Abortion resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ifeoma Anaya, M.D.[2]

Synonyms and keywords:

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

• Ruptured ectopic pregnancy
• Blunt abdominal trauma with hemodynamic instability

Common Causes

• Unknown
• Chromosomal abnormalities such as:
  • Trisomies
  • Molar pregnancies
  • Blighted ovum
• Congenital anomalies
• Infections
• Cervical insufficiency
• Abnormalities of the reproductive system. E.g. Uterine malformations, fibroids especially submucosal.
• Behavioural/lifestyle causes such as illicit drug and alcohol use, smoking
• Environmental such as exposure to radiation
• Uncontrolled chronic diseases (Diabetes, Hypertension, Hypo/Hyperthyroidism, Antiphospholipid syndrome, etc)
• Iatrogenic such as amniocentesis, chorionic villus sampling

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Abortion.

Female of reproductive age, gestation <20weeks, bleeding per vagina, +/-pelvic pain

Targeted history and examination, β-hcg,CBC, type and screen

Hemodynamically stable?

No

Yes

IV access and fluid resuscitation, move to the ED and send consult to OBGYN

Signs of peritonitis?

Yes

No

Pelvic ultrasound

Intrauterine

Extrauterine, confirmed ectopic?

Surgery. Stabilise if need be

Yes

Threatened abortion; viable preganancy+closed cervix

Missed abortion; non-viable pregnancy+closed cervix

Inevitable abortion; viable pregnancy+open cervix

Incomplete abortion; Retained Products of Conception+closed cervix

Complete abortion; empty uterus+closed cervix

Uncertain

Serial prpogesterone, β-hcg, ultrasound

Ectopic Pregnancy

↑β-hcg >66% in 48hrs,normal ultrasound, progesterone >25ng/ml

Progesterone <5ng/ml, β-hcg ↓or↔, non-viability on ultrasound

β-hcg equivocal, ultrasound not diagnostic, progesterone 5-25ng/ml

Treat accordingly

Surgery

Uncertain

β-hcg every 2-3 days, repeat ultrasound weekly till viability is ascertained

Treatment

Shown below is an algorithm summarising the treatment of abortion.

Viable pregnancy?

Yes

No

Threatened abortion

Missed, incomplete or inevitable abortion

Weekly check ups till bleeding ceases, administer Rhogam[Rhο(D)] immunoglobulin if indicated, watch out for oligohydramnios, IUGR and preterm labor

Any complications? E.g.pain, hemorrhage, sepsis

Yes

No

Counsel on expectant management

Consent

Decline

Follow-up with serial β-hcg

Uterine evacuation or medical treatment

Uterine evacuation and stabilise patient

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.

References

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