Spontaneous Abortions/Miscarriage Flashcards
define biochemical spontaneous abortion
Dx only w/ decreased hCG w/o preg visualized on u/s
more common in IVF preg
define incomplete spontaneous abortion
POC still in uterus, cervical os is open
define complete spontaneous abortion
passage of all POC
define threatened spontaneous abortion
S/S of an impending early preg loss (vaginal bleeding), cervical os remains closed, embryo/fetus still viable on u/s
define recurrent spontaneous abortion
consecutive loss of multiple pregnancies
define septic spontaneous abortion
An early preg loss cx w/ intrauterine infection → most common in non sterile abortion procedures
2 most common causes of spontaneous abortion is
chromosomal abnormalities in the fetus
advanced maternal age
RFs for spontaneous abortion
- advanced maternal age
- hx of spontaneous abortion
- obesity, comorbidities, smoking, alcohol, drugs, thyroid, celiac
- uterine structural abnormalities
- infections – STIs, zika, CMV
- antiphospholipid syndrome
- malnutrition
- Rh isoimmunization
- trauma
S/S for spontaneous abortion
biochemical/missed ➔ could be asymptomatic, only found on bloodwork
all others: vaginal bleeding, cramping, pain, tenderness, N/V, s/s of shock if hemorrhaging
if septic: purulent discharge, s/s of infection like fever
ix of spontaneous abortion
bloodwork
- CBC, PT/INR, group and screen ➔ hemodynamic stability + potential transfusion + need for RhoGAM
- electrolytes, creatinine, bilirubin
- serial b-hCG
- consider doing serial progesterones
- blood culture or cervical swab for septic
imaging
- transvaginal u/s to try to visualize the baby
- consider doing a fetal doppler for HR
tx for spontaneous abortion
- expectant - watchful waiting
- medicinal - mifegymiso (prostaglandin and progesterone antagonist)
- surgical - D+C
consider RhoGAM for Rh- mothers to prevent alloimmunization
ddx for spontaneous abortion
ectopic pregnancy
molar pregnancy
cervical or vaginal cancer
subchorionic hematoma
