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DMST 244 Obstetrics and Gyn Sonography 1 > Module 6.1 Classifications of Abortion > Flashcards

Module 6.1 Classifications of Abortion Flashcards

1
Q

What is abortion?

A

Defined as termination of pregnancy prior to 20 weeks gestation, Either spontaneous or induced

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2
Q

What is miscarriage synonymous with?

A

Spontaneous abortion

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3
Q

What is the natural pregnancy loss rate?

A

Around 25%

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4
Q

Majority of spontaneous abortions occur between which weeks?

A

5-12 weeks

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5
Q

What are some maternal factors causing spontaneous abortion? 6

A
  1. Malformation of uterus
  2. Toxic agents (alcohol, tobacco)
  3. Systemic infections
  4. Hormonal failure
  5. Poor trophoblastic reactions
  6. Advanced maternal age - 50% risk at age 45
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6
Q

What are some fetal factors causing spontaneous abortion? 2

A
  1. Malformation
  2. Genetic (50-70%)
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7
Q

What is a fetal and maternal factors causing spontaneous abortion?

A

RH incompatibility
mother is Rh- and fetus is Rh+

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8
Q

What does RH stand for?

A

Rhesus factor: an antigen on the red blood cells

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9
Q

What are some factors causing spontaneous abortion? 7

A
  1. Maternal
  2. Fetal
  3. Fetal and maternal
  4. Vaginal bleeding
  5. Cramping
  6. Dilated Cervix
  7. Uterine contractions
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10
Q

What are different types of Vaginal bleeding? 3

A
  1. Spotting
  2. Light
  3. Heavy
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11
Q

Heavy vaginal bleeding can present with what symptoms? 2

A
  1. Painful cramps
  2. 3 times more likely to miscarry than light bleeding or spotting
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12
Q

If there is vaginal bleeding, what is the probability of losing the pregnancy?

A

50%

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13
Q

Heavy bleeding and pain poses greater risk for what?

A

Complications

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14
Q

17% of those with vaginal bleeding do not miscarry will have what?

A

Complications with pregnancy such as PROM and preterm labour

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15
Q

Is all vaginal bleeding from pregnancy?

A

Not all bleeding comes from the pregnancy, it can arise from the cervix, vagina, or uterus itself

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16
Q

What can Sonography determine in terms of abortions? 3

A
  1. Threatened abortion
  2. Embryonic demise
  3. Spontaneous abortion
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17
Q

What is threatened abortion?

A

Bleeding with a viable intrauterine pregnancy

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18
Q

Can we see a heart beat during threatened abortion?

A

Usually seen

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19
Q

What is usually the result of threatened abortion bleeds?

A

Implantation bleed

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20
Q

What is Embryonic demise? 2

A
  1. An embryo is present but no heart beat is detected
  2. No fetus is visualized within retained membranes
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21
Q

What does spontaneous abortion with no retained parts look like?

A
  1. Uterus is normal or non gravid
  2. No products of conception are seen within the uterus
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22
Q

At 6 weeks the gestational sac occupies how much of the uterine cavity?

A

1/2

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23
Q

By 8 weeks the gestational sac occupies how much of the uterine cavity?

A

1/2

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24
Q

By 10 weeks the sac occupies how much of the uterine cavity?

A

The entire uterine cavity

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25
Q

At 6 weeks normal intrauterine pregnancy ultrasounds results in what?

A

Favorable outcomes

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26
Q

At 12 6/7 weeks a normal intrauterine pregnancy, ultrasound confirms what risk of loss?

A

reduces the risk of loss to 1 - 2%

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27
Q

What are some symptoms of threatened abortion? 5

A
  1. Vaginal bleeding
  2. Ultrasound shows normal pregnancy
  3. Cervix is closed
  4. May have cramping
  5. Possibly an implantation bleed

Cum vp

28
Q

How does anembryonic pregnancies look like? 3

A
  1. gestation sac develops with no fetus
  2. usually no yolk sacs
  3. Bleeding with “+” pregnancy test
29
Q

What is the DDX for anembryonic pregnancy?

A

Pseudosac

30
Q

What is another name for anembryonic pregnancy?

A

Blight ovum

31
Q

What is the MSD for Anembryonic pregnancy?

A

Sac is >20mm and no embryo seen

32
Q

With a anembryonic pregnancy what might we need to do to assist the patient?

A
  1. F/U in 10 days if GS <25mm
  2. May need a D and C
33
Q

What is a sign for anembryonic pregnancy? 3

A
  1. Uterus is small for dates
  2. Gestational sac without a fetus
  3. Trophoblastic ring with irregular borders
34
Q

What is another name for Embryonic demise?

A

Missed abortion

35
Q

What is a embryonic demise?

A

Fetus dies but remains in the uterus

36
Q

Does bleeding occur during embryonic demise?

A

It may occur

37
Q

What does embryonic demise look like? 2

A
  1. Uterus is small for dates
  2. 5mm or greater embryo without FH (fetal heart)
38
Q

When is embryonic demise often seen?

A

Often discovered between 10 and 14 weeks
The embryo has died earlier but the patient hasn’t had any symptoms of losing the pregnancy yet such as bleeding

39
Q

What are signs of Embryonic demise? 4

A
  1. No FH (fetal heart motion)
  2. Macerated fetus
  3. Spalding sign
  4. Irregular walls of GS
40
Q

What kind of tissue is macerated fetus consist of? What is a macerated fetus?

A
  1. Edematous tissue
  2. Fetal tissue is breaking down
41
Q

What is the spalding sign?

A

Overlapping of skull bones

42
Q

What is irregular walls of the GS during embryonic demise mean?

A

Placenta and sac may be in process of disintegration

43
Q

What is an inevitable abortion?

A

Spontaneous abortion in progress

44
Q

What are some signs and symptoms of inevitable abortion? 2

A
  1. Patient presents with active bleeding and an open cervix
  2. Cramping is common
45
Q

What would we see sonographically for inevitable abortion? 4

A
  1. Open cervix possibly clot in endo-cervical canal
  2. Sac low in uterus
  3. May still see a FH but placenta is detached
  4. Vascularity not seen on GS with doppler
46
Q

What is the DDX for cervical ectopic pregnancy (inevitable abortion)? 3

A
  1. “sliding sac sign”
  2. Dynamic EV scan
  3. Gestational Sac mobile with the movement of the EV transducer?
47
Q

How would a dynamic EV scan assist in the DDX of Cervical ectopic pregnancy?

A

+ If structures move
- If structures do not move

48
Q

What is an incomplete abortion?

A

A threatened abortion that has progressed BUT some products of conception have passed but some still remain causing continual bleeding

49
Q

What should we ask the patient if they have an incomplete abortion?

A

If they have passed clots or tissue

50
Q

What does a incomplete abortion look like? 3

A
  1. Enlarged uterus
  2. Empty, poorly defined gestational sac
  3. May not see a sac but some internal echoes not resembling a fetus (hyperechoic area in lower segment, clots or products of conception)
51
Q

What are treatment options for incomplete abortion/ embryonic demise? 2

A
  1. Expected management
  2. Induce abortion
52
Q

What do we do for the expectant management for incomplete abortion/ embryonic demise?

A

Do nothing, let nature take its course

53
Q

What is the method of inducing abortion <14 weeks? 3

A
  1. D and C (dilation and cutterage)
  2. Dilate the cervix and then scrape the uterine cavity
  3. Cutterage means the cleansing of diseased surface
54
Q

What is the method of inducing abortion >14 weeks?

A
  1. Inducing of labor using prostaglandin or hypertonic saline urea
55
Q

What are some complications of Inducing labor >14 weeks using prostaglandin or hypertonic saline urea? 3

A
  1. Retained products
  2. Infections
  3. Uterine perforation from D and C
56
Q

What is a complete abortion?

A

All products of conceptions have passed and bleeding and cramping has decreased

57
Q

What is the sonographic appearance of complete abortion? 3

A
  1. Empty uterus
  2. Enlarged uterus
  3. May see some blood between endometrial lining
58
Q

What is habitual abortions?

A

3 or more consecutive abortions?

59
Q

What is some reasons for habitual abortions? 5

A
  1. Luteal failure
  2. retroverted uterus
  3. DES exposure - T shaped uterus
  4. Unicornuate uterus
  5. Chromosomal abnormalities
60
Q

What does the corpus luteum secrete?

A

Progesterone

61
Q

What is a septic abortion? How might these occur? What are 3 s/s?

A
  1. Infected products of conception
  2. May occur after either a spontaneous or induced abortion
  3. Pain, fever, bleeding, and discharge
62
Q

What is the sonographic appearance of septic abortion? 2

A
  1. Retained products thick endometrium, increased endometrial echoes
  2. If there are gas producing organisms air shadowing might be visualized
63
Q

When can therapeutic abortions be performed in Alberta?

A
  1. Up to 20 weeks (personal reasons or fetal abnormalities)
  2. From 20w1d to 22w6d (For fetal abnormalities)
  3. From 23 weeks to term (If lethal fetal abnormality is diagnosed)
64
Q

Selected abortions are performed for what situations?

A

Fetal malformation or fetal reduction in multiple gestation pregnancies

65
Q

What is the role of a sonographer in TA with termination of pregnancy? 4

A
  1. Dating of pregnancy prior to termination when dates are known
  2. Diagnosis of masses or malformations that might hinder the procedure
  3. Localization of coexistent IUCD
  4. Ultrasound guidance in difficult cases
66
Q

What is the role of sonographer in Post Therapeutic abortion?

A

Diagnosis of a complication from a termination.
perforation, infection, and retained products

67
Q

What is physiological herniation? 2

A
  1. At 8 weeks the fetal gut herniates into the base of the umbilical cord.
  2. Gut rotates 90 degrees and returns back into the abdomen by 12 weeks. Should measure under 7mm

DMST 244 Obstetrics and Gyn Sonography 1 (22 decks)

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