Management

■ Investigate possible etiologies.

■ Potentially useful investigative measures include:

1. Parental peripheral blood karyotypes

2. Sonohysterogram (intrauterine structural study)

3. Luteal-phase endometrial biopsy

4. Anticardiolipin and antiphosphatidyl serine antibodies

5. Lupus anticoagulant

6. Cervical cultures for Mycoplasma, Ureaplasma, Chlamydia See Table 10-1.

If POC are retained in septic abortion, a severe coagulopathy with bleeding often occurs; otherwise, prognosis is good.

Consumptive coagulopathy is an uncommon, but serious, complication of septic abortion.

Recurrent abortion is three or more successive abortions.

Women with a history of recurrent abortion have a 23% chance of abortion in subsequent pregnancies that are detectable by ultrasound.

A clinical investigation of pregnancy loss should be initiated after two successive spontaneous abortions in the first trimester, or one in the second trimester.

TABLE 10-1. Types of Abortions

Complete abortion

Complete expulsion of POC before 20 weeks' gestation; cervix dilated

Incomplete abortion

Partial expulsion of some POC before 20 weeks' gestation; partially dilated cervix

Threatened abortion

No cervical dilatation or expulsion of POC; intrauterine bleeding before 20 weeks' gestation occurs

Inevitable abortion

Threatened abortion with a dilated cervical os

Missed abortion

Retention of nonviable POC for 4-8 weeks or more; often proceeds to complete abortion

Recurrent spontaneous abortion

Three or more consecutive spontaneous abortions

Septic abortion

Abortion associated with severe hemorrhage, sepsis, bacterial shock, and/or acute renal failure

Therapeutic abortion (induced)

Termination of pregnancy before the period of fetal viability in order to protect the life or health of the mother

Elective abortion (induced) Termination of pregnancy before fetal viability at the request of the patient; not due to maternal or fetal health risks

Ectopic pregnancy is the leading cause of pregnancy-related death during T1. Diagnose and treat before tubal rupture occurs to decrease the risk of death!

Ectopic pregnancy is the implantation of the blastocyst anywhere other than the endometrial lining of the uterine cavity: It is a medical emergency (see Figure 10-2).

Epidemiology

■ > 1/50 pregnancies in the United States is ectopic.

■ Carries a 7- to 13-fold increase in recurrence risk

FIGURE 10-2. Sites of ectopic pregnancy.

(Reproduced, with permission, from Pearlman MD,Tintinalli JE, eds. Emergency Care of the Woman. New York: McGraw-Hill, 1998:22.)

FIGURE 10-2. Sites of ectopic pregnancy.

(Reproduced, with permission, from Pearlman MD,Tintinalli JE, eds. Emergency Care of the Woman. New York: McGraw-Hill, 1998:22.)

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