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Unit II - Abortion
Unit II - Abortion
pregnancy
Bleedings in early pregnancy
Reflective activity;
Why do you think the reason for a certain
women to bleed in early pregnancy?
Bleedings in early pregnancy
Cause:
1. Abortion
2. Ectopic pregnancy
3. Gestational trophoblastic diseases
4. Other pregnancy unrelated causes:
-accidental trauma
-genital infections & cancers
Abortion
Maternal causes
• Disease acquired during pregnancy such as rubella or
influenza, + fever + sepsis
• interfere with transplacental oxygenation and may
precipitate abortion.
• Chronic disorders-- renal disease accompanied by HTN,
• Drugs - large doses of any drug are poisonous
• ABO incompatibility between mother and embryo may
result in abortion.
• Psychological factors
Causes…
1. Threatened abortion
2. Inevitable Abortion
3. Complete
4. Incomplete
5. Missed
6. Habitual abortion
7. Septic abortion
1. Threatened abortion
Diagnosis:
• Bleeding is usually excessive with passage of blood clots.
• Suprapubic pain is always present. It may be severe, radiating to
the back (like labour pains)
• Hypovolaemic shock: may occur whenever blood loss is rapid and
severe, especially in anaemic patients.
• General examination: hypotension, tachycardia, tachypnia and
oliguria.
• Bimanual Examination:
– The uterus corresponds to GA or slightly smaller.
– The cervix is dilated and products of conception may be felt through
cervical os.
Inevitable…
Ultrasonography shows:
• The foetus is usually dead.
• The placenta is partially or completely separated.
• The internal os is dilated.
Sign and symptoms
• Heavy bleeding (takes less than 5 minutes for a clean pad or cloth
to be soaked )
• Dilated cervix
• Uterus corresponds to dates Cramping/lower abdominal pain
• Tender uterus
• No expulsion of products of conception
Inevitable…
Management
• If pregnancy is < 12 wks, plan for evacuation of
uterine contents – MVA
• If evacuation is not immediately possible:
• Give ergometrine 0.2 mg IM (repeated after 15
minutes if necessary) OR misoprostol 400 mcg PO
(repeated once after 4 hours if necessary);
• Arrange for evacuation of uterus as soon as possible.
Inevitable…
Mgt…
• If pregnancy is greater than 12 weeks:
• Await spontaneous expulsion of products of conception
• then evacuate the uterus to remove any remaining
products of conception;
• If necessary, infuse oxytocin 40 units in 1 L IV fluids
(normal saline or Ringer’s lactate) at 40 drops per
minute to help achieve expulsion of products of
conception.
• Ensure follow-up of the woman after treatment.
3. Complete abortion
Abortion
abortion
Induced abortion
INTRODUCTION
Unintended pregnancy is a problem that may never be fully resolved, and women who do not
wish to continue a pregnancy will often seek out termination by any means, regardless of safety.
All patients choosing abortion are entitled to quality care by practitioners who are qualified to
perform procedures and to identify and manage complications.
Clinical guidelines were prepared with the best available evidence and professional consensus on
induced abortions.
abortion
Debate
Is performing induced abortion legal or not?
abortion
Induced abortion
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Abortion is allowed by law in the following
conditions:
CONSTITUTION OF FDRE Article 551
Implementation guide for article 551
1. Pregnancy is a result of rape/ incest – 1 –A
2. Px endanger the life of mother/ child – s 1B
3. When the fetus has incurable deformity – s 1C
4. When she has physical/ mental deficiency/ minor
1D
5. In case of grave and imminent danger – s 2
Elements of woman centered CAC
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Key reproductive rights related to abortion
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Timing & place for terminating pregnancy
• In a public/ private facility that fulfills the pre-set
criteria
• At the level of a health center and above if < 12 weeks
of gestation
• In a secondary or tertiary level of care if 13-28 weeks
of gestation
Women who are eligible for termination should have the necessary
information to seek abortion care as early in pregnancy as possible
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Methods of Induced…
1. Medication abortion
2. Manual vacuum aspiration
Medication-Abortion Pills
Mechanism of induced abortion
Mifepristone
• First developed and approved for clinical use in 1988 in
France (RU-486).
• Blocks progesterone activity in the uterus, leading to
detachment of the pregnancy.
Misoprostol
• Prostaglandin analogue that stimulates uterine
contractions and facilitate cx diltation
• stable at room temperature & available in the market.
• Easily absorbed orally/ vaginally.
• Commonly used for rx of gastric ulcers.
Effectiveness
• Combination of two drugs more effective than
either used alone.
• Combined regimen is 92 to 98 percent
effective in pregnancies ≤ nine weeks since
last menstrual period (LMP)
Diagnose and Date Pregnancy
• Confirm that the pregnancy is 63 days/nine
weeks or less since the LMP.
• Date pregnancy through medical history,
pregnancy test and bimanual exam.
• Ultrasound used to date pregnancy can be
helpful but is not required.
Contraindication of MA
Vaginal use:
56 days/8 weeks On Day 2, 3 or 4, insert four 200mcg tablets
(800mcg total) of misoprostol.
56–63 days/ On Day 2 or 3, insert four 200mcg tablets
8–9 weeks (800mcg total) of misoprostol.
Oral use:
49 days/7 weeks On Day 2 or 3, take two 200mcg (400mcg
total) tablets of misoprostol.
49–63 days/ Not recommended due to lower efficacy—
7–9 weeks use vaginal misoprostol.
(Schaff et al., 2000; Schaff et al., 1997; Ashok et al., 1998; and Creinin et al., 1999.)
Instructions for Vaginal Insertion
• Aspirator is full.
• Cannula is withdrawn past os.
• Cannula is clogged.
• Aspirator is incorrectly assembled.
When Aspirator Is Full
• Close the valve buttons.
• Detach the cannula and leave in os.
• Open the valve; squeeze plunger arms.
• Push plunger and empty the aspirator.
• Establish new vacuum.
• Reattach aspirator to the cannula and
continue.
When Cannula Is Withdrawn Past Os