Abortion

Abortion
Dr. Jafrin Yasmin Choudhury

Assistant Professor
Department of Gynaecology and Obstetrics
• Definition: Termination or disruption of pregnancy before the age of
viability with or without expulsion of product of conception is called
abortion.
• Type : 1.Spontaneous—a. threatened
b. incomplete
c. complete
d. inevitable
e. missed
f. setic
2. Induced—a. legal
b. Illegal
• Cuases of bleeding in pregnancy:
First trimester:
1.Genetic factors….triosomoy
. polyploidy
2.Endocrine disorder..luteal pahse defect
Hypothyroidism
Hyperthyroidism
Diabetes mellitus
3.Immunological disorder: Autoimmune & alloimmue
4. Infection…rubella,cmv ,toxoplasma,chlamydia,
5.Unexplained
2nd trimester:
1. Anatomical abnormality…unicornuateand bicornuate uterus,uterine
fibroid, synechiea
2. Cervical incompetence
3. Medical illness
4. Unexplained.
Difference between threatened and incomplete abortion
Type Threatened abortion Incomplete abortion
Definition It is the clinical entity where the process of It is the type of abortion where part of product of
abortion started but has not progressed to a conception is remain inside the uterus.
state from which recovery is impossible
Symptoms 1. Slight p/v bleeding History of paasage of fleshy mass followed by.
2. Slight lower abdominal pain. 1. Severe p/v bleeding
2. Severe lower abdominal pain.
Sign : Height of uterus correspond to gestational Height of uterus smaller than to gestational age
P/A: age
P/V/E Bleeding if any, escape through external os Cervical os admit tip of finger
Cervis feel soft Vary amount of bleeding
Investigation: Routine invt. Usg of pregnancy profile
Cbc, blood grouping and Rh typing, fbs and : retained product of conception in the uterine cavity
rbs 2hrs after breakfast, S.TSH, .
Urine R/M/E, usg of pregnancy profile: fetal
cardiac activity present
Treatemnet: 1.Rest Surgical method: D&C under G/A

2. analgesics Medical method: tablet misoprostol 200 mirogram
3.angiolytic vaginally every 4 hourly.
4.progesterone…it quisent the uterine
smooth muscle contraction
• Fate of threatened abortion:
2/3rd ….continuation of pregnancy….
fate.
preterm labour,
placenta previa,
IUGR,
fetal anomalies
1/3rd …inevitable abortion
Missed abortion.
INEVITABLE ABORTION: It is the type of abortion where abortion
process started, and continuation of pregnancy is impossible .
Symptoms: severe LAP
Severe p/v bleeding
Sign:
p/a : height of uterus smaller than gestational age.
p/v: cervical os dilated and product of conception is felt through the
os.
• Management:
• Before 12 weeks: Dilatation and evacuation by blunt curettage
underG/A.
• After 12 weeks: oxytocin drip 40-60 drops/min, after expulsion of
product, then curettage.
Complete abortion : when poc expelled en masse,called complete abortion.
Sympotoms : h/o expulsion of poc follwed by subsidence of p/v bleeding.
Cervical os closed.uterus not palpable.
Investigation : USG OF UT AND ADNEXA.. uterus is empty.
Treatment: if Rh negative the anti-D INJ.
Missed abortion: when fetous is dead and retained inside the uterus for a
variable period of a time is called missed abortion.
Symptoms : features of threatened abortion
Persistence of brownish vaginal discharge.
Subsidence of pregnancy symptoms
Regression of breast change
Sign: uterus is smaller than gestational age,
Cervix feel firm.
• Investigation: Cbc,
blood grouping and Rh typing,
fbs and rbs 2hrs after breakfast,
S.TSH,
Coagulation profile
Urine R/M/E,
usg of pregnancy profile:
fetal cardiac activity absent.
Management :
Expectant mx: spontaneous expulsion
Medical mx: less than 12 weeks:
Misoprostol 800 microgram pervaginally single dose then
repeat after 24 hours, then dilatation and evacuation .
More than 12 weeks: misoprostol 200 microgram pervaginally every 4
hourly for maximum 5 dose.
• Oxytocine..10-20unit in 500 ml normal saline after expulsion
evacuation and curettage.
Complication :
Haemorrage,shock,infection,DIC.
• Septic abortion :Any abortion associated with infection of uterus is called septic bortion.
Clinical feature:
• look sick and anxious
• temperature > 38’c
• chill and rigor
• persistent tachycardia
• hypothermia
• abdominal or chest pain
• tachypnea
• impaired mental state
• diarrhea or vomiting
• renal angle tender
• p/n/e… offensive, purulent vaginal discharge, uterus tender, boggy feel in pod.
Clinical grading:
• grade..1…infection localized to uterus
• grade 2.. infection spread to parametrium, f.t,ovaries, pelvic peritoneum.
• Garde 3..generalized peritonitis,
• endotoxic shock, acute renal failure
• Investigation:
• High vaginal swab for gram stain and culture sensitivity
• Blood : Cbc, blood grouping and Rh typing,
• fbs and rbs 2hrs after breakfast,
• S.TSH
• S. electrolyte
• S.Creaatinin
• C reactive protine
• Coagulation profile
• Blood culture
• Urine R/M/Eand culture sensitivity
• CXR
• Plain x-ray abdomen
• usg of whole abdoen.
Management :
• General mx:
• hospitalization
• blood transfusion for anemia
Specific mx:
• grade 1: broad spectrum antibiotics for 24 hours followed by
evacuation and curettage
• grad 2: broad spectrum antibiotics for 48 hours followed by
evacuation and curettage
• grade 3: broad spectrum antibiotics for 72 hours followed by
evacuation and curettage.
Complications:
-Immediate:
• haaemorrage
• injury
• generalized peritonitis
• endotoxic shock
• renal failure
• thrombophlebitis
-Remote:
• chronic debility
• chronic ill health, chronic pelvic pain
• dyspareunia
• secondary infertility
• Ectopic pregnancy
• Depression

Abortion

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Abortion

Dr. Jafrin Yasmin Choudhury

Treatemnet: 1.Rest Surgical method: D&C under G/A

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