Abortion

what is an abortion?

termination of pregnancy, either spontaneously or intentionally

what is a spontaneous abortion?

occurring without medical or mechanical means to empty the uterus

when do more than 80% of abortions occur?

in the first 12 weeks of pregnancy 

what increases the risk of spontaneous abortion?

parity as well as maternal and paternal age 

what are fetal factors of spontaneous abortion?

abnormal chromosomal number (50%)

what do early spontaneous abortion commonly display?

a developmental abnormality of zygote, embryo, early fetus or placenta

what are some maternal factors of spontaneous abortion?

infections, uterine defects, endocrine abnormalities, nutrition, drug use, incompetent cervix and physical trauma 

how does hypothyroidism cause spontaneous abortion?

iodine deficiency associated with excessive miscarriages 

how does diabetes mellitus cause spontaneous abortion?

poor glucose control increases the incidence of abortion

how does progesterone deficiency cause spontaneous abortion?

luteal phase defect, insufficient progesterone secretion by the corpus luteum or placenta

what nutrition maternal factors can cause spontaneous abortion?

severe malnutrition

what increases the risk of spontaneous abortion in regards to drug use?

tobacco increases risk, alcohol in first 8 weeks, caffeine

what are signs and symptoms of spontaneous abortion?

vaginal bleeding, suprapubic pain, uterine cramping

what are the S&S threatened abortion?

painless blood vaginal discharge, bleeding is frequently slight, frank blood, no cervical dilation, membranes are intact 

what is true of the frequency of threatened abortion?

extremely common

what is the treatment for threatened abortion?

bed rest, ultrasound to check for fetal life

what are the signs and symptoms of inevitable abortion?

bleeding and pain (contractions), cervical dilation, ruptured membrane, no tissue passed

what is the treatment for inevitable abortion?

ultrasound, series of blood test to check for hCG levels 

what is a complete abortion?

bleeding and pain resolve after a few days, following complete detachment & expulsion of products of conception, cervix is closed

what is an incomplete abortion?

bleeding and pain, expulsion of some but not all of the fetal tissue, cervix is dilated, may be in distress

what are the signs and symptoms of a missed abortion?

fetus dies in utero, fetus degeneration, no bleeding or pain, uterus shrinks, decrease of pregnancy symptoms

what is the treatment of a missed abortion?

may have to remove remaining tissue or it will reabsorb on its own 

what is recurrent abortion?

three or more consecutive spontaneous abortions

what is an elective abortion?

interruption of pregnancy at the request of the patient but not for reason of impaired maternal health or fetal disease

how is a dilatation and curettage before 8 weeks done?

performed first by dilating the cervix and evacuating the product of conception

how is a dilatation and curettage done?

mechanically scraping out of the content, vacuum aspiration or both 

after 8 weeks, what is true of a dilatation and curettage?

increases the risk of hemorrhage and uterine perforation

what are the three medications for early medical abortion?

antiprogestin, antimetabolite, prostaglandin