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What is the primary concern regarding cigarette smoking during pregnancy?
What type of abortion is characterized by soft uterus and cervix, with the cervix remaining closed?
Which of the following is a potential management strategy for a threatened abortion?
What is a common feature of an inevitable abortion?
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What percentage of unexplained cases of spontaneous abortion is noted in the majority?
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What is the role of tocolytic drugs in managing threatened abortion?
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Which infection is NOT commonly associated with spontaneous abortion?
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What could be a consequence of continuing a pregnancy after threatened abortion?
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What is the definition of abortion?
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Which of the following is NOT a classification of spontaneous abortion?
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What is a common fetal factor contributing to spontaneous abortion?
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What percentage of spontaneous abortions occur before the 16th week of gestation?
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Which type of abortion is classified as induced?
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Which maternal factor is a significant cause of spontaneous abortion?
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What is a symptomatic indication of complete miscarriage?
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What is the incidence rate of spontaneous abortions?
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Which of the following is NOT considered a sign of spontaneous abortion?
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What is often initiated in the management of septic abortion cases?
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Which diagnostic tool is used to check for retained products of conception?
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Recurrent miscarriage is defined as having how many consecutive spontaneous abortions?
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What is a common complication following septic abortion due to infection spread?
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What percentage of recurrent pregnancy losses have no identifiable underlying cause?
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What is an anatomical factor that can contribute to recurrent miscarriage?
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Which group of antibiotics is commonly used in treating septic abortion?
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What is a primary indication for surgical management with cervical cerclage?
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Which of the following is NOT an absolute contraindication to cervical cerclage?
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What type of cerclage is commonly used in Malawi for cervical incompetence?
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What is the purpose of administering progesterone in the management of threatened miscarriage?
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What characterizes a therapeutic abortion?
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Which of the following describes septic abortion?
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What is a conservative management strategy for a woman with cervical incompetence?
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What procedure is typically performed to evaluate gestational age in a woman considering an abortion?
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What should be assessed to identify risk factors before the procedure?
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Why is it important to screen for STIs before the procedure?
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What is the purpose of post-abortion family planning?
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When should a woman ideally begin using contraceptive methods after an abortion?
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What baseline health check should be completed before the procedure?
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Why should emotional support be provided during pre-operative counselling?
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What is a common misconception about the recovery of fertility post-abortion?
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What is one of the first steps in nursing management for all types of abortion?
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Study Notes
Defining Abortion
- An interruption or expulsion of the products of conception before the fetus can survive independently
- Considered viable after the 5th month of gestation
- Premature expulsion of the contents of the uterus
- Can be spontaneous or induced
- Expulsion or extraction of an embryo or foetus weighing 500gm or less when it is not capable of independent survival (WHO definition)
###Â Classifications
-
Spontaneous:
- Threatened: Abortion has started, but may still be reversible
- Inevitable: Continutation of pregnancy is impossible
- Complete: All products of conception are expelled
- Incomplete: Some products of conception remain in the uterus
- Missed: Fetal death occurs in the uterus, but the body is not expelled
- Septic: Infection in the uterus
-
Induced:
- Septic abortion: Occurs when the abortion procedure is performed unsafely and results in an infection
- Elective abortion: Voluntary termination of pregnancy
- Therapeutic abortion: Performed when the mother's life is at risk, or the fetus has severe abnormalities
Etiology of Spontaneous Abortion
-
Fetal factors:
- Genetic: Chromosomal abnormalities (trisomy) are a common cause
- Multiple gestation: Increased risk of miscarriage
-
Maternal factors:
- Endocrine/Metabolic Factors: Diabetes mellitus
- Anatomical Abnormalities: Cervical incompetence, uterine fibroids, congenital malformations of the uterus
- Environmental Factors: Smoking, alcohol consumption, maternal medical illnesses
- Infections: Viral (rubella, cytomegalovirus, HIV), Bacterial (chlamydia)
- Immunological Disorders: Autoimmune diseases resulting in anti-fetal antibodies
- Unexplained: The exact cuase is not known in 40-60% of cases
Types of Spontaneous Abortions and Management
Threatened Abortion
-
Clinical Features:
- Slight vaginal bleeding
- Mild backache or dull lower abdominal pain
- Soft uterus and cervix
- Closed cervix
-
Management:
- Rest
- Tocolytic drugs (Salbutamol, Nifedipine)
- Analgesics
- If pregnancy continues, there is an increased risk of preterm labor and intrauterine growth restriction (IUGR)
Inevitable Abortion
-
Clinical Features:
- Vaginal bleeding
- Aggravation of colicky pain in the lower abdomen
- Dilated cervical os (opening)
- Products of conception may be felt through the cervix
-
Management:
- Monitoring for signs of infection
- Medications to help expel the products of conception
- Dilation and Curettage (D&C) if necessary
Complete Abortion
-
Clinical Features:
- Expulsion of a fleshy mass per vagina
- Subsiding abdominal pain
- Reduced vaginal bleeding
- Uterus smaller than expected for the period of amenorrhea
- Closed cervical os
- Empty uterus on ultrasound
- Management: Counseling and family planning
Incomplete Abortion
-
Clinical Features:
- Heavy vaginal bleeding
- Abdominal pain
- Uterus larger than expected for the period of amenorrhea
- Cervical os is open
- Visible products of conception on ultrasound
-
Management:
- Dilation and Curettage (D&C) to remove remaining placental tissue
Missed Abortion
-
Clinical Features:
- Fetal death but no expulsion
- Uterus smaller than expected
- No fetal heart beat on ultrasound
-
Management:
- Dilation and Curettage (D&C) to remove the fetus
Septic Abortion
-
Clinical Features:
- Fever, chills, severe abdominal pain
- Foul-smelling vaginal discharge
- Tender uterus
-
Management:
- Antibiotics
- Dilation and Curettage (D&C)
- Intravenous fluids
- Close monitoring for complications
Recurrent Miscarriage
- Definition: Three or more consecutive spontaneous abortions
-
Etiology:
- Fetal chromosomal abnormalities
- Maternal medical conditions
- Hormonal imbalances
- Anatomical abnormalities
- Infections
- Autoimmune disorders
- Cervical incompetence
- Multiple gestations
- Prior preterm birth
Management of Recurrent Miscarriage
-
Diagnosis:
- History and physical exam
- Hysterosalpingography
-
Treatment:
- Cervical cerclage (Shirodkar suture)
- Hormonal therapy (Progesterone)
###Â Induced Abortion
- Septic Abortion: Complications from an unsafe abortion procedure
-
Elective Abortion: Voluntary termination of pregnancy
- Surgical methods: Dilation and Curettage (D&C), Vacuum aspiration
- Medical methods: Misoprostol
- Therapeutic Abortion: Performed to protect the mother's life or if the fetus has severe abnormalities
###Â Nursing Management
-
Pre-procedure Care:
- Thorough assessment
- Counseling and informed consent
- Preparation
-
Post-procedure Care:
- Monitor for bleeding and infection
- Pain management
- Emotional support and counseling
- Family planning counseling
Post-Abortion Family Planning
- Definition: Using family planning methods after an abortion to prevent unintended pregnancy
-
Importance:
- Allows for a period of recovery
- Reduces the risk of another abortion
- Contraceptive methods can ideally be started immediately after an abortion
-
Special considerations:
- Counseling about the benefits and risks of different methods
- Understanding the return of fertility, as it can occur quickly
- Addressing the woman's emotional needs
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Description
This quiz delves into the definitions and classifications of abortion, including the key differences between spontaneous and induced types. Explore various scenarios and terms associated with abortion terminology, such as threatened, inevitable, and elective abortions. Test your knowledge on this sensitive and important topic.
