Loss of pregnancy before 20 weeks - either all or part of it - with or without fetus (500gm)

Abortion Flashcards by Zahra Kalifa

What is abortion?

Loss of pregnancy before 20 weeks

either all or part of it
with or without fetus (500gm)

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In which trimester are abortions more common at?

First

Unrecognized 15% - biological 60%

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What are etiologies of abortion?

MC unknown
defect (baby anomaly- mom anatomy)
Malnutrition
infection\ toxin
endocrine\immunological
trauma\ environmental

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Name some anatomical defects that are associated with abortion?

Septate uterus - didelphys - bicornus

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Name immunological factors associated with abortion

Phospholipid disease
protein S and C
SLE

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Name infection that is associated with abortion

Severe vaginits

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What are the subtypes of spontaous abortions?

missed
threatened VS inevitable
septic
complete VS incomplete

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What are the types of abortion

spontanous

- induced

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What is missed abortion?

Dead fetus (W\out contraction or bleeding)

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What do we call missed abortion after 20 weeks

Still birth or IUFD

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What is threatened abortion

bleeding fresh red color
contraction
closed cervix
pelvic & back pain

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What is the risk for abortion in threatened abortion

50-50%

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What is inevitable abortion?

bleeding (fresh red blood)
pelvic & back pain
contractions
cervix open

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What is the difference between threatened & inevitable abortions?

The opening of the cervix in (inevitable abortion) and closed cervix in (threatened abortion)

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Differentiate between complete and incomplete abortion:

abortion of whole fetus

- part of the fetus (sac etc..) w\ dicidual part in uterus.

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How does complete & incomplete abortions present

bleeding

- passing of clot or tissue

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How to differentiate clots from tissue in abortion

Clot: liver like
Tissue: chicken like

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The passage of clot is indicative of:

Over-consumption fo coagulation factors

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When should medical intervention occur

Complete or incomplete abortion

Incomplete, by evacuation

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What is septic abortion

In incomplete abortion the ramining of dead tissue becomes necrotized, and colonized by normal flora&raquo_space; ascending infection.

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Where do we commonly see septic abortion?

In rural area and incomplete abortion

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How do patients with septic abortion usually develop?

abdominal pain
fever
bleeding
tenderness

What are the investigations to order in abortion

1- CBC 
2- blood group
3- Rh type 
4- pregnancy test 
5- US

Why would like to investigate Rh type?

Because mixing of blood can occur during abortion and she might develop anti-D antibodies

Why to order US in case of abortion?

- Sac, CRL, No. of gestations, fetal heart detected or no. | - rule out (ectopic - hydatiform mole)

What are the medical techniques for termination of pregnancy

- oxytocin - prostaglandin - misoprostol - intra amniotic hyperosmotic solution

What is the mechanism by which oxytosin can induce abortion

induce uterine contractions

What is the mechanism by which Prostaglandin can induce abortion

Ripening of cervix and initiate contraction (given vaginally)

What is the role of intraminiotic hyperosmotic solution

Tachyarrythmia or hyperkalemia for the fetus to initiate death (Not used)

What are the surgical techniques of termination of pregnancy?

- D &C | - hysterotomy

How is hysteromtomy usually done

Similar to C\S: associated with extraction of fetus especially if risk on mother

If the mother preferred to wait for a spontanous abortion to occur, how long can you wait

Only one month, after that, there’s increase risk of DIC

If the mother decides to wait for spontanous abortion to occur, how do we follow her up?

PT or PTT weekly

What are the complications of surgical intervention for aboriton?

- triad (pain, bleeding, fever) - retained product of conception\ septic\ DIC - uterine\bladder\bowel injury - cervical laceration and shock - failed abortion

When does cervical shock and laceration usually occur?

Dilated >12mm

What is cervical shock?

Vasovagal response due to dilation

DIC is a complication of:

- missed abortion | - prolonged waiting period before medically interveniing

What are the indications for termination of pregnancy (maternal)

- maternal: * president HD after cardiac decompensation * HTN vascular disease (advanced) * carcinoma of cervix (invasive) * thrombocytopenia

What are the indications for termination of pregnancy (fetal)

incompatiable w\life (anencephaly, lung aplasia, renal agenesis)

Why is invasive carcinoma of the cervix is an indication for termination of pregnancy

If they delivery it will cause post-partum hemorrhage

Define recurrent miscarriage

2 or more consecutive pregnancy loss - before 20 weeks of gestation - fetus less than 500g - non-ecotpic or molar

what are the Causes of recurrent miscarriage

Genetic, anatomic, thrombophilia, systemic diseases

Name systemic disease associated with recurrent miscarriage

Renal failure, SLE, hypOthyroidism, protein C & S, phospholipid syndrome

What is the most common cause of recurrent miscarriage

Unkown

Define cervical incompetence

PAINLESS cervical dilation followed by expulsion of product of conception

At which trimester is cervical incompetence most commonly associated

2nd trimester because of the baby weight

Funnling of cervix on US is indicative of:

Cervical incompetence

What are the causes of cervical incompetence

- Cervical abnormalities + in uteruo exposure to DES | - acquired: trauma, surgery, D&C

What are the temporary causes of cercvical cerclage?

Macdonald & modified macdonald suture

When is macdonald suture provided and when is removed

At 12-14 weeks | Removed at 37 weeks completed

What are the permanent cervical cerclage

Shirdokar suture and transabdominal

How do we do the macdonal cerclage

4 quadrant suture with small opening for the passage of fluid

What are indications for cervical cerclage

No - abdominal pain - vaginal bleeding - infection - fetal anomalies - ruptured membrane

What if before 37 weeks, the patient with macdonald sutures present with labor pain, bleeding or rupture of membrane

Immidiatly remove suture to avoid rupture or tear of cervix and postpartum bleeding