Tuesday

ABORTION
• Three widely accepted causes of RPL are
• parental chromosomal abnormalities,
• antiphospholipid antibody syndrome,
• and structural uterine abnormalities
Clinical and Laboratory Criteria for
Diagnosis of Antiphospholipid Antibody
Syndrome
RPL for 2nd TM Px
Diagnosis of cervical insufficency

• Obstetrical history-based diagnosis

• history of ≥2 consecutive prior second-trimester
pregnancy losses/extremely preterm births (ie, <28 weeks) associated with no
or minimal mild symptoms.
• Ultrasound-based diagnosis
• when cervical length is ≤25 mm before 24 weeks
Introduction

Cervical cerclage refers to a variety of surgical procedures in which

sutures, wires, or synthetic tape are used to reinforce the cervix by
mechanically increasing the tensile strength of the cervix .this can be
done with two methods.
 Trans abdominal( reserved for high risk and with vaginal failure)
 Vaginal
• With twin gestations, one retrospective analysis found no improved
outcomes in women with a cervical length <25 mm (Stoval, 2013). The
College (2016b) does not recommend the use of cerclage in twin
pregnancies.
• Complication of cerclage
• membrane rupture,
• preterm labor,
• hemorrhage, and or
• infection
Presurgical Preparation
• Contraindications to cerclage usually include bleeding, contractions,
or ruptured membranes
• screening for aneuploidy and obvious malformation is completed.
Cervical secretions are tested for gonorrhea and chlamydial infection.
These and obvious cervical infections are treated
• Surgery between 12 and 14 weeks’ gestation allows this early
intervention yet avoids surgery in a woman with a firsttrimester
pregnancy destined for spontaneous loss
• the more advanced the pregnancy, the greater the risk that surgical
intervention will stimulate preterm labor or membrane rupture
• Therapeutic abortion refers to termination of pregnancy for medical
indications.
• elective abortion or voluntary abortion describes the interruption of
pregnancy before viability at the request of the woman, but not for
medical reasons.
Missed abortion
dead products of conception that have been retained for days
or weeks in the uterus with a closed cervical os
• Incomplete Abortion
• During abortion, bleeding follows partial or complete placental separation
and dilation of the cervical os. Before 10 weeks’ gestation, the fetus and the
placenta are frequently expelled together, but later, they deliver separately.
Thus, tissue may remain entirely within the uterus or partially extrude
through the cervix. Products lying loosely within the cervical canal can be
easily extracted with ring forceps. In contrast, with incomplete expulsion,
three management options include curettage, expectant management, or
misoprostol (Cytotec), which is prostaglandin E1 (PGE1 ) (Kim, 2017).
• The last two are deferred in clinically unstable women or those with
uterine infection.
Threatened Abortion
• This diagnosis is presumed when bloody vaginal discharge or
bleeding appears through a closed cervical os during the first 20
weeks
• Characteristic findings of a complete abortion include a minimally
thickened endometrium without a gestational sac.