Spontaneous Abortion
How do you induce a surgical abortion
5-13 weeks: D&C >12 weeks: D&E
What can you check to verify viability of pregnancy
B-HCG
How do you manage a missed abortion
D&C if 1st trimester D&E Or give Misoprostol
How do you manage an incomplete abortion
D&C in the 1st trimester D&E in the 2nd-3rd trimester Give Pitocin RhoGAM if indicated
How do you manage a septic abortion
D&E to remove POC + broad spectrum abx Possible do hysterectomy if abx doesn't work
How do you manage an inevitable abortion
Dilation and Evacuation if during the 2nd trimester Sucture curretage if during the 1st trimester Possibly give RhoGam
What are causes of spontaneous abortion
TORCH, physical trauma, malnutrition, drug use
What is a septic abortion
a missed abortion that gets infected --> causing infection of uterus and organs
What is the most common cause of 1st trimester bleeding
a threatened abortion
What is the only type of spontaneous abortion that is associated with possible fetal viability
a threatened abortion
When does the mother undergo Rh screening
at the first pre-natal visit at 28 weeks right before labor
What are the sx of an inevitable abortion
bleeding for 7 days cramps the uterus size is compatible with dates
What are the sx of a threatened abortion
bloody vaginal discharge the uterus size is compatible with dates
What are the sex of a missed abortion
brown discharge pain, cramps, bleeding usually gone by the time pt presents
When is the mc time period for a spontaneous abortion
during the first 7 weeks
What comes out of the uterus during a compete abortion
everything, all products of conception is expelled from uterus
What is the most common cause of a spontaneous abortion
fetal chromosomal abnormalities (50%)
What are the sx of a septic abortion
foul brownish discharge fever, chills possibly heavy bleeding uterine tenderness
How do you manage a complete spontaneous abortion
give RhoGam if necessary
Why would you give RhoGam during a spontaneous abortion
if the mother is bleeding, it is possible that alloimmunization could ocur
How does oxytocin stimulate contraction
increase PG and increase intramuscular Ca
In which types of spontaneous abortions is the pregnancy not salvagable
inevitable, incomplete, complete, missed and septic abortions
What does the cervical os look like if there is a threatened abortion
it is closed
What are the mechanisms for an elective abortion
medical and surgical
What comes out of the uterus during a missed abortion
no products of conception are expelled from uterus
What does RhoGam do
not allow the mother to create antibodies against the "D" marker of the fetus' RBCs
What comes out of the uterus during an inevitable abortion
nothing, no products of conception
What comes out of the uterus if there is a treatened abortion
nothing, no products of conception are expelled
What is another name for pitocin
oxytocin
What are the sx of a complete spontaneous abortion
pain, cramps, bleeding usually is gone by the time patient presents the uterus size is pre-pregnancy
What is a complete spontaneous abortion
pregnancy is not salvageable
What is the MOA of Misoprostol
prostaglandin that induces uterine contractions
What comes out of the cervix during an incomplete abortion
some products of conception (POC) are expelled while some are retained
What comes out of cervix during a septic abortion
some products of conception are retained in the uterus
What is the termination of pregnancy before 20 weeks
spontaneous abortion
What is the MOA of pitocin
stimulates contraction
How do you a manage a spontaneous abortion
supportive - return to ER if sx persist or if there is a passage of products of conception Check serial B-HCG to make sure that it is doubling No sex or douching
What is the definition of a spontaneous abortion
termination of pregnancy before 20 weeks
What is the cervix like during a complete abortion
the cervical os is closed
What is the cervix like during a missed abortion
the cervical os is closed
What is the cervix like during a septic abortion
the cervical os is closed there is cervical motion tenderness
What is the cervical os like during an incomplete abortion
the cervix is dilated
What is a missed abortion
the embryo is not viable but is still in the uterus
What happens if alloimmunization occurs
the mother's anti-D antibodies can cross the placental wall and lyse the fetus' RBCs future pregnancies will not work
What in an inevitable abortion
the pregnancy is no longer salvagebale
What is an incomplete spontaneous abortion
the pregnancy is not salvagable
What does the cervix look like if there is a inevitable abortion
there is a dilated cervix 3cm, effaced There may be rupture of membranes
What are the sx of an incomplete abortion
there is heavy bleeding cramping There is retained tissue, a "boggy uterus"
Which types of spontaneous abortions is the cervix size still compatible with dates
threatened and inevitable
What is the definition of a threatened abortion
toss-up between viable pregnancy between spontaneous abortion
At what age can you induce surgical abortion
up to 24 weeks since last menstrual period
How do you induce an medical elective abortion
up to 9 weeks: Mifeprostone on day 1 + Misoprostol on day 3 if abortion does not happen with just Mifeprostone up to 7 weeks: Methotrexate + Misoprostol