Abortion

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Abortion
msinan94
Oct. 22, 2015 • 879 likes • 350,944 views
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Medical presentation for undergraduates -

Abortion: Types, Management
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Abortion
1. Abortion Mohamed Sinan Govt Medical College,
Calicut
2. Abortion is the expulsion or extraction of an embryo or
fetus weighing 500 g or less from its mother when it is
not capable of independent survival (i.e. before the
period of viability)
3. Incidence • 10–20% of all clinical pregnancies • 75%
abortions occur before the 16th week • Rates vary with
maternal age; also high in women with past
miscarriages
4. Abortion Spontaneous Induced Isolated Recurrent
MTP Illegal Threatened Inevitable IncompleteComplete
Missed Septic
5. Etiology • Fetal Factors • Maternal Factors
6. Fetal Factors • Genetic – 50% of early miscarriage is
due to chromosomal abnormalities – Numerical
defects like Trisomy, Polyploidy, Monosomy –
Structural defects like translocation, deletion, inversion
• Multiple Pregnancies • Degeneration of villi
7. Maternal Factors • ENDOCRINE AND METABOLIC
FACTORS (10–15%): – Luteal Phase Defect – Thyroid
abnormalities – Diabetes mellitus • Anatomical
abnormalities (10–15%) Cervicouterine factors –
Cervical incompetence & insu!iciency – Congenital
malformation of the uterus – Uterine Fibroid –
Intrauterine adhesions
8. • Infections (5%) – Viral: rubella, cytomegalo, HIV,.. –
Parasitic: toxoplasma, malaria,.. – Bacterial:
ureaplasma, chlamydia,.. • IMMUNOLOGICAL
DISORDERS (5–10%)— – • Autoimmune disease – •
Alloimmune disease – • Antifetal antibodies
9. • Environmental Factors – Cigarette smoking – Alcohol
consumption – Contraceptive agents • Maternal
medical illness – Cyanotic heart disease –
Hemoglobinopathies • Unexplained (40-60%) – In
majority, the exact cause is not known.
10. Threatened Abortion • Condition in which miscarriage
has started but has not progressed to a state from
which recovery is impossible
11. CLINICAL FEATURES: • The patient, having
amenorrhea, complains of: (1) Slight bleeding per
vaginam (2) Pain: Usually painless; there may be mild
backache or dull pain in lower abdomen
12. • The uterus and cervix feel so". • Digital examination
reveals closed external os • Di!erential diagnosis
includes – cervical ectopy – polyps or carcinoma –
ectopic pregnancy – molar pregnancy • Ultrasound is
diagnostic; Pelvic examination is avoided when USG is
available
13. Management & Prognosis • Rest: Patient should be in
bed for few days until bleeding stops • Relief of pain:
Diazepam 5 mg BD • 80% of pregnancies with
threatened abortions go on until term • If a live fetus is
seen on USG, pregnancy is likely to continue in over
95% cases. • If pregnancy continues, there is increased
frequency of preterm labor, placenta previa & IUGR
14. Inevitable Abortion It is the clinical type of abortion
where the changes have progressed to a state from
where continuation of pregnancy is impossible.
15. CLINICAL FEATURES: • The patient, having the features
of threatened miscarriage, presents with – vaginal
bleeding – Aggravation of colicky pain in the lower
abdomen • Sometimes, the features may develop
quickly without prior clinical evidence of threatened
miscarriage • Internal examination reveals dilated
internal os through which the products of conception
are felt
16. Management • Management is aimed: – To accelerate
the process of expulsion – To maintain strict asepsis • If
pregnancy < 12 weeks, suction evacuation is done • If
pregnancy > 12 weeks, expulsion by oxytocin infusion •
General measures: – Excessive bleeding is controlled by
administering methergin 0.2 mg – Blood loss is
corrected by IV fluid therapy and blood transfusion
17. Incomplete abortion The process of abortion has
already taken place, but the entire products of
conception are not expelled & a part of it is le" inside
the uterine cavity
18. Clinical features: • History of expulsion of a fleshy
mass per vaginam; – Continuation of pain in lower
abdomen – Persistence of vaginal bleeding • Internal
examination reveals – uterus smaller than the period of
amenorrhea – Open internal os – varying amount of
bleeding • On examination, the expelled mass is found
incomplete Complications: • The retained products
may cause: (a) bleeding (b) sepsis or (c) placental
polyp.
19. MANAGEMENT: • Evacuation of the retained products
of conception (ERCP) • Early abortion: Dilatation and
evacuation under analgesia or general anesthesia is to
be done. • Late abortion: Uterus is evacuated under
general anesthesia and the products are removed by
ovum forceps or by blunt curette. In late cases, D&C is
to be done to remove the bits of tissues le" behind. •

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