Abortion – clinical classification, causes, diagnosis and treatment

Question 1

define abortion

Answer 1

Spontaneous or induced expulsion of the products of conception from the uterus before 20 weeks
gestation or if fetal weight is <500g

Question 2

when is an abortion early

Answer 2

before 12 wks

Question 3

when is abortion late

Answer 3

after 12 wks

Question 4

factors causing abortionn

Answer 4

maternal

foetal

placental

Idiopathic

Question 5

maternal factors

Answer 5

Maternal infections
-human immunodeficiency virus, Chlamydia, Toxoplasmosis

Trauma

Endocrine causes

• progesterone deficiency=> can’t maintain preg
• DM
• hyperthyroidism

Drugs

Environmental causes

Immunological causes:

Ageing sperm or ovum.
Uterine defects
- Septum, Asherman’s syndrome (intrauterine adhesions).

Nervous and psychological conditions.

Question 6

Foetal factors

Answer 6

Chromosomal abnormalities: cause at least 50% of early abortions e.g.

trisomy.
Blighted ovum (gestational sac w/o an embryo).

Faulty implantation of the fertilized ovum

Failure of the endometrium to accept the fertilized ovum

Question 7

Placental factors

Answer 7

Placental abruption

Placental praevia

Question 8

history in dg of abortion

Answer 8

• Amenorrhea (preg)
• Abdominal pain
• Vaginal bleeding
• Expulsion of products of gestation

Question 9

Clinical classification of abortion

Answer 9

 Induced abortion
 Spontaneous abortion
 Septic abortion

Question 10

types of

Spontaneous abortion

Answer 10

 Threatened abortion
 Inevitable abortion
 Incomplete abortion
 Complete abortion
 Missed abortion
 Habitual abortion

Question 11

pain in threatened abortion

Answer 11

slight / or absent pain

Question 12

internal os in threatened abortion

Answer 12

Cervix closed

Question 13

US in threatened abortion

Answer 13

Living foetus

Question 14

Clinical picture in inevitable abortion

Answer 14

Excessive vaginal bleeding
Accompanied w/ clots
Rupture of membranes
btwn 12-20 weeks

Question 15

Clinical picture in Threatened

abortion

Answer 15

Vaginal spotting

Question 16

Pain in inevitable abortion

Answer 16

Pain in
suprapubic region radiating to
the back

Question 17

Internal os in inevitable abortion

Answer 17

Cervix is dilated
and products of
conception may
be felt

Question 18

clinical picture in incomplete

Answer 18

Continuous bleeding

Uterus large in size

Question 19

internal os Incomplete abortion

Answer 19

Cervix is opened

Question 20

Incomplete abortion US

Answer 20

Retained contents

Question 21

clinical picture in complete abortion

Answer 21

Bleeding slight

Uterus large in size

Question 22

pain in complete abortion

Answer 22

Ceases

Question 23

internal os in complete abortion

Answer 23

Empty cavity

Question 24

clinical pic in missed abortion

Answer 24

Regression of pregnancy
symptoms
Foetal movements not felt

Dark brown vaginal
discharge

Uterus fails to grow

Question 25

internal os in missed abortion

Answer 25

closed cervix

Question 26

US in missed abortion

Answer 26

Ultrasound shows either - smaller gestational sac, - absent foetal heart movement - absent foetal heart sounds

Question 27

rx of threatened abortion

Answer 27

protect the fetus pt at bed rest spasmolytic therapy: bucolysin progesterone magnesium

Question 28

specific spasmolytic therapy for threatened abortion

Answer 28

NO SPA? buscolysin spasmalgon

Question 29

specific progesterone rx for threatened abortion

Answer 29

Utrogestan caps Duphaston tab

Question 30

specific mg rx for threatened abortion

Answer 30

Magnerot tab | Magnerich tab Cormagnesin amp. for i.v.

Question 31

define habitual abortion

Answer 31

3+ spontaneous abortions

Question 32

Etiology of habitual abortion

Answer 32

``` genetic factors, endocrine fx, anatomic causes such as congenital abnormalities , infectious causes immunological problems ```

Question 33

Septic abortion

Answer 33

any type of abortion complicated by infection.

Question 34

physical exam in septic abortion

Answer 34

Pyrexia and tachycardia. Rigors = bacteraemia. Jaundice or hematouria – haemolytic infection indicated A subnormal temperature w/ tachycardia is ominous + mostly seen with gas forming organisms. Malaise, sweating, headache, and joint pain.

Question 35

rx of septic abortion

Answer 35

isolate pt bed rest cervico-vaginal swab for culture antibiotic therapy fluid therapy

Question 36

how are 1st trimester surgical abortions done

Answer 36

vacuum aspiration

Question 37

how is vacuum aspiration performed

Answer 37

cervix is dilated by expanding rods inserted into cervical opening When dilated tube attached to suction pump inserted Contents of uterus suctioned out

Question 38

aka's for vacuum dilation

Answer 38

dilation and evacuation suction dilation vacuum curettage suction curettage

Question 39

Medical abortions

Answer 39

non invasive - no surgical instuments used - no anaesthesia - drugs – per os / injection

Question 40

3 meds used used im medical abortion | 3M's for misscarriage

Answer 40

o Antiprogestin mifeprostone o Antimetabolite methotrexate o Prostaglandin misoprostol

Question 41

which drugs can cause miscarriage

Answer 41

misoprostol – used for conditions such as rheumatoid arthritis. retinoids – used for eczema and acne. methotrexate – used for conditions such as rheumatoid arthritis. non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen; these are used for pain and inflammation.

Question 42

immunological causes of Miscarriage

Answer 42

– SLE – Antiphospholipid syndrome Abs that are directed against platelets and vascular endothelium leading to thrombosis, placental destruction and abortion. – Thrombophilia

Question 43

how does magnesium help in threatened abortion

Answer 43

reduce fetal growth restriction and preeclampsia as well as increase birth weight.

Question 44

why are spas contraindicated in threatened abortion

Answer 44

Spending more than 10 minutes in a hot tub can raise your body temperature higher than 101 F (38.3 C). small increased risk of neural tube defects — serious abnormalities of the brain or spinal cord — in the babies of women who have fevers during early pregnancy