Abortion Case Discussion

– History –

  • CC: most likely will present as a pregnant lady w\ PV bleeding:
    • Onset: first time? When? Sudden\gradual? Continuous\intermittent?
    • Characteristics: amount? Color? Clots? Tissue? Smell?
  • Associated sx:
    • Constitutional: fever, chills, appetite?
    • Anemia: dizziness, syncope, headache, palpitations, SOB?
    • Labor: abdominal cramps, lower back pain, pelvic pressure, fetal movements?
    • Vagina: vaginal bleeding, clear fluid gush\leak, discharge, itching?
    • Urinary sx: dysuria, flank pain?
    • Preeclampsia: headache, visual changes, epigastric pain, lower limb swelling?
  • Obstetric Hx:
    • Gravida? Para? Abortions? Living?
      • If prev: mode of delivery? Fetal\maternal complications?
    • LMP?
    • Last US: when? Results? Singleton or multiple gestation?
    • Screening: GBS, GDM, rubella immunization, blood type\Rh immunization?
  • Gynecological Hx:
    • Menstrual Hx: regular periods? Intermenstrual bleeding?
    • Contraception use, IUCD?
    • Gynecological procedures, IVF\induction of ovulation?
  • PMHx:
    • Diseases:
      • Chronic ds (HTN, DM\GDM, DLP)
      • Cardiac, thyroid, SLE
      • Hematological (anemia, APS)
      • Gyn (PID, fibroids, uterine anomalies)
    • Medications: abx, steroids, anticoagulants, folate, herbal
    • Surgery, hospitalization, trauma
    • Allergies
  • FMHx:
    • Similar complaint?
    • Same diseases as in PMHx?
  • Social Hx:
    • Occupation, marital status, children?
    • Smoking, alcohol, recreational drugs? (exposure to diethylstilbestrol)
    • Travel Hx
    • Diet, exercise

 


– Causes –

  • Fetal:
    • Chromosomal (MC: trisomy 16)
    • Congenital anomalies
  • Maternal factors:
    • Infections (TORCH)
    • Endocrine ds
    • Thrombophilia (SLE, APS)
    • Anatomical abnormalities (septate uterus, Asherman’s)

 

– Management –

  THREATENED MISSED INEVITABLE INCOMPLETE COMPLETE
Clinical features Minimal PV bleeding ± abd pain Asymptomatic (usually) PV bleeding + abd pain ± ROM Profuse PV bleeding + passage some of POC Complete passage of POC
Pelvic exam Closed cervical OS Closed cervical OS Open cervical OS Open cervical OS Open\closed cervical OS
US Viable Non-viable Evidence of POC Retained tissue Empty uterus
Management Observe D&C, misoprostol (induces UC)? Emergency D&C Emergency D&C Observe, weekly B-hCG

 


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