Spontaneous Abortion Flashcards
Define Spontaneous Abortion
The expulsion of the fetus or embryo (POC) <20 weeks.
What is the most important factor in Spontaneous Abortion? What are the other main RF?
Age = most important.
Previous miscarriage
Uterine Malformation
Thrombophilias --> hypercoagulability
- Hyperhomocysteinaemia
- Anti phospholipid syndrome.
Bacterial vaginosis: 2nd trimester miscarriages.
What embryonic factors lead to spontaneous abortion, in order of most common to least common?
- Chromosomal aneuploidy (80% first trimester)
- Congenital anomalies eg. teratogen exposure.
- Trauma:
a. invasive techniques, CVS, amniocentesis (0.5-1%
b. direct trauma - almost insignificant.
What are the most common maternal factors that lead to spontaneous abortion, in order of most common to least common?
- Uncontrolled diabetes - 45%
- Lupus anticoagulant or antiphospholipid syndrome - 15%
Others
- Autoimmune - thyroid, PCOS
- Infections: bacterial vaginosis, malaria (most common cause of abortion WW).
- uterine abnormalities - mullerin duct fusion defects, fibroids etc.
- inherited thombophilias - Factor V Leiden, Protein C defc.
What are the 8 categories of miscarriage, what is the clinical presentation + what is seen on the US?
- THREATENED MISCARRIAGE
C - Vaginal bleeding + pain < 22 weeks, cervical os closed.
US - Intrauterine pregnancy (continues) - INEVITABLE MISCARRIAGE
C - vaginal bleeding + pain < 22 weeks, cervical os open.
US - Intrauterine pregnancy (discontinued) - INCOMPLETE MISCARRIAGE
C - vaginal bleeding + pain (most common >12 weeks)
cervical os open, with POC.
US - retained products of conception. - COMPLETE MISCARRIAGE
C - Pain and bleeding resolved, cervical os closed.
US - no intrauterine pregnancy, no POC. - MISSED MISCARRIAGE
C - With/without bleeding and pain (if present, light).
Cervical os closed.
US - Foetal pole present but no heartbeat (the POC is retained, but the realisation that it has stopped developing has not been realised). - ANEMBRYONIC
C - light/no bleeding and pain, cervical os closed.
US - Foetal sac present but no foetus present. - SEPTIC
C - variable with/without pain, bleeding, mucopurulent discharge, fever, lower abdo pain, tachypnoea, boggy uterus, dilated os.
US - Infection due to infected POC (induced pregnancy, IUD, CVS, amnio. Usually clostridium perfringens). - RECURRENT
C - variable - see above.
US - variable - see above.
= > 3 consecutive miscarriages <22 weeks. Cause must be investigated.
What is the most common organism involved in septic abortions?
Clostridium perfringens.
What investigations are ordered if abortion is suspected
- TVS!! - confirms fetal viability/non viability.
FBC- infection.
BHCG - confirms pregnancy. Determines management.
Rhesus blood group - determines whether Anti-D needs to be given.
What criteria, seen on a TVS, determines that a fetus is NON VIABLE?
Absence of fetal cardiac activity, if crown rump length is >5mm.
Absence of fetal pole when sac diameter is >2cm.
How is threatened and complete miscarriage managed
Expectant (observation)
- AntiD antibodies if necessary.
How is inevitable/incomplete or missed miscarriage managed?
1st line: D+C.
OR: misoprostol (PGE1 analogue, promotes uterine contraction, cervical relaxation + POC expulsion).
- AntiD antibodies if required.
How is septic miscarriage managed?
- Fluid resusc
- Swab –> M/C/S
- Empirical tx with
- penicillin
- gentamycin
- metronidozole - D+C for retained POC.
A severe complication of recurrent D+C is Ashermans Syndrome, what is this?
Formation of intrauterine adhesions following removal of the entire basal layer of the endometrium. This causes the anterior and posterior walls to adhere together.
What is are the aetiological factors that contribute to spontaneous abortion - embryonic + maternal
see gobi
