-IBIS-1.5.0-
tx
reproductive system
spontaneous abortion/miscarriage
diagnoses

definition and etiology

definition:
Loss of the products of conception before the fetus is viable.

etiology:
Physicians generally define spontaneous abortion as before the 20th week of pregnancy, or of a fetus with a weight of less than 500 gm; definitions do vary, however. It is estimated that between 10-15% of pregnant women will spontaneously abort their fetus: many times the fetus is grossly deformed, absent, or has genetic abnormalities that make it incompatible with life. Therefore, it is theorized that a spontaneous abortion may be a natural selection process for rejecting those fetuses that are biologically unfit for life. Most spontaneous abortions occur within the first trimester; these are often due to fetal maldevelopment. Spontaneous abortions in the second trimester seem to be due more to maternal factors such as: incompetent cervix; congenital or acquired abnormalities of the uterine cavity; hypothyroidism; DM; chronic nephritis; acute infection; trauma to the pelvic region; or severe emotional shock.

Early abortions are those that occur before 12 weeks. Late abortions are those that occur from the 12-20th week.

Spontaneous abortions may be threatened (bleeding and/or cramping in the uterus within the first 20 weeks of pregnancy), inevitable (intolerable pain or bleeding that is threatening the mother's well-being); incomplete (only part of the conception is passed) or complete (all products of conception have passed, the uterus is normal sized, and the cervix is closed).

A habitual aborter is a woman who has had 3 or more consecutive spontaneous abortions.

signs and symptoms

signs and symptoms:
The woman is pregnant (though may not know it) and experiences:
• Pain, cramping and bleeding from the uterus.
• Passage of some or all of the products of conception.

lab findings:
• serum HCG
•As needed to help discern the reason for a second trimester abortion.

course and prognosis

A woman who is having or has had a miscarriage should be checked by a physician or midwife to ensure that all the products of conceptions have passed, and to be watched for signs of infection. All abortions must be completed, and the woman offered whatever psychological counseling/processing she needs to help her through the miscarriage.

In a threatened abortion, the woman should have bed rest, avoid intercourse, and undertake appropriate treatment.

differential diagnosis

• determine the cause
• rule out DUB


footnotes