Patient will present as → a 35-year-old G3P2 with cervical dilatation >3 cm, ruptured membranes, bleeding >7 days, and the presence of cramping (inevitable abortion)
- Medical abortion: Mifepristone and Misoprostol up to first 7-9 weeks LMP
- Suction Curettage: safest and most effective for 12 weeks or less. Surgical procedure 3-12 weeks LMP. local anesthesia on cervix
- Surgical Curettage (D&C) Aspiration: a surgical abortion up to 16 weeks LMP
- Dilation and Evacuation (D&E) up to 18 weeks outpatient
- Induction of labor with intra amniotic instillation after 16 weeks
- Induction of labor with vaginal prostaglandins after 16 weeks
- Any pregnancy which ends before 20 weeks gestation and/or fetus that is less than 500 grams
- More than 80 percent of abortions occur in first 12 weeks
- Increased risk with:
- Parity: the more often you are pregnant the more likely you are to have an abortion
- Increased risk of maternal (35 +) and paternal age (45 +)
- Women who conceive within 3 months of a term birth
- 60 percent of abortions are due to chromosomal abnormalities with the next largest category is unknown
Classification based on history and physical exam findings:
- Spontaneous abortion: is an expulsion of all or part of the products of conception before 20 weeks of gestation.
- Threatened abortions: bloody vaginal discharge before 20 weeks of gestation with or without uterine contractions in the presence of a closed cervix.
- Incomplete abortion: dilated cervical os with passage of some but not all products of conception before 20 weeks of gestation.
- Inevitable abortion dilated cervical os without passage of tissue before 20 weeks of gestation.
- Missed abortion: is death of the fetus before 20 weeks of gestation, with products of conception remaining intrauterine.
Recurrent, spontaneous abortions: 2-3 or more consecutive spontaneous abortions
- Genetic testing of parents
- Thyroid (hypo and hyper)
- Autoimmune (SLE and anticardiolipin antibodies)
Diagnose by ↓ βHG and classification based on ultrasound findings
- Transvaginal ultrasonography is the cornerstone of the evaluation of bleeding in early pregnancy
- The US demonstrates inappropriate development or interval growth, poorly formed/unformed fetal pole, fetal demise
- The βHG should double every 48 hours in a viable intrauterine pregnancy
- Blood type and Rh status necessary tests to preclude Rh sensitization in mother
Traditionally managed by D&C only, monitor progress with B-hCG levels or ultrasound examination
- Comprehensive management of early pregnancy loss includes addressing the emotions of women and their partners, inquiring about future plans for pregnancy, and offering contraceptive or preconception planning as appropriate
|Spontaneous abortion is defined as loss of pregnancy before 20 weeks gestation. Excessive bleeding before 20 weeks gestation in a pregnant women may indicate a nonviable fetus. Types of spontaneous abortion include threatened, inevitable, incomplete, complete, and missed. Identifying the type of spontaneous abortion is critical for determining subsequent treatment. Interventions include promoting bed rest and providing emotional support. Since fluid imbalance may occur in spontaneous abortion, monitoring for hemorrhage includes saving the patient's pads and linens. The administration of RhoGAM may be necessary for Rh- women exposed to R+ blood of nonviable fetuses. Dilation & curettage and cerclage may be done to remove fetal tissue from inside the uterus.
uterine intramural myomata
progesterone deficiency elevated serum beta HCG
come to your office first thing in the morning for an evaluation
take some ibuprofen and see you at her next scheduled prenatal visit
rush to the emergency department because of suspected ectopic pregnancy
rush to the emergency department for an immediate dilation and curettage (D& C)
call an obstetrician-gynecologist to schedule an outpatient consultation
recurrent spontaneous abortion
medical management with vaginal misoprostol
serial β-human chorionic gonadotropin (β-hCG) measurements
Threatened abortion is characterized by bleeding in the first trimester without loss of fluid or tissue.
Complete abortion refers to a documented pregnancy that spontaneously passes all of the products of conception.
Incomplete abortion is when the cervical os is open and allows passage of blood. The products of conception may remain in utero or may partially extrude through the open os.