{"id":205,"date":"2020-08-13T16:18:46","date_gmt":"2020-08-13T16:18:46","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=205"},"modified":"2021-05-09T20:37:50","modified_gmt":"2021-05-09T20:37:50","slug":"16-spontaneous-abortion","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/overview\/16-spontaneous-abortion\/","title":{"rendered":"16. Spontaneous Abortion"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/3YveeMz55Mc\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 4:37<\/p>\n<input type='hidden' bg_collapse_expand='69e9c8eba4dba0097881371' value='69e9c8eba4dba0097881371'><input type='hidden' id='bg-show-more-text-69e9c8eba4dba0097881371' value='Comment on Mifepristone'><input type='hidden' id='bg-show-less-text-69e9c8eba4dba0097881371' value='Close'><button id='bg-showmore-action-69e9c8eba4dba0097881371' class='bg-showmore-plg-button bg-red-button bg-arrow '   style=\" color:#fcfafa;\">Comment on Mifepristone<\/button><div id='bg-showmore-hidden-69e9c8eba4dba0097881371' ><\/p>\n<p>Based on recent studies, it is now recommended that mifepristone be administered orally prior to the administration of vaginal misoprostol for the medical management of missed abortions.<\/p>\n<p style=\"text-align: right\">\u00a0&#8211; Dr. Smith<\/p>\n<p><\/div>\n<p>&nbsp;<\/p>\n<input type='hidden' bg_collapse_expand='69e9c8eba4f4d4044856109' value='69e9c8eba4f4d4044856109'><input type='hidden' id='bg-show-more-text-69e9c8eba4f4d4044856109' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9c8eba4f4d4044856109' value='Hide Transcript'><button id='bg-showmore-action-69e9c8eba4f4d4044856109' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9c8eba4f4d4044856109' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number 16<br \/>\n00:02<br \/>\nspontaneous abortion spontaneous<br \/>\n00:04<br \/>\nabortion is the loss of a pregnancy<br \/>\n00:06<br \/>\nbefore 20 weeks gestation it affects up<br \/>\n00:09<br \/>\nto 20% of recognized pregnancies note<br \/>\n00:11<br \/>\nthat medically the term abortion refers<br \/>\n00:13<br \/>\nto miscarriage this differs from the<br \/>\n00:15<br \/>\nterms elective therapeutic or induced<br \/>\n00:17<br \/>\nabortions which will be addressed in a<br \/>\n00:19<br \/>\nseparate video approximately 80% of<br \/>\n00:22<br \/>\nspontaneous abortions occur in the first<br \/>\n00:23<br \/>\n12 weeks of a pregnancy the objectives<br \/>\n00:26<br \/>\nof this video are to review the<br \/>\n00:27<br \/>\ndifferential diagnosis for first<br \/>\n00:29<br \/>\ntrimester vaginal bleeding and to<br \/>\n00:31<br \/>\ndifferentiate the types causes<br \/>\n00:33<br \/>\ncomplications and treatment options for<br \/>\n00:35<br \/>\ncontinuous abortion the differential<br \/>\n00:37<br \/>\ndiagnosis for vaginal bleeding in the<br \/>\n00:38<br \/>\nfirst trimester includes spontaneous<br \/>\n00:40<br \/>\nabortion viable intrauterine pregnancy<br \/>\n00:42<br \/>\nand ectopic pregnancy when a woman<br \/>\n00:45<br \/>\npresents with vaginal bleeding in the<br \/>\n00:46<br \/>\nfirst trimester therefore it is<br \/>\n00:48<br \/>\nessential to first determine the<br \/>\n00:49<br \/>\nlocation of the pregnancy and whether<br \/>\n00:51<br \/>\nthe pregnancy will ultimately be viable<br \/>\n00:53<br \/>\nserial beta HCG values and transvaginal<br \/>\n00:56<br \/>\nultrasound tests give us diagnostic<br \/>\n00:58<br \/>\ninformation to help us make the<br \/>\n00:59<br \/>\ndiagnosis over a 48-hour period the beta<br \/>\n01:02<br \/>\nHCG values should rise at least 50% if<br \/>\n01:05<br \/>\nthe beta HCG decreases over a 48-hour<br \/>\n01:08<br \/>\nperiod and the pregnancy is not a viable<br \/>\n01:10<br \/>\npregnancy this could be a spontaneous<br \/>\n01:12<br \/>\nabortion or it could still be an ectopic<br \/>\n01:14<br \/>\npregnancy the rule of tens is a simple<br \/>\n01:16<br \/>\nway of remembering some important beta<br \/>\n01:18<br \/>\nHCG landmarks the beta HCG peaks at<br \/>\n01:21<br \/>\napproximately 10 weeks<br \/>\n01:22<br \/>\nassuming gestational age at<br \/>\n01:23<br \/>\napproximately 100,000 it then decreases<br \/>\n01:26<br \/>\nand that term it&#8217;s about 10,000 on<br \/>\n01:28<br \/>\ntransvaginal ultrasound a gestational<br \/>\n01:31<br \/>\nsac can usually be identified around<br \/>\n01:33<br \/>\nfour and a half to five weeks estimated<br \/>\n01:35<br \/>\ngestational age a yolk sac between five<br \/>\n01:37<br \/>\nand six weeks and a fetal pull with<br \/>\n01:39<br \/>\ncardiac activity between five and a half<br \/>\n01:41<br \/>\nto six weeks there are four definitions<br \/>\n01:44<br \/>\nthat are important to remember<br \/>\n01:45<br \/>\npertaining to spontaneous abortion for a<br \/>\n01:48<br \/>\ncomplete abortion all of the products<br \/>\n01:50<br \/>\nhave been passed without the need for<br \/>\n01:51<br \/>\nany intervention and the cervix is<br \/>\n01:53<br \/>\nclosed in an incomplete abortion some<br \/>\n01:55<br \/>\nbut not all of the products have passed<br \/>\n01:57<br \/>\nand the cervix is open in an inevitable<br \/>\n02:00<br \/>\nabortion the cervix is dilated but the<br \/>\n02:02<br \/>\nproducts of consumption have not been<br \/>\n02:03<br \/>\npassed in a missed abortion there has<br \/>\n02:05<br \/>\nbeen a fetal demise usually for a number<br \/>\n02:07<br \/>\nof weeks but the products have not been<br \/>\n02:09<br \/>\nexpelled the most common causes<br \/>\n02:10<br \/>\nspontaneous abortion in the first<br \/>\n02:12<br \/>\ntrimester is<br \/>\n02:13<br \/>\nchromosomal abnormalities 50% of<br \/>\n02:15<br \/>\nrecognized early spontaneous abortions<br \/>\n02:17<br \/>\nare attributed to chromosomal<br \/>\n02:19<br \/>\nabnormalities most of which are<br \/>\n02:20<br \/>\ntrisomies increasing maternal age will<br \/>\n02:22<br \/>\nthus increase the risk of chromosome<br \/>\n02:24<br \/>\nabnormalities which will thus increase<br \/>\n02:25<br \/>\nthe risk of spontaneous abortion<br \/>\n02:27<br \/>\ncompared to first trimester abortions<br \/>\n02:29<br \/>\nsecond trimester abortions are less<br \/>\n02:31<br \/>\nlikely to be caused by chromosomal<br \/>\n02:32<br \/>\nabnormalities and can be caused by<br \/>\n02:34<br \/>\nmaternal systemic disease abnormal<br \/>\n02:36<br \/>\nplacentation or other anatomic<br \/>\n02:38<br \/>\nconsiderations other risk factors are<br \/>\n02:40<br \/>\nless well defined and are much less<br \/>\n02:42<br \/>\ncommon and include a history of<br \/>\n02:43<br \/>\nspontaneous abortion smoking having an<br \/>\n02:46<br \/>\nIUD in place and uncontrolled diabetes<br \/>\n02:47<br \/>\nof note moderate caffeine consumption is<br \/>\n02:51<br \/>\nnot a risk factor for miscarriage and<br \/>\n02:52<br \/>\nthis brings up an important point that<br \/>\n02:54<br \/>\nmany patients need reassurances that<br \/>\n02:55<br \/>\ndrinking moderate coffee having sex or<br \/>\n02:58<br \/>\nexercising did not contribute to their<br \/>\n03:00<br \/>\nmiscarriage many women need to go<br \/>\n03:02<br \/>\nthrough a grieving process after a<br \/>\n03:04<br \/>\npregnancy loss and it is important to<br \/>\n03:05<br \/>\nprovide appropriate support for this<br \/>\n03:07<br \/>\nprocess there are three options when a<br \/>\n03:09<br \/>\nwoman has a spontaneous abortion<br \/>\n03:11<br \/>\nexpectant management is fine and some<br \/>\n03:13<br \/>\nwomen may want to see if their body will<br \/>\n03:15<br \/>\nspontaneously miscarry surgical<br \/>\n03:17<br \/>\nevacuation of the pregnancy can be<br \/>\n03:18<br \/>\nperformed with either a dilation and<br \/>\n03:20<br \/>\ncurettage in the operating room or a<br \/>\n03:22<br \/>\nmanual vacuum aspiration in a clinic<br \/>\n03:24<br \/>\nsetting the third treatment option is<br \/>\n03:26<br \/>\nmedical management which can be<br \/>\n03:27<br \/>\nperformed in the first trimester with<br \/>\n03:29<br \/>\nvaginal misoprostol remember that if a<br \/>\n03:31<br \/>\npatient is Rh negative she will need a<br \/>\n03:33<br \/>\nrhogam injection to protect against I so<br \/>\n03:35<br \/>\nimmunization in future pregnancies let&#8217;s<br \/>\n03:37<br \/>\nconclude by discussing possible<br \/>\n03:39<br \/>\ncomplications from spontaneous abortion<br \/>\n03:41<br \/>\nhemorrhage may occur around the time of<br \/>\n03:43<br \/>\nspontaneous passage of the pregnancy or<br \/>\n03:45<br \/>\nrelated to surgical evacuation of the<br \/>\n03:47<br \/>\npregnancy if a patient presents with<br \/>\n03:50<br \/>\nheavy vaginal bleeding with retained<br \/>\n03:52<br \/>\nproducts of consumption then a surgical<br \/>\n03:54<br \/>\nevacuation should be performed under<br \/>\n03:55<br \/>\nmetritis after spontaneous evacuation or<br \/>\n03:58<br \/>\nspontaneous passage of the pregnancy<br \/>\n04:00<br \/>\nshould be treated with oral<br \/>\n04:01<br \/>\nbroad-spectrum antibiotics it is very<br \/>\n04:04<br \/>\nrare now for a patient to develop a<br \/>\n04:06<br \/>\nseptic abortion for this was much more<br \/>\n04:07<br \/>\nprevalent in the past before the<br \/>\n04:09<br \/>\nlegalization of elective terminations<br \/>\n04:11<br \/>\nthe signs and symptoms of a septic<br \/>\n04:13<br \/>\nabortion are fevers chills lower<br \/>\n04:15<br \/>\nabdominal discomfort and foul-smelling<br \/>\n04:17<br \/>\nvaginal discharge this concludes the<br \/>\n04:19<br \/>\naapko video on spontaneous abortion we<br \/>\n04:21<br \/>\nreviewed the important diagnostic<br \/>\n04:23<br \/>\ncriteria and therapeutic options for<br \/>\n04:25<br \/>\nthis common<br \/>\n04:25<br \/>\naddition in women<\/p>\n<p><\/div>\n<hr>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 4:37 &nbsp;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":46,"menu_order":16,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-205","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/205","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=205"}],"version-history":[{"count":1,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/205\/revisions"}],"predecessor-version":[{"id":2820,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/205\/revisions\/2820"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=205"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}