Spontaneous and Induced Abortion 1

Question 1

List the types of spontaneous abortions.

Answer 1

• Threatened
• Incomplete/Complete
• Inevitable
• Missed

Question 2

What is a threatened abortion?

Answer 2

• 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

Question 3

What is a missed abortion?

Answer 3

• 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

Question 4

What is an inevitable abortion?

Answer 4

• 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

Question 5

What is an incomplete abortion?

Answer 5

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

Question 6

What is a complete abortion?

Answer 6

• 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

Question 7

How are spontaneous abortions diagnosed?

Answer 7

• 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

Question 8

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

Answer 8

• 50% unintended
• 50% undergo termination

Question 9

What is the distribution of abortions across time in pregnancy?

Answer 9

• 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

Question 10

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

Answer 10

• 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