SPONTANEOUS ABORTION

Spontaneous abortion / miscarriage

Loss of pregnancy before 20 weeks of gestation without outside intervention

Bright red and scant vaginal bleeding.

In threatened abortion, what type of bleeding is typical?

• Bright red scant vaginal bleeding

• closed cervix

• viable pregnancy

Characteristics of threatened abortion

• early under 16 weeks

• late 16-24 weeks

Types of threatened abortion

2 weeks after finding out

This type of abortion indicated to avoid intercourse for ________

Inevitable abortion

An imminent abortion

• cervix dilated

• membranes rupture

• uterine contraction

• products of conception remain in uterus

• bleeding within 2 hours, ceases within 2 days

Characteristics of Inevitable abortion

Inevitable abortion

This type of abortion has bleed ing within 2 hours and ceases within 2 days

Complete abortion

Spontaneous passage of all products of conception

fetus, placenta, membrane

What are the products of conception

Complete abortion

This type of abortion does not require Medical intervention

20 -24 weeks

atleast 500 grams

What makes a fetus viable?

1st trimester

bleeding in Spontaneous abortion occurs in ________ trimester .

Incomplete abortion

Part expelled usually the fetus and membranes

placenta retained

Missed abortion

Type of abortion known as Early pregnancy failure

IUFD
retention of products of conception

Missed abortion is characterized by

• _________

• ________

Missed abortion

Fetus dies 4-6 weeks before symptoms

Habitual Aborters

Older term for Recurrent abortion

Recurrent abortion

• same gestational age

_________ A history of 3 or more spontaneous pregnancy losses at the ____________

• Defective ova / spermatozoa

• endocrine factors

• Deviation of uterus

• Resistance to uterine artery blood flow

• Chorioamnionitis

• Auto immune disorders

Causes of Recurrent abortion

• Decreased PBI Protein-bound iodine

• Decreased GBI Globulin Iodine

• poor thyroid function

• luteal phase defect

Endocrine factors that contributes to Recurrent Abortion

• Septate

• Bicornuate

Deviation of uterus that can cause recurrent aborton

Chorioamnionitis ( uterine infection)

type of infection that causes recurrent abortion

• Lupus anticoagulant

• Anti-phospholipids antibodies

Auto immune disorders that cause Recurrent abortion ( by increaseing blood clots)

• Hypothyroidism

• Diabetes mellitus

• PCOS

• Systemic lupus erythematous SLE

• Thrombophilia

• Anti phospholipid antibodies

What medical conditions can cause Recurrent abortion

Septic abortion

appendicitis

Surgical emergencies that can cause recurrent abortion

Asherman syndrome

Fibroids

Uterine malformations

Intrauterine causes of Recurrent abortion

Asherman Syndrome

This syndrome occurs following the Curettage of the Uterus

• Severe degrees of intrauterine adhesions

• leads to obstruction of the uterine cavity and subsequent infertility

• pregnancy loss

• insufficient endometrial tissue for implantation + placenta development

• Defective vascularization caused by fibrosis

MILD degree of adhesion in Asherman syndrome can cause what>?

1.8 % risk of miscarriage

Women with submucosal fibroids are at ____- % risk of _______

Women with submucosal fibroids

1.8 % risk of miscarriages

• distortion of blood supply in endometrium

• interfere with embryonic implantation

Projection of submucosal fibroids to the uterus can cuase?

• subserosal

• submucosal

• intramural

• Intercavitary

• pedunculated

Types of uterine fibroids

Bicornuate uterus

Most common uterine malformation

• measles

• mumps

• bacterial vaginosis

• Listeria monocytogenes infection

• Coxsackie virus infection

• Toxoplasma gondi infection (toxoplasmosis)

• Ureaplasma and mycoplasma infection

Maternal infections that can cause Recurrent abortion

Listeria Monocytogenes

Foodborne infection (unpasteurized dairy, deli meats).

Coxsackie virus

a highly contagious enterovirus, most common in children under 5, causing fever, sore throat, and painful blister-like rashes on hands, feet, and inside the mouth

• May cause:

  Myocarditis
  Fetal death

Toxoplasma gondii

From:

• Cat feces
• Undercooked meat

Mechanism:

• Parasite crosses placenta
• Infects fetus

Ureaplasma and mycoplasma

genital tract bacteria.

• Mechanism:

  • Ascending infection
  • Chorioamnionitis
  • Membrane rupture
  • Preterm labor

• maternal age at time of conception

• previous spontaneous abortion

What obstetric history to get to someone with recurrent abortion

Selective serotonin re uptake inhibitors

Angiotensin converting enzymes

Medications that may cause abortion

• detailed history

• pelvic examination

• imaging with ultrasound

Diagnostics for Abortion

• expectant management

• medical evacuation

• surgical uterine evacuation

Treatment for Abortion

• hemorrhage

• Intrauterine infection

• Depression and anxiety risk

Complications of Abortion