Abortion and Fetal Loss Part B (Lecture 17b)

What is an abortion?

pregnancy terminates before viability

What is viability?

approx 24 wks GA and/or 500 grams

What is the difference between an abortion and an early pregnancy failure?

Both can be used interchangeably however abortion refers to a general term while early preg loss refers to failure of early preg structures (ys, gs, amnion, etc.) from developing/progressing appropriately

What are spontaneous abortion? What are the 6 types?

Termination thru natural causes (fetal demise or miscarriage)

- Complete

- Incomplete

- Threatened

- Inevitable

- Missed

- Habitual

What is an induced/therapeutic abortion?

Procedural termination of undesired preg

What is embryonic demise?

no heart tones/+FHR within embryonic period (8 wks EA/10 wk GA)

What is fetal demise/death?

Often 2nd/3rd trim, any previously viable fetus that no longer shows signs of cardiac activity

What is a complete abortion? What happens to the bhCG levels? What are the SF?

Entire products of conception (POC) expelled

Rapid fall of bhCG

SF:

- Empty uterus, return to normal endo thickness, no asymmetry of endo

- No flow on Doppler

- Uterus may still be bulky and have dilatation of maternal vessels but dec. overtime w/ falling hormone levels

What is an incomplete abortion? What happens to the bhCG levels? What are the SF? What is the treatment?

- Incomplete expulsion of POC, m/c the placenta

- Slower fall of bhCG than complete

SF:

- Thickened/asymmetrical endo

- ++ Doppler signal

- Intrauterine collection, hematoma (hematometra)

Tx: misoprostol, D&C

What does misoprostol do?

Stimulates uterine contractions and cervical ripening to expel POC

What is a threatened abortion? What are SF?

High risk loss due to pt symptoms (bleeding, cramping, short cx, spotting), SF, previous history, and combo of the above

SF:

- moderate subchorionic hemorrhage or abn membranes

What is an inevitable abortion? What happens to the bhCG levels? What are the SF?

- Irreversible trend/progression towards a preg loss before viability (nothing can be done to stop preg loss)

- bhCG usually plateaus

- SF: Cx is dilated w/ membranes protrudin

What is a missed abortion? Name 3 SF.

- Fetal demise but sac/fetus not aborted for at least 6 wks after demise

SF:

- Absent heart beat - #1 indicator

- Abn sac

- No fetal movement

- Spalding sign (skull bones overlap from degeneration)

- Halo sign (edema around skull, fluid in subcutaneous tissue)

- Dec. fluid volume

- Maceration (tissue degeneration after fetal demise from autolytic enzymes)

What is the "Spalding" sign? What type of abortion is it associated with?

Skull bones overlapping due to decomposition, associated with a missed abortion

What is the "Halo" sign? What type of abortion is it associated with?

Edema around skull, fluid in subcutaneous tissue; associated w/ missed abortion

What is maceration? What type of abortion is it associated with? What are its D/D? (HINT: 2)

- Process of tissue degeneration after fetus dies due to autolytic enzymes

- Associated w/ missed abortions

- D/D: degenerated fibroid, trophoblastic disease

What is a habitual abortion? Name 3 causes.

- Spontaneous abortion occurring w/ 3 or more consecutive pregnancies

Causes:

- Chromosomal abnormalities

- Maternal envrio: hormone imbalance, cervical insufficiency, nutrition, blood group, hypertension, congenital anomalies

What is a septic abortion? What is the CP? What are the SF?

- Demise/preg loss due to acquired infection OR infection acquired due to RPOC

- CP: fever, chills, bleedings, discharge, pain

- SF: May have complex echoes w/i uterine cavity and other signs of endometritis, PID, etc.

What is expectant management for an abortion?

Wait to see if expulsion of failed preg occurs naturally

- f/u bhCG to ensure it's 0

- f/u U/S to ensure no RPOC

What is medical management for an abortion? (HINT: 2)

- Administration of medication to induce contractions/open cx

- Methotrexate: inhibits cell growth

- Misoprostol: opens cx and induces uterine contractions

What is surgical management for an abortion?

D&C

What drug is used in an induced abortion? What does it do?

Mifepristone: antiprogestin that blocks action of progesterone (used b4 9 wks GA)

What surgery is done in an induced abortion?

Vacuum aspiration (suction D&C): suction removes POC from uterus