10 COMMON DISEASES

CAUSES OF 10
COMMON SYMPTOMS

ABORTION

 
Subject Contents

Abortion - elective or therapeutic

 
Definition
Elective or therapeutic abortion is the deliberate termination of a pregnancy .
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Alternative Names
Therapeutic abortion; Elective abortion
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Causes, incidence, and risk factors
Elective abortions are those initiated by personal choice. Therapeutic abortions are those recommended by the health care provider to protect the mother's physical or mental health. In the United States, one legal abortion occurs for every four live births.
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Symptoms
Early pregnancy symptoms include:
  • breast tenderness
  • breast enlargement
  • discoloration of breast areola
  • nausea
  • light-headedness
  • or
  • dizziness
  • missed periods
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    Signs and tests
  • A pelvic examination is performed to confirm
  • pregnancy and estimate the weeks of gestation. A serum HCG (blood test) may be performed to confirm pregnancy. An ultrasound (vaginal or abdominal) may be used to determine gestational age and location.
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    Treatment
    Most elective abortions take place between 8 and 12 weeks of gestation. The procedure consists of dilating the cervix and removing the contents of the uterus by suctioning the inner walls of the uterus. Pregnancies prior to 7 weeks of gestation may be safely terminated using a combination of medications. A surgical procedure may therefore be avoided.
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    Support Groups

     
    Expectations (prognosis)
    Legally performed abortions are relatively safe. Complications rarely occur. A first trimester legal abortion is physically safer for a woman than actually giving birth.
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    Complications
    Excessive loss of blood, uterine perforation and infection, and an incomplete abortion are the most frequent complications. These complications are rare when the procedure is performed legally by a competent provider in an adequate facility. Teenagers may not be aware that they are pregnant until the second trimester and could increase the danger to their own lives with second-trimester abortions. Infection resulting from the procedure occurs most commonly in women who have a preexisting gonorrheal or chlamydial infection.
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    Calling your health care provider
    Call for an appointment with your health care provider if an unplanned pregnancy occurs and information is desired about the choice of elective abortion. Call your health care provider if an elective/therapeutic abortion has been performed and bleeding '>vaginal bleeding continues beyond what was predicted or if you continue to have symptoms of pregnancy or any severe pain. (Excessive bleeding can cause shock and continued pain or pregnancy symptoms may indicate a possible ectopic or tubal pregnancy.) Call your health care provider if signs of infection develop, including persistent fever , foul odor to vaginal drainage, vaginal drainage that looks like pus, or abdominal pain or tenderness.
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    Prevention
    Improved methods of contraception can help prevent many unplanned pregnancies. This includes education related to abstinence, or, in the case of chosen sexual activity, contraception education. Such methods will not totally alleviate the perceived need, since unplanned pregnancies occur even when couples practice adequate methods of contraception to the best of their abilities. Some women chose to terminate a pregnancy that results from a sexual assault, or a pregnancy that endangers a woman's health, or when the fetus is abnormal.
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    Abortion - spontaneous

     
    Definition
    A spontaneous abortion is the loss of a fetus during pregnancy due to natural causes. The term "miscarriage" is the spontaneous termination of a pregnancy before fetal development has reached 20 weeks. pregnancy losses after the 20th week are categorized as preterm deliveries. The term "spontaneous abortion" refers to these naturally occurring events, not elective or therapeutic abortion procedures. More specific terms include: missed abortion (a pregnancy demise where nothing is expelled); complete abortion '>incomplete abortion (not all of the products of conception are expelled); complete abortion (all of the products of conception are expelled); threatened abortion (symptoms indicate a miscarriage is possible); inevitable abortion (the symptoms cannot be stopped, and a miscarriage will happen); and infected abortion .
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    Alternative Names
    Miscarriage
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    Causes, incidence, and risk factors
    The cause of most spontaneous abortions is fetal death due to fetal genetic abnormalities, usually unrelated to the mother. Other possible causes for spontaneous abortion include: infection, physical problems the mother may have, hormone ( endocrine ) factors, immune responses, and serious systemic diseases of the mother (such as diabetes or thyroid problems). It is estimated that up to 50% of all fertilized eggs die and are lost (aborted) spontaneously, usually before the woman knows she is pregnant . Among known pregnancies, the rate of spontaneous abortion is approximately 10% and usually occurs between the 7th and 12th weeks of pregnancy . The risk for spontaneous abortion is higher in women over age 35, in women with systemic disease (such as diabetes or thyroid dysfunction), and women with a history of three or more prior spontaneous abortions.
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    Symptoms
  • Currently
  • pregnant
  • Vaginal bleeding
  • With or without
  • abdominal cramps
  • Between periods
  • Low back pain
  • or
  • abdominal pain
  • Dull or sharp or cramping
  • Persistent/constant or intermittent
  • Tissue or clot-like material that passes from the
  • vagina Note: Approximately 20% of pregnant women experience some vaginal bleeding during the first trimester. Less than half of these women have a spontaneous abortion .
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    Signs and tests
    Pelvic examination may reveal moderate thinning of the cervix (effacement), increased cervical dilation, and evidence of ruptured membranes.
  • An
  • HCG (qualitative - urine) or HCG (qualitative - serum) test confirms pregnancy
  • Serial
  • HCG (quantitative) values may be drawn at intervals of days to weeks
  • A
  • CBC '>CBC may be done to determine the degree of blood loss
  • A
  • WBC '>WBC and differential may be done to rule out potential infection An abortion, especially if incomplete or missed, may also alter the results of the following tests:
  • Transvaginal ultrasound
  • pregnancy ultrasound
  • Estriol - urine
  • Estriol - serum
  • Serum progesterone
  • Fibrin degradation products
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    Treatment
  • Treatment for
  • abortion '>threatened abortion varies from restrictions on some forms of exercise to complete bed rest. Abstaining from intercourse is usually recommended until signs have disappeared. In the event of spontaneous abortion , the tissue passed from the vagina should be examined to determine the source of the tissue (fetal vs. hydatidiform mole ) and if any fetal tissue remains in the uterus ( incomplete abortion ). Missed abortions that do not abort naturally and incomplete spontaneous abortions may require surgical removal of retained tissue ( D and C procedure). Any further vaginal bleeding should be carefully monitored.
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    Support Groups

     
    Expectations (prognosis)
    Maternal outcome is good and complications are rare. Waiting a few months before trying to become pregnant again is usually recommended.
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    Complications
  • Retained dead fetal tissue in the uterus is referred to as an
  • abortion '>incomplete abortion . This may cause infection and the retained uterine tissue must be removed surgically ( D and C ).
  • An infection may occur after either a complete or incomplete abortion.
  • In a missed
  • abortion , the demise of the pregnancy is discovered before the appearance of any symptoms. A D and C , or a D and E can be performed to remove all of the dead tissue. Some patients choose to await spontaneous expulsion.
  • The death of a second or third trimester pregnancy is addressed differently than a first trimester loss. These are usually called intrauterine fetal demises (IUFD). If the dead fetus remains in the uterus for too long, an abnormal activation of blood clotting systems (coagulation and fibrinolytic systems) can develop in response to the release of anti-clotting chemicals from the retained dead fetus. This can adversely affect maternal health.
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    Calling your health care provider
    Call your health care provider if vaginal bleeding with or without cramping occurs during pregnancy . Call your health care provider if you are pregnant and notice tissue or clot-like material passed vaginally (any such material should be collected and brought in for examination).
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    Prevention
    Many of the spontaneous abortions that are caused by maternal disease can be prevented through early (prior to conception) detection and treatment of the disease. Reduced risk of spontaneous abortions has been attributed to early, comprehensive prenatal care and avoidance of environmental hazards (such as X-rays and infectious diseases). Spontaneous abortion naturally occurs after fetal death. The dead tissue is discarded from the uterus and the woman resumes her normal menstrual cycle within a few weeks (usually). Note: It is frequently possible to become pregnant immediately after a spontaneous abortion. However, it is recommended that a woman wait for one or two normal menstrual cycles before attempting another pregnancy . On occasion, the uterus does not expel all of the fetal tissue, in which case it is considered an incomplete abortion. Incomplete spontaneous abortions may require surgical removal of the retained tissue. pregnancy loss at any gestational age may not be accompanied by prompt expulsion of the dead tissue. Signs of pregnancy decrease, the uterus begins shrinking to its original size, and a brownish or reddish vaginal discharge is often experienced. If spontaneous abortion does not occur in a reasonable amount of time (about 4 weeks), a D and C , or D and E will have to be performed, or labor induced to remove the dead fetus. When a mother's body is having difficulty sustaining a pregnancy, signs (such as slight vaginal bleeding ) may occur. This is a threatened abortion , which means there is a possibility of abortion, but it is not inevitable. A pregnant woman who develops any signs or symptoms of threatened miscarriage should contact her prenatal provider immediately.
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    Abortion - incomplete

     
    Definition
    An abortion in which a portion of the fetal or placental material is retained within the uterus. Typical symptoms include vaginal bleeding and lower abdominal cramping. An incomplete abortion often requires surgical intervention to remove the remaining material from the uterus and prevent hemorrhaging, prolonged bleeding , or infection. See also complete abortion , infected abortion , miscarriage .
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    Alternative Names
    Incomplete abortion
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    Causes, incidence, and risk factors

     
    Symptoms

     
    Signs and tests

     
    Treatment

     
    Support Groups

     
    Expectations (prognosis)

     
    Complications

     
    Calling your health care provider

     
    Prevention

    Abortion - complete

     
    Definition
    A complete abortion is an abortion (induced or spontaneous) in which all of the fetal and placental material has been expelled from the uterus before 20 weeks' gestation. This type of abortion generally does not require medical intervention. See also miscarriage .
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    Alternative Names
    Complete abortion
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    Causes, incidence, and risk factors

     
    Symptoms

     
    Signs and tests

     
    Treatment

     
    Support Groups

     
    Expectations (prognosis)

     
    Complications

     
    Calling your health care provider

     
    Prevention

    Abortion - threatened

     
    Definition
    A threatened abortion is a condition of pregnancy , occurring before the 20th week of gestation, that suggests potential miscarriage may take place.
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    Alternative Names
    Threatened miscarriage; Threatened spontaneous abortion
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    Causes, incidence, and risk factors
    Approximately 20% of pregnant women experience some vaginal bleeding, with or without abdominal cramping , during the first trimester. This is known as a threatened abortion. However, most of these pregnancies go on to term with or without treatment. Spontaneous abortion occurs in less than 30% of the women who experience vaginal bleeding during pregnancy . In the cases that result in spontaneous abortion, the usual cause is fetal death . Such death is typically the result of a chromosomal or developmental abnormality. Other potential causes include infection, maternal anatomic defects, endocrine factors, immunologic factors, and maternal systemic disease. Estimates report that up to 50% of all fertilized eggs abort spontaneously, usually before the woman knows she is pregnant. Among known pregnancies, the rate is approximately 10%. These usually occur between 7 and 12 weeks of gestation. Increased risk is associated with women over age 35, women with systemic disease (such as diabetes or thyroid dysfunction), and those with a history of 3 or more prior spontaneous abortions.
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    Symptoms
  • Vaginal bleeding during the first 20 weeks of
  • pregnancy (last menstrual period was less than 20 weeks ago)
  • Abdominal cramps
  • may or may not accompany
  • vaginal bleeding Note: With true miscarriage , low back pain or abdominal pain (dull to sharp, constant to intermittent) typically occurs and tissue or clot-like material may pass from the vagina .
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    Signs and tests
    Pelvic examination reveals a cervix that is neither thinned (effaced) nor open (dilated). The presence of effacement and/or dilation is consistent with impending miscarriage .
  • A
  • serum HCG may be performed to confirm that a pregnancy exists.
  • Beta
  • HCG (quantitative) test may be repeated over a period of days or weeks to confirm either continued pregnancy or fetal death .
  • A
  • CBC '>CBC may be obtained to determine the degree of blood loss .
  • A
  • WBC '>WBC with differential may be obtained to rule out infection.
  • A
  • pregnancy ultrasound is used to detect fetal heartbeat. This disease may also alter the results of the following tests:
  • Serum progesterone
  • Beta HCG (quantitative)
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    Treatment
    Activity restrictions vary, from avoiding some forms of exercise to complete bed rest. Restricting activity will not guarantee that a miscarriage will not occur. Providers typically recommend pelvic rest (abstaining from intercourse, douching, tampon use) until symptoms resolve. The woman's condition should be monitored carefully. The use of progesterone is controversial. The potential benefit is the relaxation of smooth muscle , including the muscles of the uterus. However, this may increase the potential risk of an incomplete abortion or an abnormal pregnancy . It also increases the risk of retaining a hydatidiform mole . In the absence of a luteal phase defect, progesterone supplementation should not be used.
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    Support Groups

     
    Expectations (prognosis)
    The probable outcome is good when the pregnancy continues to progress and all the symptoms disappear.
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    Complications
  • Spontaneous
  • abortion
  • Moderate to heavy
  • blood loss
  • Anemia
  • Dead fetus syndrome
  • Infection
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    Calling your health care provider
    It is imperative for a woman who knows she is (or is likely to be) pregnant and who has any signs or symptoms of threatened abortion to contact her prenatal provider immediately.
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    Prevention
    Early and comprehensive prenatal care decreases risk. It is preferable to detect and treat known maternal disorders before conception occurs. Avoiding environmental hazards such as X-rays and infectious diseases also decreases the risk of miscarriage in early pregnancy . Spontaneous abortion is not preventable if there is fetal death . In fact, it is important for the uterus to expel all products of conception in such cases. A missed abortion occurs when a dead fetus is not expelled from the uterus. When only part of the dead fetus is expelled, it is an incomplete abortion .
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    Abortion - infected

     
    Definition
    An abortion accompanied by infection of the fetal material, placental material, and endometrium (uterine cavity lining). Usually, a fever in the mother accompanies the other typical symptoms of an abortion or miscarriage (vaginal bleeding and cramping).
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    Alternative Names
    Infected miscarriage
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    Causes, incidence, and risk factors

     
    Symptoms

     
    Signs and tests

     
    Treatment

     
    Support Groups

     
    Expectations (prognosis)

     
    Complications

     
    Calling your health care provider

     
    Prevention

    Abortion

     
    Definition
    An abortion is a procedure, either surgical or medical, to end a pregnancy by removing the fetus and placenta from the uterus.
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    Alternative Names
    Induced abortion; Suction curettage; Surgical abortion; Medical abortion
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    Description
    A surgical abortion that is performed between 6 and 12 weeks into a pregnancy may be done while the woman is awake. She is given the option of being sedated by medications, or having her cervix numbed (local anesthesia) with an injection so that she is basically pain-free. A surgical abortion for a pregnancy over 12 weeks is usually done while the woman is sedated, although it can also be performed while the woman is awake. The cervical canal is enlarged (dilated) and a hollow tube is inserted into the uterus. A vacuum (suction) machine is used to remove the tissues (fetus and placenta) from the uterus. Medicines such as oxytocin are sometimes given to cause the uterine muscles to contract and reduce bleeding . A medical abortion for a pregnancy less than 7 weeks from the first day of the last menstrual period can be safely performed using a combination of medications. The current regimen approved by the FDA includes administration of one dose of Mifepristone (RU486), an antiprogestin, followed by one dose of Misoprostol, a prostaglandin analogue two days later. These medications may be given in the doctor's office, after a thorough history and physical is performed.
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    Indications
  • Woman's choice to end a
  • pregnancy (elective termination)
  • Woman's health is endangered by pregnancy (therapeutic abortion)
  • An abnormality in the developing fetus (birth defect, genetic abnormality)
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    Risks
    Risks for any anesthesia are:
  • Reactions to medications
  • Problems breathing
  • Risks for any surgery are:
  • Bleeding
  • Infection
  • Additional risks of surgical abortion include:
  • Excessive Bleeding '>Bleeding
  • Infection of the uterus
  • Infection of the fallopian tubes (which can cause scarring and interfere with fertility (
  • infertility )
  • Puncture (perforation) of the uterus, or damage to the cervix (rare)
  • Emotional or psychological distress
  • Risks of medical abortion include:
  • Prolonged Bleeding '>Bleeding
  • Incomplete abortion necessitating a surgical abortion
  • Nausea
  • Vomiting
  • Diarrhea
  • Pain
  • The decision to have an abortion is an intensely personal one. Most health care providers recommend competent counseling before making this decision.
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    Expectations after surgery
    Most women who undergo surgical abortions done in appropriate medical facilities recover without any physical complications. Any significant emotional and psychological issues should be considered and addressed before and after a chosen abortion.
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    Convalescence
    Physical recovery usually occurs within a few days, depending on the stage of the pregnancy . A small amount of vaginal bleeding and mild uterine cramping should be expected for a few days. A hot bath or use of a heating pad or hot water bottle on the abdomen may help relieve discomfort. Strenuous activity should be avoided for a few days following an abortion. Tampons may be used after 3 days. Sexual intercourse should be avoided for 2 to 3 weeks. A normal menstrual period should occur 4 to 6 weeks after the operation.
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