abortion/miscarriage special populations

what is an abortion

termination of a pregnancy either spontaneously or intentionally

what is a spontaneous abortion

abortion that occurs without medical or mechanical means to empty the uterus

what is a pregnancy lost after the 20th week of gestation known asa 

still birth 

what is it called if fetal birth is less than 500 grams 

still birth 

what weeks of pregnancy do most spontaneous abortions occur in

first 12 weeks

what increases the risk of spontaneous abortion

parity

maternal and paternal birth age

what is the incidence of spontaneous abortion in women younger than 20 

12% 

what is the incidence of spontaneous abortion in women older than 40

26%

what do spontaneous abortions commonly display 

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

what maternal factors can contribute to the incidence of spontaneous abortion 

infections

uterine defects

endocrine abnormalities 

nutrition

drug use

incompetent cervix 

physical trauma

radiation

contraceptives 

what infections can contribute to spontaneous abortion 

chlamydia 

gonorrhea

streptococcus agalactiae 

herpes simplex

listeria 

what endocrine abnormalities can contribute to spontaneous abortion

hypothyroidism (iodine deficiency)

diabetes mellitus (congenital malformations and abortions)

progesterone deficiency

where does progesterone deficiency start 

luteal phase defect

insufficiency progesterone secretion from corpus luteum or placenta 

what nutrition risks can increase risks of spontaneous abortion

malnutrition

diabetes mellitus

what drugs/environmental factors increase incidence of spontaneous abortion 

tobacco (abortion risk)

alcohol (fetal abnormalities and abortion)

caffeine (5+ cups of coffee per day)

what is an incompetent cervix

painless dilation of the cervix in 2nd or early 3rd trimester 

what environmental toxins can cause spontaneous abortion

anesthetic gasses

arsenic,lead, formaldehyde, benzene, ethylene oxide

does shortwave or ultrasound increase the risk of abortion

no

what are the s/s of spontaneous abortion 

vaginal bleeding 

suprapubic pain

uterine cramping 

what are the types of spontaneous abortion

threatened

inevitable

complete or incomplete

missed

recurrent

what is the treatment for a threatened abortion

bed rest

ultrasound to check for fetal life

what percent of abortions are threatened abortions 

20-30%

what are the s/s of a threatened abortion

painless bloody vaginal discharge

bleeding frequently slight but may persist for days or weeks

frank blood

no cervical dilation

membranes still intact

what are the s/s of an inevitable abortion

bleeding and pain (uterine contractions)

cervical dilation

rupture of membrane

no tissue passed

what is the treatment for an inevitable abortion 

ultrasound

series of blood tests to check HCG levels 

describe a complete abortion

rare

bleeding and pain resolve after a few days

following complete detachment and expulsion of products of conception

cervix is closed post bleeding

no treatment needed

describe an incomplete abortion

bleeding and pain

expulsion of some but not all fetal tissue

cervix dilated

might be distress

treatment required (material removal)

what are the s/s of a missed abortion 

fetus dies in utero 

fetus degeneration 

no pain/bleeding 

uterus shrinks

decreased pregnancy symptoms

treatment (remove material or it resorbs)

what is a recurrent abortion 

3 or more consecutive spontaneous abortions 

when are induced abortions indicated

continuation of pregnancy may threaten the life of the mother or impair her health

pregnancy from rape or incest

child birth will likely result in severe physical deformities or mental retardation

what are some examples of health implications that a mother could suffer from if they do not get an induced abortion when indicated

persistent heart disease

advanced hypertensive vascular disease

invasive carcinoma of the cervix

what is an elective abortion 

interruption of the pregnancy at the request of the pt but not for reasons related to maternal health or fetal disease 

how is an abortion performed before 8 weeks gestation

dilating cervix and evacuating product of conception

mechanically scrape contents

vacuum

what should be kept in mind when performing an abortion beyond 8 weeks gestation

increased risk of hemorrhage and infection

uterine perforation

what are 2 importatn determinants when getting an abortion after 8 weeks gestation 

skill of physician 

position of uterus 

what is an alternative to surgiccal abortion with pregnancies less than 49 days gestation

outpatient medical abortion

what are 3 medications for abortion

antiprogestin

antimetabolite

prostaglandin

is fertility altered by an elective abortion 

no 

what 4 factors of birth/pregnancy do elective abortions not impact

2nd trimester spontaneous abortions

preterm delivery

ectopic pregnancy

LBW infants

when can ovulation resume following abortion

2 weeks post

if pregnancy is to be prevented what is an important factor to consider following an abortion 

effective contraception