ABORTION

1. ABORTION

2. Learning objectives • Define abortion • Causes of abortion • Understand the pathology of abortion • Enumerate different clinical types • c/f & investigations • Complications • Describe the management

3. INTRODUCTION The causes for bleeding in early pregnancy are due to : • Those related to pregnancy status – abortion 95%, EP, MP, implantation bleeding • Those associated with the pregnancy. Incidence : • 10-15 % • 75% abortion occur before 16 weeks.

4. Definition • It is the expulsion or extraction from its mother of an embryo or fetus weighing 500gms or less when it is not capable of independent survival (WHO) • Usually 500gm of fetal development will be attained at 22 weeks.

5. etiology Fetal : • abnormal zygote development • aneuploid abortion- 50 -60% ve chromosomal abnormalities, autosomal trisomy is the most common monosomy X triplody tetraploidy • Euploid abortion

6. Maternal : • infections • endocrine abnormalities • drugs /environmental factors- tobacco, alcohol, arsenic, pesticide, lead, formaldehyde, benzene, nitrous oxide • stress • immunological-antiphospholipd antibodies • uterine cause - submucus fibroids • idiopathic

7. Paternal factors • Thrombophilias • Environmental factors • Unexplained (40-60%)

8. pathology • Haemorrhage into decidua basalis – • necrosis of adjacent tissues to bleeding • ovum detaches & expelled once uterine contraction begins.

9. Clinical types • Threatened • Inevitable • Incomplete • Complete • Missed • recurrent

10. Types of abortion • Based on onset: spontaneous induced medical termination illegal Based on complication: septic /non septic

11. Threatened miscarriage • It is clinical entity where the process of miscarriage has started but has not progressed to a state from which recovery is impossbile. Clinical features : • Bleeding PV, Pain, • Signs

12. Investigations : USG • Treatment : bed rest, pain relief Prognosis : • It is unpredictable in two thirds pregnancy continues beyond 28 weeks. • In the rest it terminates as inevitable are missed. • If the pregnancy continues there is increase risk of placenta praevia, preterm labour, IUGR and fetal anamolies.

13. Blighted ovum : • It is sonographic diagnosis. There is absence of fetal pole in a gestational sac. With diameter of 3cm or more.

14. Inevitable • The changes have progressed to a state where continuation of pregnancy is impossible. • Management- maintain strict asepsis. accelerate the process of expulsion.

15. Incomplete miscarriage • Entire products of conception are not expelled Complications : • Profuse bleeding, sepsis, placental polyp

16. Complete miscarriage • The products of conception are expelled enmass. • In RH negative women anti-D to be given within 72 hours.

17. Missed miscarriage • The fetus is dead and retained inside the uterus for a variable period. • Carneous mole (blood mole or fleshy mole). Complications : • Blood coagulation disorders . Management : • Expectant /Medical / surgical • less than 12 weeks • More than 12 weeks

18. Septic abortion • Any abortion associated with clinical evidence of infection of the uterus and its contents. Incidence : 10% Mode of infection : Endogenous Micro organism : Anaerobic, aerobic, mixed.

19. Clinical features • Fever with chills and rigors – atleast >38oc for 24 hours or more. If hypothermia is present it is an ominous feature of endotoxic shock . • Pain abdomen • Tachycardia. • Variable systemic and abdominal findings. • Internal examination –offensive purulent discharge/tender ut wth patulous os,boggy feel of ut, collection in pod

20. Clinical grading : • Grade-I : Infection localised to uterus. Usually associated with spontaneous. • Grade-II : Beyond the uterus but confined to pelvis. • Grade-III : Generalised peritonitis / endotoxic shock / Jaundice / ARF . Associated with illegal induced abortion.

21. Investigations : • Routine blood investigations • cervical / high vaginal swab • Urine culture • USG • Blood culture • Plain X-ray Chest and abdomen

22. Complications : • Immediate • Haemorrhage • Injuries to uterus and adjacent structures and gut • Spread of infection leads to generalised peritonitis, endotoxic shock, ARF, thrombophlebitis. • All of the above may lead to 20-25% of maternal deaths.

23. Prevention • Boost family planning methods • Rigid enforcement of legalised abortion • To take antiseptic & aseptic precaution

24. Management : Grade-I • Hospitalisation • Antibiotics • Prophylactic anti tetanus / anti gasgangrene serum. • Analgesic and sedatives

25. Grade-II • Antibiotics • Blood transfusion if required • Surgery – evacuation of uterus - Posterior colpotomy

26. Grade-III • Antibiotics • Clinical monitoring • Supportive therapy • Active surgery • Injury to uterus / bowel • Foreign body • Unresponsive peritonitis • Septic shock / oliguria • Uterus bulky evacuate from below • Laparotomy

27. Unsafe abortion : • The procedure of termination of unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking minimal standards or both.

28. Thank you

29. 1) 15 • 2) 13 • 3) 14 • 4) 12 Most septic abortions occur before which week of pregnancy

30. Approximately 50% abortion are caused by : a) Ch. Abmormalities b) Maternal hypothyroidism c) Maternal toxoplasmosis d) Incompetent cx OS

31. An inevitable abortion can be clinically differentiated from threatened abortion a) Closed cervical os b) Increasing bleeding c) Absence of membranes d) Open cervical os

32. Most common cause of early abortion is a) Maternal DM b) Abnormal zygote development c) Corpus luteum insufficiency d) Maternal hypertensive disorder

33. All of the following are characteristic of threatened abortion except a) Presence of vaginal bleeding b) Pain in lower abdomen c) Cervical os open d) Uterus corresponds to period of gestation