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1、SPONTANEOUSABORTIONINTRODUCTION·Lossofpregnancy<20weeksor<500g·Incidenceof15%ofclinicallyrecognizedpregnancies·Incidenceof30-50%ofoverallpregnancies·RatesdramaticallydecreaseafterdocumentationofFHRwith8wkU/S(3-5%)·PVbleedingoccursin25%ofpregnancies·PVbleeding(early)leadstoabor
2、tionrateof30-50%·80%ofabortionsoccurinthe1sttrimester·Definitions(<20weeks)ØThreatenedabortion:closedcervix,NOpassageofPOCsØInevitableabortion:cervixopen,NOpassageofPOCsØIncompleteabortion:cervixopen,passageofsomebutnotallPOCsØCompleteabortion:cervixclosed,passageofallPOCsØSep
3、ticabortion:maternalinfectionØMissedabortion:noFHR,nopassageofPOCsandfailureofuterinegrowthovertime(shouldbecalled1st/2ndtrimesterfetaldeath)ØBlightedovum=anembryonicgestation:suspectedwithgestationalsac>25mmwithnofetalpoleCompleteabortioncannotbediagnosedunlessanintactgestati
4、onalsacisseen,pathologicconfirmationofPOCsonD&Cspecimen,orconversionofpregnancytesttonegative(4weeks)CLINICALFEATURES·HistoryØGestationalage,LMP,ectopicRF,syncope,bloodtypeØPain,bleeding,fever,crampsØThreatenedabortionhasdullacheb/cuterusnotcontracting;inevitableandincompleteh
5、avecrampypainb/cuterusiscontracting;nopainw/complete·PhysicalExamØVitals:stable?orthostaticchanges?fever?ØAbdomenalexam:masses,peritonitis,tendernessØPelvic:cervixopen,bleeding,tissue,uterussize/tenderness,adnexalmassortenderness,removetissuepresentinvaginaorcervix,mayprobecer
6、vixgentlyifopentosearchfortissueandtoseeifinternalosisopen(notin2ndb/criskoflowplacenta)·InvestigationsØCBC,Typeandscreen(?needsrhogam):crossmatchifunstableØBHCG:urinequalatative,serumquantitativeØBloodculturesiffever/septicØSalinepreparationoftissue:chorionicvilli,presentin50
7、%,rulesoutectopicexceptinrarecircumstanceofco-existingectopicandIUPØOther:CA-125,lowprogesterone,lowurinaryHCGhavebeenusedasindicatorsofmiscarriageØUltrasoundallshouldgetanultrasoundb/cofpossibilityofectopicnoFHR=fetallossonlyiflength>15mmorgestsac>25mmunstable:toORwithoutultr
8、asoundstable:urgentultrasoundorRTEDinamforultrasound(signific
