Abortion resident survival guide: Difference between revisions

Revision as of 18:51, 12 October 2020

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
Abdominal trauma with hemodynamic instability

Common Causes

Chromosomal abnormalities such as:
- Trisomies
- Molar pregnancies
- Blighted ovum
Infections
Cervical insufficiency
Uterine malformations
Drug and alcohol use
Smoking
Uncontrolled chronic diseases (Diabetes, Hypertension, Hypo/Hyperthyroidism, etc)

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 summarizing the treatment of Abortion.

{Family tree/end}}

Do's

The content in this section is in bullet points.

Don'ts

The content in this section is in bullet points.

References

Template:WikiDoc Sources

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

@@ Line 76: / Line 76: @@
 ==Treatment==
+Shown below is an algorithm summarizing the treatment of Abortion.
 {{Family tree/start}}
 {{Family tree | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |A01=Viable pregnancy?}}
@@ Line 81: / Line 83: @@
 {{Family tree | | | | | | B01 | | | | | | B02 | | | | | | | | | | | | | | | | | | | | | | | | | | | | |B01=Yes|B02=No}}
 {{Family tree | | | | | | |!| | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
-{{Family tree | | | | | | C01 | | | | | | C02 | | | | | | | | | | | | | | | | | | | | | | | | | | | | |C01=Threatened abortion|C02=Missed abortion,Incomplete abortion, Inevitable abortion}}
+{{Family tree | | | | | | C01 | | | | | | C02 | | | | | | | | | | | | | | | | | | | | | | | | | | | | |C01=Threatened abortion|C02=Missed, incomplete or inevitable abortion}}
 {{Family tree | | | | | | |!| | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
-{{Family tree | | | | | | D01 | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | | |D01=Weekly check ups till bleeding ceases,Administer Rhogam[Rhο(D)] immunoglobulin if indicated, watch out for oligohydramnios, IUGR and preterm labor}}
+{{Family tree | | | | | | D01 | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | | |D01=Weekly check ups till bleeding ceases, administer Rhogam[Rhο(D)] immunoglobulin if indicated, watch out for oligohydramnios, IUGR and preterm labor}}
 {{Family tree | | | | | | | | | | | | | | J01 | | | | | | | | | | | | | | | | | | | | | | | | | | | |J01=Any complications? E.g.pain, hemorrhage, sepsis}}
 {{Family tree | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
@@ Line 93: / Line 95: @@
 {{Family tree | | | | | | | | | | |!| | | G01 | | | | | | G02 | | | | | | | | | | | | | | | | | | | | |G01=Consent|G02=Decline}}
 {{Family tree | | | | | | | | | | |!| | | |!| | | | | | | |!| | | | | | | | | | | | | | | | | | | |}}
-{{Family tree | | | | | | | | | | |!| | | H01 | | | | | | H02 | | | | | | | | | | | | | | | | | | | | |H01=Follow-up with serial β-hcg|H02=Uterine evacuation or Medical treatment}}
+{{Family tree | | | | | | | | | | |!| | | H01 | | | | | | H02 | | | | | | | | | | | | | | | | | | | | |H01=Follow-up with serial β-hcg|H02=Uterine evacuation or medical treatment}}
-{{Family tree | | | | | | | | | | K01 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |K01=Uterine evacuation}}
+{{Family tree | | | | | | | | | | K01 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |K01=Uterine evacuation and stabilise patient}}
 {{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
 {{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
@@ Line 105: / Line 107: @@
 {{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
 {Family tree/end}}
-Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.
-{{familytree/start |summary=PE diagnosis Algorithm.}}
-{{familytree | | | | | | | | A01 |A01= }}
-{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
-{{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }}
-{{familytree | | | |!| | | | | | | | | |!| }}
-{{familytree | | | C01 | | | | | | | | |!| |C01= }}
-{{familytree | |,|-|^|.| | | | | | | | |!| }}
-{{familytree | D01 | | D02 | | | | | | D03 |D01= |D02= |D03= }}
-{{familytree | |!| | | | | | | | | |,|-|^|.| }}
-{{familytree | E01 | | | | | | | E02 | | | E03 |E01= |E02= |E03= }}
-{{familytree | | | | | | | | | | |!| | | | |!| }}
-{{familytree | | | | | | | | | | F01 | | | F02 |F01= |F02= }}
-{{familytree/end}}
 ==Do's==