Abortion Abortion is the removal or destruction of an embryo or fetus before birth. It may be spontaneous or induced.

Abortion is an extraction or expulsion of an embryo which is capable of independent survival weighing 500 grams or less before the 20 th week of gestation.

Causes of Abortions 1. Genetic Causes Of all chromosomal abnormalities 50 are autosomal trisomies ! most common trisomy is "# $ %econd most common cause of chromosomal anomolies is monosomy & !'5&O$ "5(20 of all spontaneous A)s

 *ouples that share +,A antigens have increase ab rates 2. Environmental causes of Abortion Infections- .ndometritis/ 0oxoplasmosis/ +erpes %moking Alcohol 1adiation 0oxins- Anesthetic agents/ ,ead/ Arsenic/ 2ormaldehyde/ )en3ene/ .thylene oxide 3. Uterine Causes ,eiomyoma of the uterus- fibroids 4terine anomalies- 5.% exposure( 0 shaped uterus/ 4terine adhesions/ 6alformation of the uterus( 4terus didelphys/ unicornate uterus/ bicornate uterus/ uterine septum/ Incompetent cervix( congenital or ac7uired 4. Medical conditions: 5iabetes/ %evere malnutrition/ +yperthyroidism 5. Immunolo ical causes: *lient with recurrent fetal loss have antiphospolipid antibodies 80 of the time

!. Endocrinolo ic causes: 9rogesterone deficiency/ +ypo or +yper thyroidism/ 5iabetes mellitus

"#$es of Abortion %$ontaneous abortion or miscarria es ( is a type of abortion that occur without medical or other intervention. About 25 of all pregnancies result in miscarriages/ women older than :5 or younger than "; years old and couples who have difficulty in achieving pregnancy< and women who have had at least two miscarriages has a higher chance of experiencing miscarriage. About =0 of miscarriages occur during the first trimester !first three months/ or "2 weeks of pregnancy$. %ome cases of miscarriages happen even before a woman reali3es that she is pregnant/ and she even may not reali3e that she has aborted. %#m$toms of Miscarria e: A typical "0th week miscarriage is characteri3ed by a very heavy menstrual period. A pregnant woman may experience several days of bleeding and cramps before the contents of the uterus are removed/ followed by a short period of bleeding until the lining of the uterus heals.

 6iscarriage after the "2th week is like a mild version of the labor of during childbirth/ with strong contractions that dilate the cervix and expel the fetus. 6iscarriages between the ":th and 2'th weeks !second trimester$ are most often caused by faulty attachment of the placenta to the walls of the uterus or from a weak cervix that dilates too soon.

"#$es of %$ontaneous Abortion "&reatened abortion is a condition of pregnancy/ occurring before the 20th week of gestation/ the patient usually experiences vaginal bleeding with or without some cramps/ and the cervix is closed. )ed rest is usually the only treatment needed. In a few cases the symptoms disappear and the rest of the pregnancy is normal. Inevitable abortion is when the bleeding continues and becomes heavy/ it usually means that the cervix is dilating and the contents of the uterus are being expelled. 9regnant women will experience lower abdominal cramping and bleeding. Com$lete abortion is when all the contents are expelled. 0here is no treatment other than rest is usually needed. All of the tissues that came out should be saved for examination by a doctor to

make sure that the abortion is complete. 0he laboratory examination of the saved tissue may determine the cause of abortion. Incom$lete abortion is a name given to abortion where the uterus retains part or all of the placenta. )leeding may occur because part of the placenta may adhere to the uterine wall and the uterus does not contract to seal the large blood vessels that feed the placenta. 0he usual treatment is a drug that induces labor by stimulating uterine contractions/ a surgical procedure called curettage can also be done to remove the remaining material from the uterus/ the goal of this treatment is to prevent prolonged bleeding or infection. Missed abortion ( is a case in which an intrauterine pregnancy is present but is no longer developing normally. )efore widespread use of ultrasonography/ the term missed abortion was applied to pregnancies with no uterine growth over a prolonged period of time/ typically # weeks after its !fetus$ death. A missed abortion is usually indicated by the disappearance of the signs of pregnancy except for the continued absence of menstrual periods. 6issed abortions are usually treated by induction of labor by dilation !or dilatation$ and curettage !5 > *$. Induced abortion ' this type of abortion uses drugs or instruments to stop the normal course of pregnancy.

(ifferent met&ods for $erformin abortions Menstrual E)traction *endometrial or vacuum as$iration+ . 0his method is used for most abortions performed during the first trimester. It is done by suctioning out the lining of the uterus !endometrium$ through a thin opening of the undilated cervix. It is a method used after a woman has ?ust missed a period/ or anytime up to about the eight week or pregnancy. It can be performed safely in the doctor@s office and has a very low rate of mortality. (ilation and Evacuation *( , E+ *also called vacuum suction or suction curettage$ and (ilation and Curetta e *( , C+. 0his method is commonly used for late first trimester or early second trimester abortions. In this method suction is used to remove the fetus and placenta. 0he cervix is first dilated under local anesthesia using a suction tube that is firm/ and a stronger suction is used than in menstrual extraction. Another way of dilating the cervix is the use of a type of dried seaweed/ called laminaria/ which expands as it absorbs moisture. %ome doctors use a hollow/ spoon(shaped knife/ or curette/ to ensure that all the placental tissues are removed by scraping the uterine walls. If curettes are used throughout the procedure instead of suction/ the method is called dilation and curetta e !5>*$. -efore t&e 12t& .ee/ of $re nanc#0 (,E is $referred over (,C because it does not re7uire general anesthesia/ causes less discomfort and is less costly. (,C can be used u$ to t&e 12t& .ee/ of $re nanc#. 0he

mortality rate for both 5>. and 5>* is approximately : per "00/000 abortions. 1rosta landin or %aline Administration. 0his method is done by in?ecting prostaglandins or saline solution through the uterine wall and into the amniotic sac holding the fetus to induce labor and delivery of a nonviable fetus. 0his procedure is commonly used for second trimester abortions. 1rosta landins may cause nausea/ elevated temperatures/ and vomiting but are safer than the saline solution. 6ortality rate for second trimester abortions performed by this method is approximately 20 per "00/000 abortions. 2#sterotom#. 0his method is similar to caesarian section/ the uterus is opened through a small abdominal incision and the fetus is removed. +ysterotomy is usually performed only when other methods have failed repeatedly/ it is performed under general anesthesia. It is used between the "2th and the 2'th week of pregnancy. 0his method has the greatest risk of complications out of all the abortion procedures/ maternal mortality rate is approximately 200 per "00/000 abortions.