SPONTANEOUS ABORTION

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

What is spontaneous abortion?

More than 20–24 weeks OR weighing at least 500 g.

When is a fetus considered viable according to the slide?

Spontaneous abortion.

First-trimester bleeding in early pregnancy most commonly suggests what?

• Threatened

• Inevitable

• Complete

• Incomplete

• Missed

• Recurrent

Enumerate the types of spontaneous abortion.

Bright red and scant vaginal bleeding.

What kind of bleeding occurs in threatened abortion?

Closed cervix.

: What is the cervical status in threatened abortion?

Yes, it is a viable pregnancy.

Is the pregnancy still viable in threatened abortion?

Early — under 16 weeks
Late — 16–24 weeks

How is threatened abortion classified by gestational age?

Avoid sexual intercourse for 2 weeks after bleeding.

What sexual activity instruction is given in threatened abortion?

The cervix has dilated.

What indicates that abortion is inevitable?

They have ruptured.

What happens to the membranes in inevitable abortion?

No, they remain in the uterus initially.

Are the products of conception expelled immediately in inevitable abortion?

Uterine contractions.

: What uterine activity occurs in inevitable abortion?

Bleeding begins within 2 hours and ceases within 2 days.

What is the bleeding pattern in inevitable abortion?

Inevitable abortion

Bleeding begins within 2 hours and ceases within 2 days.

Spontaneous passage of all products of conception — fetus, membranes, and placenta.

What defines complete abortion?

Complete abortion

abortion that requires NO require medical treatment

Usually the fetus.

Membranes and placenta.

What is expelled in incomplete abortion?

What remains in incomplete abortion?

: Early pregnancy failure with intrauterine fetal death (IUFD) and retention of products of conception.

What is missed abortion?

4–6 weeks before symptoms appear.

In missed abortion, when did fetal death usually occur relative to symptoms?

Three or more spontaneous pregnancy losses at the same gestational age.

What qualifies as recurrent abortion?

Defective ova or spermatozoa.

What reproductive cell problem can cause recurrent abortion?

Decreased protein-bound iodine (PBI), decreased globulin iodine (GBI), poor thyroid function, and luteal phase defect.

What thyroid-related abnormalities are associated with recurrent abortion?

Abortion

Luteal phase defect can lead to?

Septate uterus and bicornuate uterus.

Which uterine structural abnormalities are linked to recurrent abortion?

Bicornuate uterus.

Which uterine malformation is the most common?

It reduces blood supply to the pregnancy.

How can resistance to uterine artery blood flow cause miscarriage?

Chorioamnionitis.

What uterine infection is associated with abortion?

Lupus anticoagulants and antiphospholipid antibodies.

Which autoimmune conditions increase miscarriage risk?

• Hypothyroidism

• Diabetes mellitus

• Polycystic ovary syndrome (PCOS)

• Thrombophilia

• Antiphospholipid antibodies

• Systemic lupus erythematosus (SLE)

Enumerate maternal medical conditions that increase risk of miscarriage.

Septic abortion

Appendicitis

Enumerate surgical emergencies associated with miscarriage.

Intrauterine adhesions that occur after curettage of the uterus.

What is Asherman syndrome?

Obstruction of the uterine cavity leading to infertility.

What happens in severe Asherman syndrome?

Insufficient endometrial tissue for implantation and defective vascularization due to fibrosis.

How can mild adhesions cause miscarriage?

They distort the uterine cavity and interfere with embryonic implantation.

How do submucosal fibroids increase miscarriage risk?

1.8% risk.

What is the miscarriage risk associated with submucosal fibroids?

• Bacterial vaginosis

• Listeria monocytogenes

• Measles

• Mumps

• Coxsackie virus

• Toxoplasma gondii

• Ureaplasma

• Mycoplasma

Enumerate maternal infections associated with miscarriage.

SSRIs

Which antidepressant class is associated with miscarriage?

ACE inhibitors.

Which antihypertensive drug class increases miscarriage risk?

Detailed history, pelvic examination, and ultrasound.

What are the main diagnostic approaches in spontaneous abortion?

Expectant management, medical evacuation, and surgical uterine evacuation.

What are the management options for spontaneous abortion?

Hemorrhage, intrauterine infection, and increased risk for depression and anxiety.

What are the complications of spontaneous abortion?

Advanced maternal age and previous spontaneous abortion.

Which obstetric history factors increase miscarriage risk?

High caffeine consumption, obesity, smoking, and substance abuse.

Which lifestyle factors increase miscarriage risk?

A pregnant woman in her first trimester presents with thin, grayish vaginal discharge and a fishy odor. She later develops first-trimester bleeding and pregnancy loss. Which infection is most associated with this presentation?

Bacterial vaginosis

Listeria monocytogenes

A pregnant woman develops fever and flu-like symptoms after eating unpasteurized cheese. Weeks later, she experiences spontaneous abortion. Which organism is the most likely cause?

Measles

A pregnant woman contracts a viral illness characterized by fever, cough, conjunctivitis, and rash. Shortly after, she experiences pregnancy loss. Which viral infection is implicated?

Mumps

A pregnant patient develops parotid gland swelling with fever during early pregnancy and subsequently experiences miscarriage. Which viral infection is most likely responsible?

Coxsackie virus

A pregnant woman develops a viral illness associated with vesicular lesions on the hands and mouth. She later has a spontaneous abortion. Which virus is most associated?

Toxoplasma gondii (toxoplasmosis)

A pregnant woman who frequently handles cat litter develops flu-like symptoms. Ultrasound later shows fetal compromise followed by pregnancy loss. Which parasitic infection is the likely cause?

Ureaplasma and Mycoplasma

pregnant woman with chronic genital tract infection and inflammation experiences recurrent early pregnancy loss. Which group of organisms is most commonly implicated?