Spontaneous Abortions

Question 0

Incomplete

-POC, pain/bleeding, os, tx

Answer 0

Some POC are expelled, some remain
Bleeding and mild cramping w/ visible tissue on exam
Open os
U/S shows retained fetal tissue
Tx: MUA or D&C

Question 1

Complete

-POC, pain/bleeding, os

Answer 1

POC are expelled.
Pain ceases, but spotting persists
Closed os

Question 2

Threatened

-POC, pain/bleeding, os, tx

Answer 2

No POC expelled
Uterine bleeding +/- abdominal pain
Closed os + intact membranes + fetal cardiac motion on U/S
Tx: pelvic rest for 24-48 hours; f/u U/S

Question 3

Inevitable

-POC, pain/bleeding, os, tx

Answer 3

No POC expelled
Bleeding and cramps
Open os +/- ROM
Tx: MUA, D&C, misoprostol, or expectant management

Question 4

Missed

-POC, pain/bleeding, os, tx

Answer 4

No POC are expelled, no fetal cardiac motion
No uterine bleeding, some brownish vaginal discharge
Closed os, retained fetal tissue on U/S
MUA, D&C, misoprostol

Question 5

Septic

-POC, pain/bleeding, os, tx

Answer 5

Endometritis leading to septicemia
Hypotention, hypothermia, Increased WBC
Tx: MUA, D&C and IV anbx

Question 6

Intrauterine fetal demise

Answer 6

Absence of fetal cardiac activity
No fetal movement on U/S
Tx: Induce labor, evacuate the uterus (D&E) to prevent DIC

Question 7

Recurrent

Answer 7

Early: chromosomal abnormalities
Late: hypercoaguability
Hx of painless dilation of cervix and delivery of normal fetus between 18-32 wks: incompetent cervix

Dx: karyotype, hypercoaguability workup, evaluate for uterine abnormalities

Tx: surgical cerclage suture the cervix closed until labor or ROM