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Y4R2 - Obstetrics I 🤰 > L8: Abortion > Flashcards

L8: Abortion Flashcards

1
Q

Def of Abortion

A
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2
Q

types of Abortion

A
  • Spontaneous abortion (miscarriage or early pregnancy loss).
  • Induced abortion: See induction of abortion.
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3
Q

Def of Spontaneous Abortion

A
  • Interruption or termination of pregnancy before fetal viability through natural passage without any mechanical or medical intervention
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4
Q

Incidence of Spontaneous Abortion

A

10-15% of clinical pregnancies.

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5
Q

Etiology of Spontaneous Abortion

A
  • Fetal Causes
  • Maternal Causes
  • Paternal Causes
  • Abnormalities in Placenta & AVF
  • Idiopathic
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6
Q

Etiology of Spontaneous Abortion

  • fetal Causes
A
  • fetal Deaths
  • Chromosomal abnormalitie
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7
Q

What is the most common Causes of Etiology of Spontaneous Abortion?

A

Chromosomal abnormalities

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8
Q

Types of Chromosomal abnormalites resulting in spontaneous abortion

A

Numerical disorders (monosomy & trisomy) or structural disorders.

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9
Q

Effects of Chromosomal abnormalites on spontaneous Abortion

A

Non formation of embryo (blighted ovum) or congenital malformation of embryo.

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10
Q

Etiology of Spontaneous Abortion

  • Maternal Causes
A
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11
Q

Etiology of Spontaneous Abortion

  • Anatomical Congenital Causes
A
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12
Q

Etiology of Spontaneous Abortion

  • Anatomical Acquired Causes
A
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13
Q

Etiology of Spontaneous Abortion

  • Endocrinal Causes
A

LPD, DM or thyroid disorders.

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14
Q

Etiology of Spontaneous Abortion

  • Infection Causes
A

STORCH, AIDS, mycoplasma & typhoid.

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15
Q

Etiology of Spontaneous Abortion

  • Immunological Causes
A

Rh isoimmunization, antiphospholipid syndrome (APS) & SLE.

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16
Q

Etiology of Spontaneous Abortion

  • miscellaneous Causes
A
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17
Q

Etiology of Spontaneous Abortion

  • Chronic Causes
A

HTN, heart diseases, chronic renal failure or TB.

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18
Q

Etiology of Spontaneous Abortion

  • Environmental Causes
A
  • Smoking, alcoholism, caffeine (> 5 cups coffee /day), drugs (quinine, ergot & cytotoxic drugs), inhalation anesthetics, toxins (heavy metals & organic solvents) & ionizing radiation
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19
Q

Etiology of Spontaneous Abortion

  • Traumatic Causes
A

External abdominal trauma or trauma during abdominal operations.

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20
Q

Etiology of Spontaneous Abortion

  • Abnormalities of Placenta & AF
A
  • Acute polyhydramnios (due to uterine distention).
  • Circumvallate or marginate placenta or partial vesicular mole
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21
Q

Etiology of Spontaneous Abortion

  • Paternal Causes
A

Abnormal sperms give rise to pathological zygot.

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22
Q

Etiology of Spontaneous Abortion

  • Idiopathic
A

…

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23
Q

Types of Spontaneous Abortion

A
  • According to time
  • According to number
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24
Q

Types of Spontaneous Abortion

  • Acc to time
A
  • Early abortion: In 1st trimester (80%).
  • Late abortion: In 2nd trimester (20%).
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25
Q

Types of Spontaneous Abortion

  • Acc to number
A
  • Accidental (isolated) abortion.
  • Repeated abortion: Occurrence of 2 successive abortions.
  • Recurrent (habitual) abortion: Occurrence of ≥ 3 successive abortions.
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26
Q

Mechanism of Spontaneous Abortion

A
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27
Q

Mechanism of Spontaneous Abortion

  • > 8 weeks
A
  • 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.
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28
Q

Mechanism of Spontaneous Abortion

  • 8-12 weeks
A

Rupture of decidua capsularis → expulsion of fetus followed by separation & expulsion of decidua

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29
Q

Mechanism of Spontaneous Abortion

  • > 12 weeks
A

ROM → expulsion of fetus followed by expulsion of placenta.

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30
Q

Pathological changes in abortus

A
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31
Q

Def of Blighted ovum (anembryonic pregnancy or oval dysgenesis)

A

Sac è large volume of fluid & absent embryonic pole.

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32
Q

def of Carneous mole

A

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”.

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33
Q

Sonographic Features of Blighted ovum (anembryonic pregnancy or oval dysgenesis)

A

 Ill defined GS.

 Small GS in relation to GA.

 Absent embryonic pole è sac > 30 mm (8 weeks gestation)

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34
Q

Pathological changes in abortus

  • Dissolution
A

Occurs in early weeks.

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35
Q

Pathological changes in abortus

  • Fetus compressus
A

AF is absorbed & fetus is compressed & desiccated

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36
Q

Pathological changes in abortus

  • Fetus papyraceous (fetal mummification)
A

Fetus is so dry & compressed like parchment.

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37
Q

Pathological changes in abortus

  • Lithopedion
A

Calcified fetus

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38
Q

Complications of Spontaneous Abortion

A

Early & Late

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39
Q

Early Complications of Spontaneous Abortion

A
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40
Q

Early Complications of Spontaneous Abortion

  • Shock
A

Hypovolemic, septic or neurogenic

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41
Q

Early Complications of Spontaneous Abortion

  • Trauma
A

Uterine Perforation & cervical or vaginal lacerations during attempts of surgical evacuation by inexperienced personnel

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42
Q

Early Complications of Spontaneous Abortion

  • Rh isoimmunization
A

In Rh –ve females (so, anti-D Ig should be given to Rh – ve females in all types of abortion).

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43
Q

Late Complications of Spontaneous Abortion

A
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44
Q

CP of Spontaneous Abortion

A

…

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45
Q

Symptoms of Spontaneous Abortion

A
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46
Q

Signs of Spontaneous Abortion

A
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47
Q

INVx for Spontaneous Abortion

A

 To detect abortion: Pregnancy test (to document pregnancy) & ultrasound.

 To detect the cause: As chromosomal or immunological studies.

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48
Q

Clinical types of Spontaneous Abortion

A
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49
Q

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
A
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50
Q

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
A
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51
Q

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
A
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52
Q

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
A
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53
Q

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
A
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54
Q

Fate of Threatened abortion

A
  • continuation of pregnancy
    Or investable , missed abortion
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55
Q

DDx of Snow Storm Appearence

A
  1. missed abortion
  2. vesicular mole
  3. degenerated submucous fibroid
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56
Q

Most important clinical feature differentiating ( ) types of abortion is the ……

A

state of cervix.

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57
Q

Most reliable investigation for abortion is …..

A

ultrasound.

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58
Q

Mechanism of Missed abortion

A
  • 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.
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59
Q

Complications of Missed abortion

60
Q

INVx for Missed abortion

61
Q

DDx of Missed abortion

A
  • Causes of undersized uterus.
  • Causes of snow storm appearance on ultrasound
62
Q

Def of Cervical abortion

A

Variety of inevitable abortion in which products of conception is separated from uterus & retained in cervical canal

63
Q

Etiology of Cervical abortion

A

Stenosis of external os.

64
Q

Dx of Cervical abortion

A

Considerable bleeding + severe colicky pain + enlarged barrel shaped cervix

65
Q

TTT of Cervical abortion

A

Cervical dilatation (under anesthesia) + removal of products of conception.

66
Q

Def of Septic abortion

A

Infection superimposed on any type of abortion.

67
Q

Organisms Causing Septic abortion

A
  • Staphylococcus aureus, hemolytic streptococci, E. coli, anaerobes, clostridium welchii & bacteroids.
68
Q

Routes of infection in Septic abortion

69
Q

Pathology of Septic abortion

A
  • Infection may be in products of conception (infected abortion) or may reach uterine wall (endometritis) or may reach circulation (septicemia).
70
Q

Complications of Septic abortion

A

Septic shock, acute renal failure or DIC.

71
Q

Symptoms & Signs of Septic abortion

72
Q

INvx for Septic abortion

73
Q

Prevention of Septic abortion

A

Avoid criminal abortion & asepsis & giving antibiotics during evacuation.

74
Q

TTT of Septic abortion

75
Q

TTT of Septic abortion

  • Isolation
76
Q

TTT of Septic abortion

  • Bed Rest
A

semisetting position

77
Q

TTT of Septic abortion

  • Light nutritive diet & liberal fluids
78
Q

TTT of Septic abortion

  • Analgesics & Antipyretics
79
Q

TTT of Septic abortion

  • Antibiotics
A

Start by triple antibiotics (broad spectrum penicillin or cephalosporin + gentamycin + metronidazole) to cover mixed infection then change according
to results of culture & sensitivity testing.

80
Q

TTT of Septic abortion

  • Anti Gas-Gangrene Serum
A

Given if clostridium welchii infection is suspected.

81
Q

TTT of Septic abortion

  • Antishock Measures
A

IV fluids, fresh blood transfusion (to ↑↑ immunity) & corticosteroids.

82
Q

TTT of Septic abortion

  • Evacuation
A

Surgical procedures are postponed (for about 24 hours) till normalization of fever except in cases è severe resistant infection or severe bleeding where evacuation is soon done under cover of antibiotics.

83
Q

TTT of Septic abortion

  • Hystretomy
A

Rarely indicated (in Cl. welchii infection or uterine perforation).

84
Q

TTT of Septic abortion

  • Observation
A

Pulse, BP, temperature, urine output & fluid intake.

85
Q

DDx of Abortion

86
Q

DDx of Abortion

  • Obstetric Causes
87
Q

DDx of Abortion

  • Gynecological Causes
88
Q

Def of Postabortive bleeding

A

Persistent or recurrent vaginal bleeding èin 4 weeks after abortion

89
Q

Etiology of Postabortive bleeding

90
Q

Etiology of Postabortive bleeding

  • Trauma
A

Perforated uterus, cervical lacerations or vaginal lacerations.

91
Q

Etiology of Postabortive bleeding

  • Bleeding Tendency
A

Hypofibrinogenemia or DIC

92
Q

Etiology of Postabortive bleeding

  • Hormonal
A
  • Hyperthyroidism or hypoovarian function due to pituitary failure
93
Q

Def of Recurrent (habitual) abortion

A

Occurrence of ≥ 3 successive spontaneous clinically recognized abortions.

94
Q

Incidence of Recurrent (habitual) abortion

A

0.2% of all pregnancies

95
Q

Etiology of Recurrent (habitual) abortion

96
Q

Recurrent (habitual) abortion

  • Only undiputed causes are …….
A

chromosomal abnormalities & APS

97
Q

Etiology of Recurrent (habitual) abortion

  • Fetal Causes
A

Chromosomal abnormalities

98
Q

Etiology of Recurrent (habitual) abortion

  • Maternal Causes
99
Q

Etiology of Recurrent (habitual) abortion

  • Idiopathic
A

In 33-50% of cases

100
Q

Dx of Recurrent (habitual) abortion

  • Hx
101
Q

Dx of Recurrent (habitual) abortion

  • personal Hx
A

↑↑ maternal or paternal age.

102
Q

Dx of Recurrent (habitual) abortion

  • Obstetric Hx
103
Q

Dx of Recurrent (habitual) abortion

  • Obstetric Hx (Deliveries)
A

History of difficult labor

104
Q

Dx of Recurrent (habitual) abortion

  • Obstetric Hx (Abortions)
105
Q

Dx of Recurrent (habitual) abortion

  • Recurrent early abortion Mostly Suggest …….
A
  • Chromosomal abnormalities (commonest cause), submucous fibroid, LPD, APS or chronic nephritis.
106
Q

Dx of Recurrent (habitual) abortion

  • Recurrent abortion with ↓↓ duration of pregnancy suggest ……
A

Cervical incompetence or Rh incompatibility (very rare).

107
Q

Dx of Recurrent (habitual) abortion

  • Recurrent abortion with ↑↑ duration of pregnancy suggest …….
A

Uterine hypoplasia or syphilis.

108
Q

Dx of Recurrent (habitual) abortion

  • Characters of abortus
A
  • Living: Local uterine causes (cervical incompetence).
  • Dead: General or fetal causes.
109
Q

Dx of Recurrent (habitual) abortion

  • special Characters
A

Characters of abortion of cervical incompetence

110
Q

Dx of Recurrent (habitual) abortion

  • Past Hx
A

Medical disorders, infection & surgical or gynecological operations.

111
Q

Dx of Recurrent (habitual) abortion

  • Family Hx
A

Consanguinity

112
Q

Dx of Recurrent (habitual) abortion

  • Present Hx
A

GA, symptoms of pregnancy, symptoms of abortion or cervical cerclage.

113
Q

Dx of Recurrent (habitual) abortion

  • Ex
A

Signs of the cause

114
Q

Dx of Recurrent (habitual) abortion

  • INVx
115
Q

Dx of Recurrent (habitual) abortion

  • INVx (Detection of Cause)
116
Q

Dx of Recurrent (habitual) abortion

  • INVx (Monitoring of subsequent pregnancy)
A
  • Serum β-HCG.
  • Ultrasound.
  • Maternal serum AFP (MSAFP): To screen for chromosomal anomalies.
  • Fetal karyotyping
117
Q

ACOG (2001) recommended only 2 types of testing as having a clear value in investigating recurrent abortion: …….

A
  • Parental cytogenetic analysis
  • Anticardiolipin Abs (ACA) & lupus anticoagulant (LAC) Abs assay.
118
Q

TTT of Recurrent (habitual) abortion

119
Q

TTT of Recurrent (habitual) abortion Defore pregnancy

A

Treatment of the cause (if there is treatable cause).

120
Q

TTT of Recurrent (habitual) abortion During pregnancy

121
Q

TTT of Recurrent (habitual) abortion During pregnancy

  • General Lines
A
  • Reassurance & psychological support.
  • Rest (physical & mental).
  • Avoid intercourse.
  • Adequate diet & vitamins & minerals supplementation
122
Q

TTT of Recurrent (habitual) abortion During pregnancy

  • TTT of Cause
123
Q

TTT of Recurrent (habitual) abortion During pregnancy

  • Obsrvation
A

For development of any problem (as preeclampsia, preterm labor or IUGR)

124
Q

TTT of Recurrent (habitual) abortion During pregnancy

  • Prophylactic Corticosteroids
A

At 28 weeks for lung maturity

125
Q

TTT of Recurrent (habitual) abortion During pregnancy

  • Delivery
A

Elective LSCS or induction of labor according to condition.

126
Q

Def of Cervical Incompetence

A

Inability of cervix to maintain pregnancy till term due to wide internal os

127
Q

Etiology of Cervical Incompetence

128
Q

Etiology of Cervical Incompetence

  • Functional Incompetence
A
  • Congenital weakness of cervix in association è uterine anomalies.
129
Q

Etiology of Cervical Incompetence

  • Anatomical Incompetence
A

Due to cervical trauma in internal os region as in:

  • Use of forceps or ventouse or breech extraction before full cervical dilatation.
  • Manual cervical dilatation during labor.
  • Rapid delivery.
  • Unrepaired cervical tear.
  • Rapid mechanical dilatation of cervix (> Hegar 8) during D&C.
  • Amputation or conization of cervix.
130
Q

Dx of Cervical Incompetence

  • Hx
131
Q

Dx of Cervical Incompetence

  • Ex
A
  • Short patulous cervix è bulging membranes through cervix.
  • Cervical tear may be present.
132
Q

Dx of Cervical Incompetence

  • INVx
133
Q

Dx of Cervical Incompetence

  • INVx (Between Pregnancies)
134
Q

Dx of Cervical Incompetence

  • INVx (During Pregnancy)
135
Q

Prevention of Cervical Incompetence

A

Avoid the Causative factors

136
Q

TTT of Cervical Incompetence

137
Q

TTT of Cervical Incompetence

  • In Between pregnancies
A
  • Some operations are developed to regain cervical competence (however, they aren’t as successful as cerclage).
138
Q

TTT of Cervical Incompetence

  • During Pregnancy
139
Q

Def of Cervical cerclage

A

Encircling cervical internal os è suture to support weak cervix.

140
Q

Time of Cervical cerclage

A
  • Ideally done ( ) 12 weeks (to ensure absence of fetal anomalies) & 14 weeks (after that, uterus is difficult to manipulate vaginally).
141
Q

Techniques of Cervical cerclage

142
Q

Techniques of Cervical cerclage

  • Mcdonald Cerclage
A

Purse string tight suture is passed around cervix & tied posteriorly.

143
Q

Techniques of Cervical cerclage

  • Shirodkar’s cerclage
A
  • Tight suture is passed around internal os under vaginal mucosa through 2 small transverse vaginal incisions at 6 & 12 O’clock after upward mobilization of bladder & peritoneum of Douglas pouch.
144
Q

Techniques of Cervical cerclage

  • Abdominal Cerclage
A
  • Indications: Amputation of cervix or deep cervical tear.
  • Disadvantages: Delivery is by CS
145
Q

Removal of Cervical cerclage

A

Removal of stitch:

  • Generally removed (except abdominal cerclage) after 37 weeks or at start of labor but some prefer to leave it (specially in Shirodkar’s cerclage) & do CS.
146
Q

Complications of Cervical cerclage

A

a) ROM & chorioamnionitis.

b) Cervical lacerations.

c) Cervical hematoma: Due to injury of cervical branch of uterine artery.

d) Cervical fibrosis leading to cervical dystocia in the following labor.

e) Bladder injury.

f) ↑↑ uterine irritability.

g) Induction of abortion or preterm labor.

h) ↑↑ incidence of operative delivery

Y4R2 - Obstetrics I 🤰 (59 decks)

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