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ABORTIONS

ABORTIONS. OBJECTIVES. At the end of this session you should be able to: Define various types of abortions. Outline the causes and management approach for various types of abortions. Describe the relation between complications of abortions and maternal mortality. DEFINITIONS OF ABORTION.

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ABORTIONS

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  1. ABORTIONS

  2. OBJECTIVES At the end of this session you should be able to: • Define various types of abortions. • Outline the causes and management approach for various types of abortions. • Describe the relation between complications of abortions and maternal mortality

  3. DEFINITIONS OF ABORTION • Termination of pregnancy before 28/40 • Delivery of a fetus of weight less than 500 grams

  4. STATISTICS OF ABORTIONS • 50 - 60% of all pregnancies end in spontaneous abortion (SAB) since 2-4 wk pregnancies will often go unnoticed. • 15% of all recognized pregnancies 4-20 wks end in SAB. • 30% lost between implantation and the 6thwk. • 70% of first trimester losses are due to chromosomal abnormalities

  5. TYPES TYPES OF ABORTIONS • Induced • Threatened • Inevitable • Incomplete • Complete • Septic • Missed • Recurrent

  6. 1. INDUCED ABORTION • Intentional medical or surgical termination of a pregnancy • Types • Elective: if performed for a woman’s desires • Therapeutic: if performed for reasons of maintaining health of the mother

  7. INDUCED ABORTION – MEDICO-LEGAL ASPECTS IN TANZANIA • Only allowed for medical indications • If continuation of pregnancy is risk to life of the woman • At least two medical doctors should reach the decision and sign • Elective abortions – are unlawful

  8. INDUCED ABORTIONS - COMPLICATIONS Because most induced abortions are done by less skilled persons they are usually associated with fatal complications including: 1. Perforation of uterus, intestines, etc 2. Severe haemorrhage, 3. Sepsis and its associated complications, 4. Asherman’s syndrome, etc

  9. 2. THREATENED ABORTION Refers to a stage in the abortion that suggests potential miscarriage may take place. Symptoms • Minimal or no lower abdominal pain or cramps • Slight abd pain • Minimal draining of liquor

  10. Threatened abortion cont Signs • Stable general condition • Fundal height corresponds to GA • Cervix closed

  11. Management of threatened abortion • Bed rest • Avoid strenuous exercises • If GA > 16/40 give - tocolytics

  12. 3. INEVITABLE ABORTION Refers to a stage in the abortion when it is not possible for the pregnancy to continue.

  13. INEVITABLE ABORTION CONT Symptoms • Moderate to severe vaginal bleeding • Severe abd pain • Significant draining of liquor Signs • Dilatation of cervix with evidence of imminent expulsion of the PoC • Fundal height corresponds to GA • Presence of contractions

  14. Management of Inevitable abortion • Resuscitation: IV fluids: RL, NS • Blood grouping & Cross matching • Evacuation • MVA for GA < 12/40 • Augment if the GA > 12/40 • Oxytocin • If some PoC remain after abortion manage like incomplete abortion.

  15. MANUAL VACUUM ASPIRATOR

  16. 4. INCOMPLETE ABORTION • Some POC have been expelled from the uterine cavity and other are retained inside. Symptoms • Moderate to severe vaginal bleeding • Cramping/severe abd pain • Partial expulsion of POC Signs • Uterus smaller than dates • Cervix is dilated of cervix

  17. Management of Incomplete abortion • Resuscitation: IV fluids: RL, NS • Blood grouping & Cross matching → BT if indicated • Evacuation • MVA for GA < 12/40 • Augment if the GA > 12/40 • Oxytocin • If some PoC remain after abortion manage like incomplete abortion. 4. Antibiotics: ampicilin, metronidazole 5. Analgesics

  18. 5. SEPTIC ABORTION An abortion complicated by infection Symptoms • Abdominal pain • Fever • Vaginal discharge (foul smelling) Signs • Sick looking, febrile or jaundiced • Tender uterus • Offensive vaginal discharge or bleeding • Cervix is usu. soft and may be dilated

  19. Immediate cpx Haemorrhage Peritonitis Pelvic abscess, endometritis, Septicemia, Septic/haemorrhagic shock Late cpx PID Pelvic adhesions 2° Infertility Chronic LAP Complications of septic abortions

  20. Management • Resuscitation • IV fluids: RL, NS • Insert urethral catheter • Monitor Input/output • Blood grouping & Cross matching • Antibiotics: • Preferably cephalosporins, if not available ampicilin and metronidazole • Evacuation • Haematenics

  21. 6. RECURRENT PREGNANCY LOSSES • Defined as 3 or more consecutive pregnancy losses Other names: • habitual abortions • habitual miscarriage • recurrent abortions • recurrent miscarriages.

  22. Genetic Factors Endocrine Factors Anatomic Causes Congenital anomalies, in competencies, Infectious causes Immunologic problems Aetiology of RPL Aetiology: Can be established in only 30%

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