORCH, AIDS, mycoplasma & typhoid.
Etiology of Spontaneous Abortion
- Immunological Causes
Rh isoimmunization, antiphospholipid syndrome (APS) & SLE.
Etiology of Spontaneous Abortion
- miscellaneous Causes
Etiology of Spontaneous Abortion
- Chronic Causes
HTN, heart diseases, chronic renal failure or TB.
Etiology of Spontaneous Abortion
- Environmental Causes
- Smoking, alcoholism, caffeine (> 5 cups coffee /day), drugs (quinine, ergot & cytotoxic drugs), inhalation anesthetics, toxins (heavy metals & organic solvents) & ionizing radiation
Etiology of Spontaneous Abortion
- Traumatic Causes
External abdominal trauma or trauma during abdominal operations.
Etiology of Spontaneous Abortion
- Abnormalities of Placenta & AF
- Acute polyhydramnios (due to uterine distention).
- Circumvallate or marginate placenta or partial vesicular mole
Etiology of Spontaneous Abortion
- Paternal Causes
Abnormal sperms give rise to pathological zygot.
Etiology of Spontaneous Abortion
- Idiopathic
…
Types of Spontaneous Abortion
- According to time
- According to number
Types of Spontaneous Abortion
- Acc to time
- Early abortion: In 1st trimester (80%).
- Late abortion: In 2nd trimester (20%).
Types of Spontaneous Abortion
- Acc to number
- Accidental (isolated) abortion.
- Repeated abortion: Occurrence of 2 successive abortions.
- Recurrent (habitual) abortion: Occurrence of ≥ 3 successive abortions.
Mechanism of Spontaneous Abortion
Mechanism of Spontaneous Abortion
- > 8 weeks
- Repeated attacks of choriodecidual separation → complete separation of GS → sac is in uterine cavity → uterus deals è it as a FB → uterine contraction → expulsion of products of conception -+outside uterus.
Mechanism of Spontaneous Abortion
- 8-12 weeks
Rupture of decidua capsularis → expulsion of fetus followed by separation & expulsion of decidua
Mechanism of Spontaneous Abortion
- > 12 weeks
ROM → expulsion of fetus followed by expulsion of placenta.
Pathological changes in abortus
Def of Blighted ovum (anembryonic pregnancy or oval dysgenesis)
Sac è large volume of fluid & absent embryonic pole.
def of Carneous mole
Variety of missed abortion in which dead embryo in early pregnancy is surrounded by clotted blood forming “bloody mole” then later on, fibrosis of blood clots occurs forming “fleshy mole”.
Sonographic Features of Blighted ovum (anembryonic pregnancy or oval dysgenesis)
Ill defined GS.
Small GS in relation to GA.
Absent embryonic pole è sac > 30 mm (8 weeks gestation)
Pathological changes in abortus
- Dissolution
Occurs in early weeks.
Pathological changes in abortus
- Fetus compressus
AF is absorbed & fetus is compressed & desiccated
Pathological changes in abortus
- Fetus papyraceous (fetal mummification)
Fetus is so dry & compressed like parchment.
Pathological changes in abortus
- Lithopedion
Calcified fetus
Complications of Spontaneous Abortion
Early & Late
Early Complications of Spontaneous Abortion
Early Complications of Spontaneous Abortion
- Shock
Hypovolemic, septic or neurogenic
Early Complications of Spontaneous Abortion
- Trauma
Uterine Perforation & cervical or vaginal lacerations during attempts of surgical evacuation by inexperienced personnel
Early Complications of Spontaneous Abortion
- Rh isoimmunization
In Rh –ve females (so, anti-D Ig should be given to Rh – ve females in all types of abortion).
Late Complications of Spontaneous Abortion
CP of Spontaneous Abortion
…
Symptoms of Spontaneous Abortion
Signs of Spontaneous Abortion
INVx for Spontaneous Abortion
To detect abortion: Pregnancy test (to document pregnancy) & ultrasound.
To detect the cause: As chromosomal or immunological studies.
Clinical types of Spontaneous Abortion
Threatened abortion
- Def
- Symptoms (Symptoms of pregnancy - vaginal Bleeding - pain - passage of products of conception)
- Signs (Uterine Size - Cervix - ROM)
- INVx (Pregnancy Test - US)
- TTT
Inevitable abortion
- Def
- Symptoms (Symptoms of pregnancy - vaginal Bleeding - pain - passage of products of conception)
- Signs (Uterine Size - Cervix - ROM)
- INVx (Pregnancy Test - US)
- TTT
Incomplete abortion
- Def
- Symptoms (Symptoms of pregnancy - vaginal Bleeding - pain - passage of products of conception)
- Signs (Uterine Size - Cervix - ROM)
- INVx (Pregnancy Test - US)
- TTT
Complete abortion
- Def
- Symptoms (Symptoms of pregnancy - vaginal Bleeding - pain - passage of products of conception)
- Signs (Uterine Size - Cervix - ROM)
- INVx (Pregnancy Test - US)
- TTT
Missed abortion
- Def
- Symptoms (Symptoms of pregnancy - vaginal Bleeding - pain - passage of products of conception)
- Signs (Uterine Size - Cervix - ROM)
- INVx (Pregnancy Test - US)
- TTT
Fate of Threatened abortion
- continuation of pregnancy
Or investable , missed abortion
DDx of Snow Storm Appearence
- missed abortion
- vesicular mole
- degenerated submucous fibroid
Most important clinical feature differentiating ( ) types of abortion is the ……
state of cervix.
Most reliable investigation for abortion is …..
ultrasound.
Mechanism of Missed abortion
- Repeated attacks of choriodecidual separation → choriodecidual Hge → death of embryo or fetus but progesterone is still secreted → relaxation of uterus & prevention of expulsion of embryo or fetus.