A BORTION & C ARE OF A BORTED F ETUS

OBJECTIVES Definitions.

INTRODUCTION WHO: expulsion or extraction of an embryo or fetus weighing 500 g or less from its mother. This typically corresponds to a GA of 20 wks. Occurs In up to 20% of clinically recognized pregnancies under 20 weeks. 80% of these occur in the first 12 weeks

RISK FACTORS Age Prev. spont Abortion Smoking NSAIDS Gravidity Fever Caffeine Low folate Maternal weight

ETIOLOGY Chromosomal Congenital anomalies Trauma Host factors e.g Uterine anomalies Unexplained

CLINICAL MANIFESTATION

TERMINOLOGY Threatened abortion Bleeding closed cervical os painless, but may be accompanied by minimal/mild suprapubic pain.

INEVITABLE ABORTION Abortion is imminent bleeding increases painful uterine cramps/contractions reach peak intensity cervix is dilated.

COMPLETE ABORTION Before 12 weeks of gestation contents of the uterus to be expelled one third of all cases are complete, uterus is small and well contracted with a closed cervix, scant vaginal bleeding, and only mild cramping.

INCOMPLETE ABORTION After 12 weeks the membranes rupture the fetus is passed placental tissue may be retained The amount of bleeding varies, but can be severe enough to cause hypovolemic shock. Painful cramps/contractions are often present.

M ISSED ABORTION In-utero death of the embryo or fetus prior to the 20th week of gestation, with retention of the pregnancy for a prolonged period of time. The cervix is usually closed.

SEPTIC ABORTION Fever Chills Malaise abdominal pain vaginal bleeding, and discharge

DIAGNOSTIC EVALUATION Direct visualization of a dilated cervix or the gestational sac may be sufficient to diagnose an inevitable, incomplete, or complete abortion clinically ultrasound examination can provide additional, sometimes unexpected, information such as the presence of a multiple gestation or retained products of conception.

TREATMENT Expectant. Medical. Surgical.

POST ABORTION CARE MATERNAL: Environmet Monitoring Emotional support Pain control FETAL: The remains. < 16 wks > 16 wks

OTHER CONSIDERATIONS All fetal remains after 16 weeks will be washed and coffined by the parents for burial. Placing the fetal remains in an empty room to allow grieving. Placing the mother in a room away from other patients with live born babies. Consider admitting the patient if needed on the surgical floor instead of OB for the same reason.

PATIENT EDUCATION