Module 6.1 : Classification of Abortions Flashcards Preview

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Flashcards in Module 6.1 : Classification of Abortions Deck (32)
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1

abortion - definition

- termination of pregnancy prior to 20 weeks, either spontaneous or induced
- rate of pregnancy loss is 25%
- over 40 years old increases to 50%

2

Threatened abortion

- bleeding with a viable intrauterine pregnancy
- heart beat is seen
- usually result of implantation

3

embryonic demise

- an embryo is present but no heart beat is detected
or
- no fetus is visualized within the retained membranes, inly gestational sac visualized

4

spontaneous abortion with no retained parts

- uterus is normal or non gravid

5

factors causing SA - maternal

- malformations of uterus
+ synechiae (scars)
+ fibroids (take up volume)
+ septet uterus
- toxic agents
+ tabacco
+ alcohol
- systemic infection
- hormonal failure
- poor trophoblastic reaction
- advanced maternal

6

factors causing SA - fetal

- malformations
- genetic (50-70%)

7

factors causing SA - maternal and fetal

- RH incompatibility
+ RH is the Rhesus factor an antigen on the red blood cells
+ mother is Rh- and the fetus (2nd pregnancy) is Rh+

8

clinical signs of abortion

- vaginal bleeding
+ spotting
+ light
+ heavy
- cramping
- dilated cervix
- uterine contractions
* heavy bleeding with painful cramps is 3x more likely to miscarry

9

vaginal bleeding

- 50% will lose pregnancy
- heavy bleeding and pain pose greater risk
- 17% that don't miscarry will have complications with the pregnancy such as PROM (premature rupture of membranes) and preterm labor
- not all bleeding comes from pregnancy, can arise from cervix, vagina or uterus

10

treatment

- do nothing
+ let nature take its course
- have a D & C
+ dilation and curettage
+ dilate the cervix and scrape the uterine cavity
+ curettage means the cleansing of diseased surface

11

changes in uterine size

- at 6 weeks the gestational sac occupies less than 1/2 of total uterine cavity
- by 8 weeks the gestational sac occupies 1/2 of the uterine cavity
- by 10 weeks the sac occupies the entire cavity

12

MSD and yolk sac visualization

- EV = see yolk sac when MSD 8mm
- TA = see yolk sac when MSD 20mm

13

viable pregnancies

- a 6 week normal intrauterine pregnancy ultrasound results in favourable outcome =s
- a 12 6/7 week normal intrauterine pregnancy ultrasound
+ reduces risk of loss to 1-2%
+ not because ultrasound but demonstrates of a confirmation of normal pregnancy by US

14

classifications of abortions

- threatened abortion
- anembryonic/blighted ovum
- embryonic demise/missed abortion
- inevitable abortion/in progress
- incomplete abortion
- complete abortion
- habitual abortions
- specific abortions

15

threatened abortion

- vaginal bleeding
- ultrasound shows normal pregnancy
- cervix is closed
- may have cramping
- possibly implantation bleed
- could be a resolving coexisting twin or vanishing twin

16

anembryonic

- aka blighted ovum
- gestational sac develops
- no embryo
- usually no yolk sac
- bleeding with ''+" pregnancy test

17

sonographic appearance of anembryonic

- uterus is small for dates
- gestational sac without a fetus
- MSD greater than 20mm and no embryo seen
- F/U (follow up) in 10 days
+ to see if anything changed, give pregnancy benefit of the doubt
- may need D & C

18

embryonic demise

- aka missed abortion
- fetus dies but remains in uterus
- bleeding
- small for dates uterus
- 5mm or greater embryo without fetal heart
- occurs between 10 and 14 weeks
+ embryo died earlier but the patient hasn't had any symptoms of loosing the pregnancy yet

19

embryonic demise - sonographic appearance

- no FH
- macerated uterus
+ fetal tissue breaking down
- irregular walls
- spalding sign
+ brain atrophy and skull bones collapsing
- M mode only definitive way to show demise
+ color doppler over fetal heart to confirm demise

20

Inevitable abortion

- in progress
- patient presenting with active bleeding and cramping
- clinically patient has an open cervix

21

inevitable abortion - sonographic appearance

- clot in endometrium
- sac low in uterus
- may still see a FH but placenta detached

22

differential diagnosis - inevitable abortion

- cervical ectopic pregnancy
+ negative dynamic EV
- dynamic EV putting pressure to see if structures move + if structures move - if structures do not move
+ dynamic EV scan will help differentiate from inevitable abortion

23

incomplete abortion

- some parts of conception have passed but some still remain
- ask patient if they haves passed clots or tissue

24

incomplete abortion - sonographic appearance

- enlarged uterus
- poorly defined gestational sac
- may see an echogenic mass like structure

25

complete abortion

- all products of conception have passed
- bleeding and cramping have ceased

26

complete abortion - sonographic appearance

- empty uterus
- enlarged uterus
- may see some blood between the endometrium lining
- deciding if need a D&C

27

habitual abortions

- 3 or more consecutive abortions
- may be due to
+ luteal failure
+ retroverted uterus
+ DES exposure - T shaped uterus
+ unicornuate uterus
+ chromosomal abnormalities

28

septic abortion

- infected products of conception
- after a spontaneous or therapeutic abortion
- pain, FEVER, bleeding, and discharge

29

septic abortion - sonographic appearance

- retained products
- thick endometrium
- if their are gas producing organisms air shadow may be visualized

30

Therapeutic abortions

- selective abortions are performed for malformations
- in Alberta therapeutic abortions are performed
+ up to 20 weeks for personal reasons or fetal abnormalities
+ from 20w 1d to 22w 6d for any fetal abnormalities
+ from 23weeks to term only if lethal fetal abnormality is diagnosed