abortion (miscarriage) طیبه غریبی عضو هیئت علمی دانشکده پرستاری و...
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AbortionAbortion (miscarriage)(miscarriage)AbortionAbortion (miscarriage)(miscarriage)
دانشکده علمی هیئت عضو غریبی طیبهمامایی و پرستاری
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DefinitionDefinitionDefinitionDefinition
The termination of pregnancy before the 20th week, when the fetus weight is less than 1000 grams.
Early abortion: <12th week of pregnancyLate abortion: 12th-20th week of pregnancy
Spontaneous abortionArtificial abortion
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EtiologyEtiologyEtiologyEtiology
Genetic factors: chromosomal abnormal accounts 50 ~ 60% of the early abortions• Numeral abnormalities: polyploidy, triploidy, monosomy• Structural abnormalities: break, translocation, deletion
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EtiologyEtiologyEtiologyEtiology
Extrinsic factors• Chemical: mercury, lead, cadmium,
smoking, • Physical:
radioactive materials, noise,
hyperthermia
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EtiologyEtiologyEtiologyEtiology
Maternal factors• General diseases:
infection, heart diseases, hypertension, anemia• Reproductive organic diseases:
congenital uterine malformation, pelvic tumor, cervical incompetence
• Endocrine disorders:
LPD, hypothyroidism• Injuries
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EtiologyEtiologyEtiologyEtiology
Defects in the developing placenta
Immunologic factors: paternal histo-compatibility antigen , maternal cellular immunity regular disorder, deficiency of maternal blocking antibody
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PathologyPathologyPathologyPathology
The death of the embryo or rudimentary analog
Hemorrhage into the decidua basalis
Uterine contraction, dilation of the cervix
Expulsion of the products conception
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PathologyPathologyPathologyPathology
Before the 8th week of the pregnancy, the abortus can be expelled completely
During the 8th-12th week of the pregnancy, retention of the tissue is common
After the 12th week of the pregnancy, the abortus may be expelled totally
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Clinical subgroups Clinical subgroups of abortionof abortionClinical subgroups Clinical subgroups of abortionof abortion
Threatened miscarriage
Inevitable miscarriage
Incomplete miscarriage
Complete miscarriage
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The developing processesThe developing processesof the abortionof the abortionThe developing processesThe developing processesof the abortionof the abortion
Threatened miscarriage
Normal pregnancy Inevitable miscarriage
Complete miscarriage Incomplete miscarriage
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Classifications and Classifications and characteristicscharacteristicsClassifications and Classifications and characteristicscharacteristics
conceptus Vaginal abdominal Cervix os Uterine Subgroups expulsion bleeding pain dilation enlargement
Threatened no + -+ - compatible
miscarriage
Inevitable no + + + + + - compatible or miscarriage smaller
Incomplete part + + + + + - smaller
miscarriage
Complete all + - - - normal
miscarriage
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Alternative Alternative classificationclassificationAlternative Alternative classificationclassification
Blighted ovum
Missed abortion
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Special subgroups:Special subgroups:
Missed abortionMissed abortionSpecial subgroups:Special subgroups:
Missed abortionMissed abortion
Expulsion of the conceptus does not occur
despite a prolonged period after embryonic
death.
Symptoms of pregnancy regress
Pregnancy test becomes negative
No fetal heart motion is detected
Uterine enlargement ceases
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Special subgroups:
Recurrent abortionRecurrent abortionSpecial subgroups:
Recurrent abortionRecurrent abortion(Habitual abortion)
Three or more consecutive spontaneous losses
of pregnancy
First-trimester: LPD, hypothyroidism, chromosomal abnormalities, immunologic factors
Second-trimester: uterine malformations, cervical incompetence, myomas
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Special subgroups:
Septic abortionSeptic abortionSpecial subgroups:
Septic abortionSeptic abortion
Any type of spontaneous miscarriage is
complicated by infection
Endometritis, parametritis, peritonitis
Fever, abdominal tenderness, uterine pain
Septicemia, septic shock
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DiagnosisDiagnosisDiagnosisDiagnosis
History: amenorrhea, symptoms of pregnancy, vaginal bleeding……
Examination: general and pelvic
Ultrasounograph
Pregnancy test, ß-HCG
Others:
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Differential diagnosisDifferential diagnosisDifferential diagnosisDifferential diagnosis
Ectopic pregnancy
Molar pregnancy
Dysfunctional uterine bleeding (DUB)
Pelvic infective diseases (PID)
Acute appendicitis
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ManagementManagementManagementManagement
Threatened miscarriage:
rest, follow-up
Inevitable & incomplete miscarriage: Evacuation of the uterus,vacuum or suction curettage, oxytocin iv, antibiotics
Complete miscarriage:
no further therapy is necessary.
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Management
Missed miscarriageMissed miscarriageManagement
Missed miscarriageMissed miscarriage
First- trimester:
suction curettage
The second-trimester:
D&E(dilation and evacuation)
D&C(dilation and curettage)
Induction of labor with intravaginal prostaglandin E2 or misoprostol
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Management
Recurrent miscarriageRecurrent miscarriageManagement
Recurrent miscarriageRecurrent miscarriage
A workup for possible causes of recurrent pregnancy loss (RPL): anatomic, hormonal,genetic,and autoimmune factors (underlying maternal factors)
Incompetent cervix: cerclage designed to reinforce the cervix at the level of the internal os at the end of the first trimester, the suture is removed after 37 weeks’ gestation
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Management
Septic miscarriageSeptic miscarriageManagement
Septic miscarriageSeptic miscarriage
Evacuation of the uterus within a few hours after antibiotics iv
High-dose, broad-spectrum coverage antibiotics, aggressive use before, during, and after removal of necrotic tissue by curettage
hysterectomy
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Summary pointsSummary pointsSummary pointsSummary points
The most frequent etiology of miscarriage is a chromosomal abnormality of the conceptus and most of the abortions occur in the first-trimester.
The processes of the pathology decide the characteristics of the subgroups.
Ultrasound is helpful in diagnosis.
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Problem-based learning (1)Problem-based learning (1)Problem-based learning (1)Problem-based learning (1)
A 22 year old women attends you with a 12 h history of vaginal bleeding accompanied by cramping lower abdominal pain. She has had 6 weeks amenorrhoea and tells you that she recently used a urinary pregnancy test from her local pharmacy; the test proved to be positive. She has had no previous pregnancies and was using no contraception.
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The End The End