spontaneous abortion Flashcards
What is the definition of spontaneous abortion?
known as miscarriage, is defined as delivery occurring before the 20th completed week of gestation, involving the delivery of all or any part of the products of conception, with or without a fetus weighing less than 500 grams. It is the most common complication of pregnancy.
Describe the characteristics of threatened abortion.
Threatened abortion is characterized by vaginal bleeding during early pregnancy. There may or may not be uterine contractions, and the cervix is closed and not dilated. The products of conception have not been expelled, and the pregnancy remains viable.
What are the features of inevitable abortion?
there is bleeding along with the dilatation of the cervix. However, the products of conception have not yet been expelled from the uterus.
How is incomplete abortion defined?
ncomplete abortion occurs when only a portion of the products of conception, such as fetal tissue or placental fragments, is expelled from the uterus.
What defines a complete abortion?
when all of the products of conception are expelled from the uterus before the 20th completed week of gestation. Slight bleeding may continue for a short time, but pain usually ceases.
Explain what missed abortion is
when the embryo or fetus dies in the uterus, but the products of conception are retained in the uterus.
What are the characteristics of septic abortion?
infection of the uterus or surrounding structures. It can present with symptoms like fever, malodorous vaginal discharge, pelvic and abdominal pain, and cervical motion tenderness. It often occurs when strict disinfection measures are not followed, such as in illegal abortion facilities.
How do morphologic and genetic abnormalities contribute to spontaneous abortion?
Morphologic and genetic abnormalities are a major cause of spontaneous abortion. Aneuploidy (abnormal chromosomal number) is responsible for at least 50% of early spontaneous abortions. Autosomal trisomies are common in first - trimester losses, and trisomy 16 is the most frequently encountered trisomy. Polyploidy, usually in the form of triploidy, is found in about 20% of all miscarriages.
List the maternal factors that can lead to spontaneous abortion.
Maternal factors include systemic diseases (such as infections like syphilis, chlamydia; endocrine disorders like hyperthyroidism or diabetes; cardiovascular and connective tissue diseases), uterine defects (congenital anomalies like unicornuate or septate uterus, acquired anomalies like submucous myomas, uterine scarring), immunologic disorders (blood group incompatibility), and malnutrition.
What are the toxic factors associated with spontaneous abortion?
Toxic factors include radiation, antineoplastic drugs, anesthetic gases, alcohol, and nicotine. These agents have been shown to be embryotoxic, which means they can harm the developing embryo and increase the risk of miscarriage.
What are the pathological changes in spontaneous abortion?
In spontaneous abortion, hemorrhage often occurs in the decidua basalis, the part of the uterine lining where implantation occurs. Necrosis and inflammation appear in the implantation area. The pregnancy becomes partially or entirely detached, and uterine contractions along with cervical dilatation result in the expulsion of most or all of the products of conception.
How can you differentiate between different types of spontaneous abortion based on clinical findings?
Threatened abortion has less bleeding, no or slight abdominal pain, no passage of tissue, and a closed cervix. Inevitable abortion has moderate - to - heavy bleeding, heavy abdominal pain, no passage of tissue, and a dilated cervix. Incomplete abortion has more or less bleeding, light abdominal pain, partial passage of tissue, and a dilated cervix with possible tissue tamponade. Complete abortion has less - to - no bleeding, no abdominal pain, complete passage of tissue, and a closed cervix.
What can a complete blood count show in cases of spontaneous abortion?
If significant bleeding has occurred, the patient may be anemic. Even without infection, both the white blood cell count and the sedimentation rate may be elevated due to the inflammatory response triggered by the detachment and expulsion of fetal and placental tissues from the uterine wall.
How do pregnancy tests help in diagnosing spontaneous abortion?
Falling or abnormally low plasma levels of β - hCG are predictive of an abnormal pregnancy, such as a blighted ovum, spontaneous abortion, or ectopic pregnancy. In a normal pregnancy, hCG levels double approximately every 48 - 72 hours during the first few weeks.
What is the role of ultrasonography in diagnosing spontaneous abortion?
Ultrasonography helps determine which pregnancies are viable and which are likely to miscarry. Transvaginal ultrasound can detect intrauterine pregnancies as early as 4 - 5 weeks’ gestation. Fetal heart motion should be seen in embryos >5mm from crown to rump or at least 5 - 6 weeks’ gestation. Different types of abortions have specific ultrasound findings, such as a normal sac in threatened abortion and deflated sac with placental tissue in incomplete abortion.
What are the complications of spontaneous abortion?
Complications include severe or persistent hemorrhage, which can be life - threatening, especially in more advanced gestations. Sepsis can develop, most frequently after self - induced abortion. Other complications are infection, intrauterine synechia (uterine adhesions), infertility, perforation of the uterine wall, injury to the bowel and bladder, and hemorrhage, infection, and fistula formation.
How is threatened abortion treated?
Treatment usually involves bed rest and pelvic rest, although their effectiveness in preventing miscarriage is not fully proven. If significant bleeding persists or if products of conception are retained, dilation and curettage (D&C) may be necessary.
What is the treatment for inevitable or incomplete abortion?
The uterus should be evacuated promptly, usually by suction D&C. A type and cross - match for possible blood transfusion and determination of Rh status should be obtained. If the retained tissue is evacuated promptly and completely, the prognosis for the mother is excellent.
How is complete abortion managed?
The patient should be observed for further bleeding, and the products of conception should be examined. The prognosis for the mother is excellent, similar to that of inevitable and incomplete abortions when managed properly.
What is the treatment for septic abortion?
Septic abortion requires hospitalization and intravenous antibiotic therapy with agents that cover both anaerobic and aerobic bacteria. A D&C should be performed, and if the infection does not respond to treatment, a hysterectomy may be necessary.
What is the definition of recurrent abortion?
Recurrent abortion is defined as 3 or more consecutive pregnancy losses before 20 weeks gestation, each with a fetus weighing less than 500g. Approximately 4% - 1% of women are habitual aborters.
How is recurrent abortion treated?
Treatment varies depending on the cause. For genetic errors, options include artificial insemination by donor, embryo transfer, preimplantation diagnosis, or prenatal testing. Uterine abnormalities may require uterine operations or cervical cerclage. Hormonal abnormalities can be treated with thyroid replacement, progesterone supplementation, etc. Infections are treated with appropriate antibiotics, and for immunologic factors, low - dose aspirin and/or heparin may be beneficial.
A 25-year-old pregnant woman presents with vaginal bleeding in her 8th week of pregnancy. The cervix is closed, and there are no contractions. What type of spontaneous abortion is most likely?
Threatened abortion.
Explanation: Threatened abortion is characterized by vaginal bleeding during early pregnancy with a closed cervix and no contractions. In this case, the woman’s symptoms match these criteria. Inevitable abortion would involve a dilated cervix, incomplete abortion would have partial expulsion of products of conception, and complete abortion would mean all products have been expelled, so these can be ruled out.
Which of the following is a common genetic cause of spontaneous abortion in the first trimester?
A. Trisomy 16
B. Monosomy of chromosome 1
C. Normal chromosomal count
D. Triploidy in the form of tetraploidy
A. Trisomy 16.
Explanation: Trisomy 16 is the most commonly encountered trisomy in spontaneous abortions during the first trimester. Autosomal trisomies, including trisomy 16, are a major cause of early - stage miscarriages. Monosomy of chromosome 1 does not occur in spontaneous abortions; autosomal trisomies have been noted for all chromosomes except chromosome 1. A normal chromosomal count is not a cause of spontaneous abortion. Triploidy usually occurs in the form of triploidy (not tetraploidy) and is less common than trisomies in first - trimester losses.
