This document discusses abortion, including definitions, pathogenesis, etiology, clinical classifications, and management. It defines different types of abortion such as threatened, incomplete, complete, missed, inevitable, and septic. It describes common fetal and maternal risk factors. It outlines guidelines for diagnosing early pregnancy loss using ultrasound criteria. It provides management guidelines for different clinical classifications of abortion. The document is a comprehensive overview and reference for abortion.
This document discusses abortion, including definitions, pathogenesis, etiology, clinical classifications, and management. It defines different types of abortion such as threatened, incomplete, complete, missed, inevitable, and septic. It describes common fetal and maternal risk factors. It outlines guidelines for diagnosing early pregnancy loss using ultrasound criteria. It provides management guidelines for different clinical classifications of abortion. The document is a comprehensive overview and reference for abortion.
This document discusses abortion, including definitions, pathogenesis, etiology, clinical classifications, and management. It defines different types of abortion such as threatened, incomplete, complete, missed, inevitable, and septic. It describes common fetal and maternal risk factors. It outlines guidelines for diagnosing early pregnancy loss using ultrasound criteria. It provides management guidelines for different clinical classifications of abortion. The document is a comprehensive overview and reference for abortion.
This document discusses abortion, including definitions, pathogenesis, etiology, clinical classifications, and management. It defines different types of abortion such as threatened, incomplete, complete, missed, inevitable, and septic. It describes common fetal and maternal risk factors. It outlines guidelines for diagnosing early pregnancy loss using ultrasound criteria. It provides management guidelines for different clinical classifications of abortion. The document is a comprehensive overview and reference for abortion.
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Abortion
Williams Obstetrics and Gynecology 25th ed
Maxima Vera Pinalgan, MD
Nomenclature Abortion Pregnancy termination or loss before 20weeks or with fetus delivered weighing <500g spontaneous abortion Includes threatened, inevitable, complete , incomplete or missed Septic abortion Complicated by infection Recurrent pregnancy Loss 2 or more failed pregnancies <20weeks AOG or fetal weight <500g Pregnancy off unknown location Pregnancy identified by bHCG without a confirmed sonographic location Pathogenesis
80% of spontaneous abortions occur within 12 weeks AOG
Death usually accompanied by hemorrhage into the decidua basalis, followed by adjacent tissue necrosis that stimulates uterine contractions and expulsion
Incidence Pregnancies aged 5 to 20weeks incidence ranges from 11 to 22% Etiology
Etiology Fetal factors • Chromosomal anomalies Maternal factors • Age >35yrs old • Infections • Medical disorders • Anatomical factors • Exposure to chemotherapy/radiation • Social and behavioral factors • Occupational and environmental factors
Paternal factors Age
Spermatozoa anomalies Fetal Factors
chromosomal abnormality Most common in first trimester, 50% 75% occurred by 8wks gestation 95% are caused by maternal gametogenesis errors Most common abnormalities are trisomies Chromosome 13, 16, 18, 21, 22 are most common
Monosomy X (45,X) single most frequent specific chromosomal abnormality
Can be followed by prolapsed and ballooning of membrane into vagina then expulsion of immature fetus Indications unequivocal history of second-trimester painless delivery, prophylactic cerclage placement is an option and reinforces a weak cervix by an encircling suture. physical finding of early dilation of the internal cervical os presence of funneling in transvaginal sonography; membranes into a dilated internal os, but with a closed external os
cervical length measurement
16 and 24weeks- every 2 weeks CL 25-29mm weekly interval CL <25mm cerclage is offered Contraindications Bleeding, contractions, ruptured membrane Spontaneous Abortion Clinical Classification
Must be differentiated from that implantation bleeding Maybe accompanied the suprapubic discomfort, mild cramps, pelvic pressure or persistent low backache Management Bed rest Early pregnancy + vaginal bleeding + pain = primary goal is prompt diagnosis of ectopic HCT, HGB and BT requested pregnancy, serial BhCG and TVS Incomplete Abortion
Bleeding follows partial or complete placental separation and dilatation of the cervical os Before 10weeks AOG- placenta are frequently expelled together Management Curettage- quick resolution, 95-100% successful Misoprostol- 800ug vaginal, 400ug oral/SL Expectant Complete Abortion Complete expulsion of entire pregnancy and cervical os subsequently closes History of heavy bleeding, cramping and passage of tissue TVS Minimally thickened endometrium without GS Empty uterus with endometrial thickness <15mm Complete abortion cannot be surely diagnosed unless True products of conception are seen Sonography confidently documents 1st an intrauterine pregnancy then later an empty cavity serial serum BHCG level measurements aid clarification Missed abortion
Dead products of conception that have been retained for days or weeks in the uterus with closed cervical os TVS At 5 to 6 weeks- 1-2mm embryo adjacent to the yolk sac can be seen 6-6.5weeks fetal cardiac activity typically detected CRL 1-5mm MSD 13-18mm Guidelines for Early pregnancy Loss
Yolk sac diameter ≥6mm in pregnancies <10 wks AOG
Slower heart rate <85bpm <5mm difference between MSD and CRL Subchrionic hematoma Inevitable Abortion Preterm premature rupture of membrane(PPROM) at a previable gestational age Nearly always followed by either uterine contractions, infection and termination Risk factors Prior PPROM Prior 2nd trimester delivery Tobacco use 2nd trimester spontaneous PPROM at previable age, 70-80% will deliver within 2-5weeks Evacuation If with bleeding, cramping and fever Expectant Antibiotics are considered and given for 7days to extend latency Types Cervix Uterus BOW FHT Plan Threatened closed Compatible + + Bed rest abortion Tocolysis Missed closed Compatible + - Cervical abortion ripening ±curettage Complete closed Incompatible - - Observe abortion TVS Measure HCG
Incomplete Open Incompatible - - Expectantly
abortion Curettage Medical(misop rostol)
Inevitable Open Compatible - +/- Expectant
abortion Oxytocin Curettage Septic abortion
With spontaneous or induced abortion organism may invade myometrial tissues and extend to cause parametritis, peritonitis and septicemia Most bacteria are part of the normal vaginal flora Severe necrotizing infections and toxic shock syndrome – group A streptococcus- S. pyogenes Management Broad spectrum antibiotic Suction curettage Most patient respond 1-2days treatment, discharged once afebrile Induced Abortion
Therapeutic abortion Termination of pregnancy for medical indications Fetus with significant anatomical, metabolic or mental deformity In cases of incest or rape Elective/voluntary abortion Interruption of pregnancy before viability at the request of the woman Postabortal contraception
Ovulation may resume as early as 8days but average time is 3 weeks
Effective contraception is initiated For those who desire another pregnancy, conception should be delayed with interval of 6months Thank you.
