1.3 Gestational Conditions: Spontaneous Abortion

Spontaneous Abortion

• Loss of pregnancy before 20 weeks of gestation without outside intervention

• First trimester bleeding

Viable fetus

• more than 20-24 weeks

• or weighs at least 500 g

• Threatened

• Inevitable

• Complete

• Incomplete

• Missed

• Recurrent

Types of Spontaneous Abortion:

Threatened Abortion

• bright red and scant vaginal bleeding

• presence of a viable pregnancy

• with a closed cervix

  • Early under 16 weeks

  • Late 16-24 weeks

• Avoid sexual intercourse 2 weeks after

• Bright red and scant

• viable pregnancy

• closed cervix

  • 16 weeks

  • 16-24 weeks

• 2 weeks

THREATENED

• ___________ vaginal bleeding

• presence of a _____________

• with a __________

  • Early under ___________

  • Late ___________

• Avoid sexual intercourse __________

Inevitable Abortion

• Imminent

• Cervix has dilated

• Membranes have ruptured

• The products of conception remain in utero

• There is uterine contractions

• Bleeding within 2 hours and

• ceases within 2 days

• dilated

• ruptures

• remain

• uterine contraction

INEVITABLE ABORTION

• Imminent

• Cervix has _______

• Membranes have ______

• The products of conception ________ in utero

• There is _____________

• Bleeding within 2 hours and

• ceases within 2 days

Complete Abortion

• spontaneous passage of all the products (fetus, membrane, placenta) of conception

• does not require medical treatment

Incomplete Abortion

Part expelled usually the fetus and membranes and placenta retained

Missed Abortion

• Early pregnancy failure

• Characterized by intrauterine fetal death (IUFD) and retention of the products of conception

• Fetus died 4-6 weeks before symptoms

Intrauterine Fetal Death

4-6 weeks

MISSED ABORTION

• Early pregnancy failure

• Characterized by __________________ and retention of the products of conception

• Fetus __________ before symptoms

Recurrent Abortion

• Habitual aborters

• A history of 3 or more spontaneous pregnancy losses at the same gestational age

• Defective ova or spermatozoa

• Endocrine factors

• Deviations of the uterus

• Resistance to uterine artery blood flow

• Chorioamnionitis

• Autoimmune disorders

Recurrent Abortion

Causes:

• -

• -

• -

• -

• -

• -

• Decreased

  • Protein-bound Iodine

  • Globulin iodine

  • poor thyroid function

  • luteal phase defect

Recurrent Abortion

CAUSES:

• Endocrine factors

• Septate

• Bicornuate uterus

Recurrent Abortion

CAUSES:

• Deviations of the uterus

Chorioamnionitis

Uterine infection

• Lupus anticoagulants

• Antiphospholipid antibodies

Recurrent Abortion

CAUSES:

• Autoimmune disorders

HDPTAS

• Hypothyroidism

• Diabetes Mellitus

• PCOS

• Thrombophilia

• Antiphospholipid antibodies

• Systemic Lupus Erythematosus (SLE)

Recurrent Abortion

Maternal conditions that increase risk

• Medical Conditions:

• septic abortion

• appendicitis

• Asherman syndrome

• Fibroids

• Uterine Malformations

Recurrent Abortion

MEDICAL CONDITIONS

• Surgical emergencies

  • -

  • -

• Intrauterine causes

  • -

  • -

  • -

Asherman Syndrome

• occurs following curettage of the uterus

• Severe degrees of intrauterine adhesions

• leads to obstruction of the uterine cavity and subsequent infertility

• Pregnancy Loss

• Endometrial Tissue

• Defective Vascularization; Fibrosis

Recurrent Abortion

ASHERMAN SYNDROME:

Mild degree of adhesions :

• __________

• insufficient amount of normal ___________ for implantation and placental development

• __________ of the remaining endometrial tissue caused by __________

Submucosal Fibroids

Endometrium

Recurrent Abortion

FIBROIDS

• Women with__________ (1.8% risk of miscarriage)

• involves a projection of the___________ into uterine cavity

  • distortion of the blood supply in the ___________

  • interferes with embryonic implantation

Bicornuate Uterus

Recurrent Abortion

UTERINE MALFORMATIONS

• ___________

  • Most common malformation

ok

Recurrent Abortion

MATERNAL INFECTIONS

a. Bacterial vaginosis

b. Listeria monocytogenes infection

c. Measles

d. Mumps

e. Coxsackie virus infection

f. Toxoplasma gondii infection (toxoplasmosis)

g. Ureaplasma and Mycoplasma infection

• Caffeine consumption

• Obesity

• Smoking

• Substance Abuse

Recurrent Abortion

DIET AND LIFESTYLE

• Selective Serotonin Reuptake Inhibitor (SSRI)

• Angiotensin-Converting Enzymes inhibitors

Recurrent Abortion:

• Medications

ok

DIAGNOSTICS

• A detailed history

• Pelvic examination

• Imaging with ultrasound

• Expectant management

• Medical Evaluation

• Surgical Uterine Evacuation

TREATMENT

• Hemorrhage

• Intrauterine Infection

• Increased risk for depression and anxiety

COMPLICATIONS