Preterm Labor/Threatened Abortion Lecture Powerpoint Flashcards
15% (1/6) of all pregnancies end in…
…miscarriage
Implantation bleeding
A source of first trimester bleeding that may be mistaken as presence of the period, is common and usually lighter than menses and benign
Causes of bleeding in the 1st trimester (6)
- implantation bleeding (from invasion into the spiral arterioles of the uterine wall, occurs around the time of the first missed period - often mistaken for being a period)
- subchorionic hemorrhage (usually self resolving)
- miscarriage
- ectopic pregnancy
- cervix infection (chlamydia often)
- trauma from sex
Bleeding in the first trimester will lead to loss of pregnancy __% of the time
50%
Causes of early abortion (3)
- most often chromosomal abnormality*** (aneuploidy or triploidy are most common or inversions or deletions)
- infection
- environmental factors (smoking, diabetes, aging gametes, incompetent cervix)
Recurrent abortion definition and plan (2)
3 or more abortions in a row, parental chromosomal screening, uterine cavity eval
Asherman syndrome
Intrauterine adhesions that prevent the opening of the uterus often becoming a source of miscarriage
Spontaneous abortion
Abortion without medical or mechanical means to empty the uterus (empties on own without coaching), more than 80% occur before 13 weeks, increased with parity and with increased maternal and paternal age
Threatened abortion
Cramping and bleeding without passage of tissue, os remains closed
Inevitable abortion
Threatned abortion with more severe cramping and opened os
Mifepristone
Antiprogesterone that is used for elective abortion, ineffective in low progesterone spontaneous abortions in helping them pass, causes less bleeding than surgical intervention
Gold standard for treatment of ectopic pregnancy
surgery, but most often non gold standard and more commonly used is medical management because it is less invasive
Ectopic pregnancy definition
Implantation anywhere other than endometrial lining of uterine cavity, most often fallopian tubal in origin, has increased risk of death due to hemorrhage than vaginal delivery
Risk factors for ectopic pregnancy (4)
- tubal corrective surgery
- previous ectopic pregnancy
- IUD
- previous STD
Criteria for medical treatment of ectopic pregnancy (4)
- has to be smaller than 3.5cm on ultrasound (too much fetal tissue)
- no cardiac activity present on fetus (too much fetal tissue)
- no signs of intra abdominal bleeding
- liver functioning (for methotrexate)
Required studies to treat an ectopic pregnancy (2)
- ultrasound with empty uterus
- 2 hCG levels that aren’t progressing properly
Drug of choice for ectopic pregnancy
Methotrexate 50mg/meter square of body surface
Preterm labor isn’t a miscarriage or an ectopic pregnancy in that…
….it is common 10-11% in the population and that these infants are able to be self sustained
As birth weight decreases, survival rates…
…also decrease
Complications of prematurity are responsible for over half of…
…perinatal morbidity and mortality
No induction of labor or c section should occur sooner than __ weeks to prevent prematurity
39
Aneuploid abortions peak at ___ weeks, euploid at ___
8 weeks, 13 (later)
Incomplete abortion
Bleeding and passage of tissue but some is retained
Complete abortion
Abortion has passed tissue and os is now closed
Missed abortion
Retention of dead products of conception for several weeks
Discriminatory zone
Refers to how hCG must exceed 1500 units before an intrauterine pregnancy can typically be detected on transvaginal ultrasound exam, if above threshold but not see on ultrasound may have aborted or have ectopic
Spontaneous abortion is in a sense, a form of delivery, and as a result, it typically presents with…
…uterine pain until delivery then sudden cessation after the cervix has dilated and ox has gone back to closed
Misoprostol
Drug used to induce abortion in mothers with dead fetus syndrome or empty fetal sac that have low progesterone levels and thus do not respond to elective abortion medication
Treatment for incomplete or missed abortion
D&C
3 biggest causes of early labor
- spontaneous preterm labor
- obstetrical complications
- fetal distress
Prior preterm birth is a large predictive factor for…
….future preterm births
Criteria that determine labor commencement
- 4 contractions over 20 minutes or 8 over 60 + cervical changes
- cervical dilation >1cm
- cervical effacement (thinning) >80%
Fetal fibronectin
Vaginal swab test to determine fake labor, negative has high predictive value for remaining pregnant for 3 more weeks while positive 50% chance of remaining pregnant for 2 more weeks
Inhibition of labor (tocolysis) and its contraindications (4)
Medications that can stop the uterus from contracting, contraindicated in fetal distress, pre/eclampsia, hydramnionos, infection
Tocolytic drugs (3)
- terbutaline (B2 adrenergic blockers)
- magnesium sulfate
- ca2+ channel blockers
Drug for prevention of preterm delivery (1)
-17 a hydroxyprogesterone IM injection in those that have previous preterm birth
Cervix length and indication
Normal is 36mm at 22 weeks,
<10mm can put at risk for 32 weeks delivery, and shorter the cervix, earlier risk of delivery
Vaginal progesterone gel
Intravaginal gel that reduces delivery before 34 weeks in almost half of patients
If a fetus is too large for methotrexate treatment in ectopic pregnancy, then treatment is…
…surgery
Intrauterine pregnancy with no fetus 3 treatment options
- D&C
- observation (let nature take its course)
- misoprostol
