Classifications of Abortions

sponteneous abortion

What does SA stand for

Therapeutic abortion

What does TA stand for

True

T/F: miscarriage is synonymous with spontaneous abortion

25%

What is the natural pregnancy loss rate

5-12 weeks

When in the pregnancy does majority of spontaneous abortions occur

Maternal, fetal, fetal and maternal (both)

What are the three major categories of factors causing spontaneous abortion

50%

What is the risk of a spontaneous abortion when the mother becomes pregnant beginning at age 45 or older

Genetic (50-70%)

What is the most common fetal factor causing spontaneous abortions

Rh incompatibility

What is an example of a fetal and maternal factor causing SA

Mother is Rh- and fetus is Rh+

When does Rh incompatibility occur

Vaginal bleeding, cramping, dilated cervix, uterine contractions

What are the four major clinical signs for a spontaneous abortion

Heavy bleeding with cramps

What type of vaginal bleeding is 3 times more likely to be because of a miscarriage compared to the other types of bleeding

50%

What percent of women that have vaginal bleeding during pregnancy will lose the pregnancy

PROM and preterm labour

If the patient does not miscarry when experiencing vaginal bleeding, there is a 17% chance they will have complications such as _______________ and ___________________

Cervix, vagina, or uterus

Where else can vaginal bleeding come from, if not coming from the pregnancy

Bleeding with viable IU pregnancy and heart beat seen

What is a threatened abortion

Embryo present but no heart beat detected

What is an embryonic demise

Uterus is non gravid

What is a spontaneous abortion with no retained parts

Less then half

How much of the total uterine cavity should the gestational sac occupy at 6 weeks

Half

How much of the uterine cavity should the gestational sac occupy by 8 weeks

Entire uterine cavity

How much of the uterine cavity should the sac occupy by 10 weeks

B (inner to inner)

Which is the correct measuring technique for yolk sac

There is something wrong

What does it usually mean when you can not see the embryo/fetal pole by a MSD of 25mm

12 w 6 d

When in the pregnancy does a normal intrauterine pregnancy ultrasound reduce the risk of loss by 1-2%

Threatened abortion

Vaginal bleeding in a pregnancy less than 20 weeks

Closed

Is the cervix closed or open if the patient has a threatened abortion

Implantation bleeding

What may be a possible explanation of a threatened abortions

Document location relative to GS, image ins 2 planes, measure in 3 dimensions

How do you document a sub chorionic hemorrhage

Less than 90bpm

What fetal heart rate becomes worrisome

Less than 5mm

A MSD to CRL measurement becomes concerning when it is :

Measurement less than 6mm or calcified

When do we become concerned about the yolk sac

Irregularly shaped

When do we become concerned about the gestational sac

Abnormal, less than 5mm

Is this MSD to CRL normal or abnormal

Anembryonic pregnancy

A pregnancy which failed prior to the development of an identifiable embryo

Blighted ovum

What is another name for an anembryonic pregnancy?

Bleeding with positive pregnancy test but no embryo

What may indicate a anembryonic pregnancy

Less than 20mm

What does the MSD have to be in order to be an anembryonic pregnancy

It is breaking down

What can a gestational sac that has an irregular shape indicate

Embryonic demise

An early failed pregnancy that remains in the uterus

Missed abortion

What is another term for embryonic demise

5mm or greater embryo without FH

What are the characteristics of an embryonic demise

Bleeding and small for dates

What are the two major symptoms of embryonic demise

10-14 weeks

When in the pregnancy is embryonic demise often discovered

No FH, macerated fetus, Spaulding sign, irregular walls of GS

What are some sonographic indicators of an embryonic demise

Embryo not as bright as we would expect

What indicates an echopenic fetal pole

Overlapping of skull bones

What is the spalding sign

In process of disintegration

Why would the gestational sac have irregular walls when suspicious of an abortion

Put colour doppler over heart of fetus

How can we confirm a fetal demise

Inevitable abortion

Failed early pregnancy that is in the process of being expelled from the uterus

Active bleeding and an open cervix

What symptoms indicate an inevitable abortion

Low in uterus

Where would the sac be in an inevitable abortion

No vascularity surrounding GS with Doppler and

What are the two major sonographic characteristics of an inevitable abortion

Dynamic EV scan

What may help determine is the GS moves or not

Incomplete abortion

A spontaneous abortion in which some products of conception remain in the uterus

Enlarged uterus, empty/poorly define GS, internal echoes no resembling a fetus

What are some sonographic characteristics of an incomplete abortion

Let nature take its course

What is the first step of treatment for an incomplete abortion/embryonic demise

Induce abortion

If doing nothing is not working, what is the next step of treatment for an incomplete abortion

Dilation and curettage

What is D & C

Less than 14 weeks in pregnancy

When would the patient be treated with a D & C

Dilate cervix and remove contents

In simple terms, how is a D & C preformed

Dilation and evacuation

What is D & E

Indication of labour

What is D & E also know as

Prostaglandin or hypertonic saline urea

What is used to induce labour

More than 14 weeks in the pregnancy

When would the patient be treated with induced labour

Risk of complications from D&C when over 14 weeks

Why are patients that are over 14 weeks induced into labour instead of D&C

Complete abortion

all products of conception are expelled and bleeding/cramping has decreased

Empty/enlarged uterus, may see some blood within endometrium

What are some sonographic characteristics of a complete abortion

3 or more consecutive abortions

What are habitual abortions

Luteal failure, retroverted uterus, DES exposure, unicornuate uterus, chromosomal abnormalities

What may cause habitual abortions

Progesterone

What does the corpus luteum secrete

Infection as a result of abortion

What is a septic abortion

Pain, fever, bleeding, discharge

What are some symptoms of a septic abortion

Thick endometrium, air shadowing, increased endometrium echoes

What are some sonographic characteristics of a septic abortion

Personal reasons or fetal abnormalities

In Alberta, TA can be performed up to 21 weeks for:

Any fetal abnormality

In Alberta, TA can be performed from 21w 1d - 23w 6d weeks for:

Lethal fetal abnormalities

In Alberta, TA can be performed from 24 weeks to term for:

Date of pregnancy, diagnosis of masses or malformations, locate IUCD, guide procedure

What are some of roles of a sonographer before/during TA

Diagnosis of potential complications

What is role of the sonographer after TA

Threatened abortion

Classify this abortion

Anembryonic pregnancy

Classify this abortion

Embryonic demise

Classify this abortion

Inevitable abortion

Classify this abortion

Incomplete abortion

Classify this abortion

Complete abortion

Classify this abortion

5mm

When should you be able to detect a fetal heart rate

Absent YS or embryo when should be seen, absent FH, abnormal morphology of GS or YS

What are the diagnostic criteria for a IUP failure/abortion