a bortion & c are of a borted f etus. objectives definitions
TRANSCRIPT
ABORTION & CARE OF ABORTED FETUS
OBJECTIVES
Definitions.
INTRODUCTION
WHO: expulsion or extraction of an embryo or fetus weighing 500 g or less from its mother. This typically corresponds to a GA of 20 wks.
Occurs In up to 20% of clinically recognized pregnancies under 20 weeks. 80% of these occur in the first 12 weeks
RISK FACTORS
Age Prev. spont Abortion Smoking NSAIDS Gravidity Fever Caffeine Low folate Maternal weight
ETIOLOGY
Chromosomal Congenital anomalies Trauma Host factors e.g Uterine anomalies Unexplained
CLINICAL MANIFESTATION
TERMINOLOGY
Threatened abortionBleeding closed cervical os painless, but may be accompanied
by minimal/mild suprapubic pain.
INEVITABLE ABORTION
Abortion is imminent bleeding increases painful uterine cramps/contractions reach
peak intensity cervix is dilated.
COMPLETE ABORTION
Before 12 weeks of gestation contents of the uterus to be expelled one third of all cases are complete, uterus is small and well contracted with a
closed cervix, scant vaginal bleeding, and only mild cramping.
INCOMPLETE ABORTION
After 12 weeks the membranes rupture the fetus is passed placental tissue may be retained The amount of bleeding varies, but can be
severe enough to cause hypovolemic shock. Painful cramps/contractions are often
present.
MISSED ABORTION
In-utero death of the embryo or fetus prior to the 20th week of gestation, with retention of the pregnancy for a prolonged period of time.
The cervix is usually closed.
SEPTIC ABORTION
Fever Chills Malaise abdominal pain vaginal bleeding, and discharge
DIAGNOSTIC EVALUATION
Direct visualization of a dilated cervix or the gestational sac may be sufficient to diagnose an inevitable, incomplete, or complete abortion clinically
ultrasound examination can provide additional, sometimes unexpected, information such as the presence of a multiple gestation or retained products of conception.
TREATMENT
Expectant. Medical. Surgical.
POST ABORTION CARE
MATERNAL: Environmet Monitoring Emotional support Pain controlFETAL: The remains. < 16 wks > 16 wks
OTHER CONSIDERATIONS
All fetal remains after 16 weeks will be washed and coffined by the parents for burial.
Placing the fetal remains in an empty room to allow grieving.
Placing the mother in a room away from other patients with live born babies.
Consider admitting the patient if needed on the surgical floor instead of OB for the same reason.
PATIENT EDUCATION