abortions

• Gestational Trophoblastic Disease/Molar Pregnancy

  Uterine bleeding starting at 6-16 weeks, fundal height>>dates, excessive N/V, b/l enlarged cystic ovaries, pre-eclampsia/eclampsia in 2nd trimester
• Gestational Trophoblastic Disease/Molar Pregnancy

  • Risk factors: prior SAB, history of molar pregnancy, <21 years old or >35 years old
• Choriocarcinoma


  Continued/recurrent uterine bleed post evacuation of mole; ulcerative vaginal tumor, pelvic mass, distant metastases
• Labs for Gestational Trophoblastic Disease/Molar Pregnancy

  • High serum beta-hCG
  • Thyroid
  • LFT
  • H&H blood type
• Treatment for Gestational Trophoblastic Disease/Molar Pregnancy

  Surgery
• Spontaneous Abortion


  Passing of pregnancy <20 weeks
• Causes of Spontaneous Abortion

  • Abnormal fetal karyotype
  • Infection
  • Anatomic/endocrine defects
  • Immunologic factors
  • Exposure to toxic substances
  • Unknown
• Specific causes of Spontaneous Abortion

  • Aneuploidy (monosomy, trisomy)
  • Maternal (age, infection, endo/CV/autoimmune disorders)
  • Uterine/cervical issues (Asherman's disease, fibroids, cervical insufficiency)
  • Toxic (ETOH, nicotine, cocaine)
  • Trauma
• Diagnosis of Spontaneous Abortion

  Shows anemia if significant bleeding, elevated WBC, beta-hCG quantitative falling/abnormal rising
• Transvaginal Ultrasound


  Visualize gestational sac in uterus at 4-5 weeks gestation
• Threatened Abortion


  • Normal gestational sac and viable embryo, cervix remains closed, patient has symptoms of bleeding, maybe cramps, risk for recurrent bleed, preterm premature rupture of membranes, preterm labor
• Inevitable Spontaneous Abortion


  • Bleeding with cervical dilation, symptoms of back/abdominal pain indicating impending abortion, products of conception have not passed from uterine cavity
• Incomplete Spontaneous Abortion


  • Passage of some but not all products of conception from uterine cavity, symptoms of bleeding/cramping ongoing until all is expelled, severe pain, heavy bleeding, medical evaluation and possible surgical procedure
• Missed Abortion


  • Cervix is closed and products of conception remain in situ, pregnancy has been retained in uterus after embryonic/fetal demise, maybe cramping/bleeding, asymptomatic
• Anembryonic Pregnancy (Blighted Ovum)


  Presents like missed/threatened abortion
• Septic Abortion


  • Intrauterine infection involving endometrium/products of conception, symptoms include fever, chills, abdominal pain, vaginal bleeding, malodorous vaginal discharge
• Workup for Septic Abortion

  • CBC
  • UA
  • Endocervical cultures
  • Blood culture
  • Abdominal X-ray
  • Pelvic ultrasound
• Treatment for Septic Abortion

  Hospitalization, broad spectrum antibiotics, dilation and curettage (D&C)