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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
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.
26
Mechanism of **Spontaneous Abortion**
27
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.
28
Mechanism of **Spontaneous Abortion** - 8-12 weeks
Rupture of decidua capsularis → expulsion of fetus followed by separation & expulsion of decidua
29
Mechanism of **Spontaneous Abortion** - > 12 weeks
ROM → expulsion of fetus followed by expulsion of placenta.
30
Pathological changes in abortus
31
Def of **Blighted ovum (anembryonic pregnancy or oval dysgenesis)**
Sac è large volume of fluid & absent embryonic pole.
32
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".
33
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)
34
Pathological changes in abortus - Dissolution
Occurs in early weeks.
35
Pathological changes in abortus - Fetus compressus
AF is absorbed & fetus is compressed & desiccated
36
Pathological changes in abortus - Fetus papyraceous (fetal mummification)
Fetus is so dry & compressed like parchment.
37
Pathological changes in abortus - Lithopedion
Calcified fetus
38
Complications of **Spontaneous Abortion**
Early & Late
39
Early Complications of **Spontaneous Abortion**
40
Early Complications of **Spontaneous Abortion** - Shock
Hypovolemic, septic or neurogenic
41
Early Complications of **Spontaneous Abortion** - Trauma
Uterine Perforation & cervical or vaginal lacerations during attempts of surgical evacuation by inexperienced personnel
42
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).
43
Late Complications of **Spontaneous Abortion**
44
CP of **Spontaneous Abortion**
...
45
Symptoms of **Spontaneous Abortion**
46
Signs of **Spontaneous Abortion**
47
INVx for **Spontaneous Abortion**
 To detect abortion: Pregnancy test (to document pregnancy) & ultrasound.  To detect the cause: As chromosomal or immunological studies.
48
Clinical types of **Spontaneous Abortion**
49
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
50
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
51
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
52
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
53
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
54
Fate of **Threatened abortion**
- continuation of pregnancy Or investable , missed abortion
55
DDx of **Snow Storm Appearence**
1. missed abortion 2. vesicular mole 3. degenerated submucous fibroid
56
Most important clinical feature differentiating ( ) types of abortion is the ......
state of cervix.
57
Most reliable investigation for abortion is .....
ultrasound.
58
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.
59
Complications of Missed abortion
60
INVx for **Missed abortion**
61
DDx of Missed abortion
- Causes of undersized uterus. - Causes of snow storm appearance on ultrasound
62
Def of **Cervical abortion**
Variety of inevitable abortion in which products of conception is separated from uterus & retained in cervical canal
63
Etiology of **Cervical abortion**
Stenosis of external os.
64
Dx of **Cervical abortion**
Considerable bleeding + severe colicky pain + enlarged barrel shaped cervix
65
TTT of **Cervical abortion**
Cervical dilatation (under anesthesia) + removal of products of conception.
66
Def of **Septic abortion**
Infection superimposed on any type of abortion.
67
Organisms Causing **Septic abortion**
- Staphylococcus aureus, hemolytic streptococci, E. coli, anaerobes, clostridium welchii & bacteroids.
68
Routes of infection in Septic abortion
69
Pathology of **Septic abortion**
- Infection may be in products of conception (infected abortion) or may reach uterine wall (endometritis) or may reach circulation (septicemia).
70
Complications of **Septic abortion**
Septic shock, acute renal failure or DIC.
71
Symptoms & Signs of **Septic abortion**
72
INvx for Septic abortion
73
Prevention of **Septic abortion**
Avoid criminal abortion & asepsis & giving antibiotics during evacuation.
74
TTT of **Septic abortion**
75
TTT of **Septic abortion** - Isolation
...
76
TTT of **Septic abortion** - Bed Rest
semisetting position
77
TTT of **Septic abortion** - Light nutritive diet & liberal fluids
...
78
TTT of **Septic abortion** - Analgesics & Antipyretics
...
79
TTT of **Septic abortion** - Antibiotics
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
TTT of **Septic abortion** - Anti Gas-Gangrene Serum
Given if clostridium welchii infection is suspected.
81
TTT of **Septic abortion** - Antishock Measures
IV fluids, fresh blood transfusion (to ↑↑ immunity) & corticosteroids.
82
TTT of **Septic abortion** - Evacuation
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
TTT of **Septic abortion** - Hystretomy
Rarely indicated (in Cl. welchii infection or uterine perforation).
84
TTT of **Septic abortion** - Observation
Pulse, BP, temperature, urine output & fluid intake.
85
DDx of **Abortion**
86
DDx of **Abortion** - Obstetric Causes
87
DDx of **Abortion** - Gynecological Causes
88
Def of **Postabortive bleeding**
Persistent or recurrent vaginal bleeding èin 4 weeks after abortion
89
Etiology of **Postabortive bleeding**
90
Etiology of **Postabortive bleeding** - Trauma
Perforated uterus, cervical lacerations or vaginal lacerations.
91
Etiology of **Postabortive bleeding** - Bleeding Tendency
Hypofibrinogenemia or DIC
92
Etiology of **Postabortive bleeding** - Hormonal
- Hyperthyroidism or hypoovarian function due to pituitary failure
93
Def of **Recurrent (habitual) abortion**
Occurrence of ≥ 3 successive spontaneous clinically recognized abortions.
94
Incidence of **Recurrent (habitual) abortion**
0.2% of all pregnancies
95
Etiology of **Recurrent (habitual) abortion**
96
Recurrent (habitual) abortion - Only undiputed causes are .......
chromosomal abnormalities & APS
97
Etiology of **Recurrent (habitual) abortion** - Fetal Causes
Chromosomal abnormalities
98
Etiology of **Recurrent (habitual) abortion** - Maternal Causes
99
Etiology of **Recurrent (habitual) abortion** - Idiopathic
In 33-50% of cases
100
Dx of **Recurrent (habitual) abortion** - Hx
101
Dx of **Recurrent (habitual) abortion** - personal Hx
↑↑ maternal or paternal age.
102
Dx of **Recurrent (habitual) abortion** - Obstetric Hx
103
Dx of **Recurrent (habitual) abortion** - Obstetric Hx (Deliveries)
History of difficult labor
104
Dx of **Recurrent (habitual) abortion** - Obstetric Hx (Abortions)
105
Dx of **Recurrent (habitual) abortion** - Recurrent early abortion Mostly Suggest .......
- Chromosomal abnormalities (commonest cause), submucous fibroid, LPD, APS or chronic nephritis.
106
Dx of **Recurrent (habitual) abortion** - Recurrent abortion with ↓↓ duration of pregnancy suggest ......
Cervical incompetence or Rh incompatibility (very rare).
107
Dx of **Recurrent (habitual) abortion** - Recurrent abortion with ↑↑ duration of pregnancy suggest .......
Uterine hypoplasia or syphilis.
108
Dx of **Recurrent (habitual) abortion** - Characters of abortus
- Living: Local uterine causes (cervical incompetence). - Dead: General or fetal causes.
109
Dx of **Recurrent (habitual) abortion** - special Characters
Characters of abortion of cervical incompetence
110
Dx of **Recurrent (habitual) abortion** - Past Hx
Medical disorders, infection & surgical or gynecological operations.
111
Dx of **Recurrent (habitual) abortion** - Family Hx
Consanguinity
112
Dx of **Recurrent (habitual) abortion** - Present Hx
GA, symptoms of pregnancy, symptoms of abortion or cervical cerclage.
113
Dx of **Recurrent (habitual) abortion** - Ex
Signs of the cause
114
Dx of **Recurrent (habitual) abortion** - INVx
115
Dx of **Recurrent (habitual) abortion** - INVx (Detection of Cause)
116
Dx of **Recurrent (habitual) abortion** - INVx (Monitoring of subsequent pregnancy)
- Serum β-HCG. - Ultrasound. - Maternal serum AFP (MSAFP): To screen for chromosomal anomalies. - Fetal karyotyping
117
ACOG (2001) recommended only 2 types of testing as having a clear value in investigating recurrent abortion: .......
- Parental cytogenetic analysis - Anticardiolipin Abs (ACA) & lupus anticoagulant (LAC) Abs assay.
118
TTT of **Recurrent (habitual) abortion**
119
TTT of **Recurrent (habitual) abortion** Defore pregnancy
Treatment of the cause (if there is treatable cause).
120
TTT of **Recurrent (habitual) abortion** During pregnancy
121
TTT of **Recurrent (habitual) abortion** During pregnancy - General Lines
- Reassurance & psychological support. - Rest (physical & mental). - Avoid intercourse. - Adequate diet & vitamins & minerals supplementation
122
TTT of **Recurrent (habitual) abortion** During pregnancy - TTT of Cause
123
TTT of **Recurrent (habitual) abortion** During pregnancy - Obsrvation
For development of any problem (as preeclampsia, preterm labor or IUGR)
124
TTT of **Recurrent (habitual) abortion** During pregnancy - Prophylactic Corticosteroids
At 28 weeks for lung maturity
125
TTT of **Recurrent (habitual) abortion** During pregnancy - Delivery
Elective LSCS or induction of labor according to condition.
126
Def of **Cervical Incompetence**
Inability of cervix to maintain pregnancy till term due to wide internal os
127
Etiology of **Cervical Incompetence**
128
Etiology of **Cervical Incompetence** - Functional Incompetence
- Congenital weakness of cervix in association è uterine anomalies.
129
Etiology of **Cervical Incompetence** - Anatomical Incompetence
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
Dx of **Cervical Incompetence** - Hx
131
Dx of **Cervical Incompetence** - Ex
- Short patulous cervix è bulging membranes through cervix. - Cervical tear may be present.
132
Dx of **Cervical Incompetence** - INVx
133
Dx of **Cervical Incompetence** - INVx (Between Pregnancies)
134
Dx of **Cervical Incompetence** - INVx (During Pregnancy)
135
Prevention of **Cervical Incompetence**
Avoid the Causative factors
136
TTT of **Cervical Incompetence**
137
TTT of **Cervical Incompetence** - In Between pregnancies
- Some operations are developed to regain cervical competence (however, they aren't as successful as cerclage).
138
TTT of **Cervical Incompetence** - During Pregnancy
139
Def of **Cervical cerclage**
Encircling cervical internal os è suture to support weak cervix.
140
Time of **Cervical cerclage**
- Ideally done ( ) 12 weeks (to ensure absence of fetal anomalies) & 14 weeks (after that, uterus is difficult to manipulate vaginally).
141
Techniques of **Cervical cerclage**
...
142
Techniques of **Cervical cerclage** - Mcdonald Cerclage
Purse string tight suture is passed around cervix & tied posteriorly.
143
Techniques of **Cervical cerclage** - Shirodkar’s cerclage
- 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
Techniques of **Cervical cerclage** - Abdominal Cerclage
- Indications: Amputation of cervix or deep cervical tear. - Disadvantages: Delivery is by CS
145
Removal of **Cervical cerclage**
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
Complications of **Cervical cerclage**
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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