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
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
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
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
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
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
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
8
Q
What percentage of US pregnancies are unintended? How many of the unintended pregnancies undergo termination?
A
- 50% unintended
- 50% undergo termination
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
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