Spontaneous and Induced Abortion 1 Flashcards

Distinguish different types of spontaneous abortion when challenged with simulated clinical scenarios.

1
Q

List the types of spontaneous abortions.

A
  • Threatened
  • Incomplete/Complete
  • Inevitable
  • Missed
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2
Q

What is a threatened abortion?

A
  • Diagnostic criteria for spontaneous abortion have not been met
  • However, vaginal bleeding has occurred and the cervical os is closed
  • pregnancy loss odes not always follow
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3
Q

What is a missed abortion?

A
  • A spontaneous abortion in a patient with or without symptoms having a closed cervical os
  • Women often notice symptoms associated with early pregnancy have abated
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4
Q

What is an inevitable abortion?

A
  • Patient has vaginal bleeding
    • often accompanied by crampy pelvic pain
    • cervix has dilated
  • Products of conception can often be felt or visualized through the internal cervical os
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5
Q

What is an incomplete abortion?

A
  • Vaginal bleeding and/or pain are present
  • Cervix is dilated
  • Products of conception are found within the cervical canal on examination
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6
Q

What is a complete abortion?

A
  • Products of conception are entirely out of the uterus and cervix
  • On examination, the cervix is closed and the uterus is small and well contracted
  • Vaginal bleeding and pain may by mild or may have resolved
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7
Q

How are spontaneous abortions diagnosed?

A
  • Combination of:
    • serial HCG assay
    • ultrasound
    • physical exam
  • Normal pregnancies typically demosntrate an increase in HCG of at least 60% over a 48 hour period
  • Most sonologists can identify an intrauterine gestation using transvaginal ultrasound when the HCG is ~1500 mIU
    • at 5000 mIU, can see gestation using abdominal ultrasound
  • Diagnosis based on abnormal rise in HCG and inability to see gestation at these times
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8
Q

What percentage of US pregnancies are unintended? How many of the unintended pregnancies undergo termination?

A
  • 50% unintended
  • 50% undergo termination
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9
Q

What is the distribution of abortions across time in pregnancy?

A
  • 1-1.5 million abortion procedures annually in the US
  • 90% occur during the first 12 weeks of gestation
  • 10% occur during the second trimester
  • Only 1% occurs after 20 weeks gestation
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10
Q

What is the risk of rate of maternal deaths per live births in the US? How do abortion rates compare?

A
  • 10 maternal deaths per 100k live births
  • 1 maternal death per 500k 9 week abortions
  • Maternal death from second trimester dilation and evacuation is 3 per 100k
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