pregnancy loss and ectopic pregnancy Flashcards
spontaneous abortion
pregnancy that ends spontaneously before the fetus reaches a viable gestational age (22wks)
risks for spontaneous abortions
age >35 or young. previous sAb. smoking BMI 25 maternal disease trauma alcohol NSAIDS caffeine fever >100
sAb etiology
abnormal chromosomes, aneuploides (abnormal # chromosomes, autosomal trisomies, monosomy X, polyploides, anembryonic (no plantation), dystrophic, unidentifiable. congenital anomalies, teratogens (maternal DM with poor glycemic control, drugs, environment)
sAb characteristics
vaginal bleeding
pelvic pain/cramping
cervical os (open or closed)
products of conception-passed or retained
uterus-appropriate size, consistency, tenderness
threatened abortion
vaginal bleeding through a closed cervical os, pregnancy may still be vaible.
sxs threatened abortion
vaginal bleeding, painless or mild suprapubic pain, closed cervical os, products of conception not usually visualized, uterine size appropriate for gestational age.
reassuring factors for threatened abortion
serum hcg up to 15 weeks
detectable cardiac activity
inevitable abortion
sAb is imminent. vag bleeding, pelvic cramping, cervical os OPEN, gestational products may or may not be visible, uterus may still be appropriately sized. Expectant mgmt.
Complete abortion
sAb in which the entire contents of uterus are expelled. Common
incomplete abortion
sAb with retained products. common after 12 wks
heavy bleeding, severe cramps, cervical os OPEN, retained products, uterus small for gestational age, not well contracted. Surgical mgmt
missed abortion
retention of a failed intrauterine pg. sxs of pg abated (nausea, breast tenderness). mild vaginal bleeding, spotting, cervical os CLOSED, POF not visible, uterus small. surgical mgmt
septic abortion
spotaneous abortion complicated by uterine infection. staph aures, gram negative bacilli, or some gram + cocci.
risks for septic abortion
invasive procedures, foreign bodies, incomplete or illegal induced abortion
sAb eval
LMP
signs of sAb
signs of sepsis
consider ddx-physiologic- due to implantation, ectopic pg, cervical, vaginal, or uterine pathology
indication for surgical mgmt
retained products
septic abortion
prevent complications
unstable
recurrent pregnancy loss (RPL)
3 or more losses before 20 wks. possible causes- uterine anomalies, chromosomal, endocrine, immunologic, heme
medical abortion
less than 9 wks gestation.
methotrexate-progesterone inhibitor, induces contractions, vascular destruction, necrosis, and detach of POC. Misoprostol-pg directly stimulates myometrium, softens uterus and uterine contractions. surgery if not successful
ectopic pg location
MC=fallopian tube, then ovary, abdominal cavity, and cervix
risks for ectopic pg
pelvic infections, previous ec. pg, age >35, h/o abdominal or pelvic surgeries, IUD, exposure to DES
ectopic pg symptoms
range from asymptomatic to acute abdomen/hypovolemic shock. abdominal pain abnormal bleeding pg sxs dizziness amenorrhea
physical findings of ectopic pg.
abdominal tenderness, peritoneal signs, adnexal tenderness, CMT, uterus normal size.
eval ectopic pg
UPT, quant hCG (hits 1500 and then doesn’t double), transvag US, CBC
hCG > 1500-2000 IU/L
if not visualized follow hCG. if decreases nonviable pg, follow to 0. if increases ectopic is dx
hCG
normal rise-doubles every 48 hours, transvag sonogram when 1500 IU/L. slow rise-abnormal pg. decreases-nonviable pg, follow to 0
