Abortion

Dr. Awatif Shamata

 By
Dr. Awatif Shamata
Omar Al-Mukhtar University
Al-Bayda, Libya

Dr. Awatif Shamata

 Abortion
Definition:
Expulsion of the uterine contents of the gravid uterus before full term.

Spontaneous abortion Induced abortion

Dr. Awatif Shamata

 Spontaneous abortion
Common causes of spontaneous abortion:

1. Disease of the mother.

✓ General disease, such as fever, nephritis and HTN.
✓ Local disease, such as fibroid and bicornuate uterus.

2. Disease of the fetus, membrane or placenta, such as

✓ Vesicular mole.
✓ Hydramnios.
✓ fetal deformity.
Dr. Awatif Shamata
 Induced abortion

Therapeutic (lawful) abortion Criminal (unlawful) abortion

Dr. Awatif Shamata

 Therapeutic (lawful) abortion
It is performed by a doctor to save the mother’s life in some situations related to
mother or pregnancy:
✓ Extensive pulmonary tuberculosis.
✓ Chronic renal failure.
✓ Decompensated heart failure.
✓ Uncontrolled DM.
✓ Advanced HTN.
✓ Invasive carcinoma of cervix and uterus.
✓ Pre-eclampsia and eclampsia.
✓ Persistent bleeding.
Dr. Awatif Shamata
 Therapeutic (lawful) abortion
Methods employed to induce therapeutic abortion:
1. Dilation and Curettage (D & C).
2. Suction aspiration of the fetus and membranes.
3. Hystereotomy.

Dr. Awatif Shamata

Vacuum aspiration
 Therapeutic (lawful) abortion
Precautions before performance of therapeutic abortion:
✓ The decision to perform a therapeutic abortion should be arrived at after
consultation of two specialists and a written opinion about the necessity of
induction of abortion should be taken.
✓ A written consent must be taken from the woman and her husband.
✓ It should be done in general or maternal hospital.
✓ It must be done by a specialist.
✓ The cases must be recorded in the hospital files.

Dr. Awatif Shamata

 Criminal (unlawful) abortion
It is performed without any justification cause, i.e. for any reason other than
saving mothers' life.

Medico-legal conditions in which a female is examined for signs of abortion

are:
1. A woman-alleging abortion after a blow in a quarrel.
2. A woman notifying that a medical man gave her some abortifacient drugs.
3. A woman wishing to conceal abortion after being charged with it.

Dr. Awatif Shamata

 Criminal (unlawful) abortion
Methods of induction of criminal abortion:

1. General violence. 3. Abortifacient drugs.

2. Local violence.

Dr. Awatif Shamata

 Methods of induction of criminal abortion
1. General violence
✓ Violence exercise, such as cycling, jumping, carrying a heavy object.
✓ Application of sever force on the wall of abdomen, such as punching, kicking
or tight pressure. These applications may be self-inflicted, or they may be
inflicted by some other ‘helper’.

Dr. Awatif Shamata

 Methods of induction of criminal abortion
2. Local violence
1. Introduction of foreign bodies into vagina, passing them into the uterus →
rupture of the membranes (bleeding and haemorrhage).

Dr. Awatif Shamata

 Methods of induction of criminal abortion
2. Local violence
2. Introduction of plug containing irritant substance into vagina → irritate the
uterus and initiate its contractions (sever congestion or ulceration of the parts).

Dr. Awatif Shamata

 Methods of induction of criminal abortion
2. Local violence
3. Insertion a douche nozzle or a Higginson syringe, forcibly flushing the uterus
with some antiseptic solutions → separates the sac from the interior of the uterus,
and disturbs the pregnancy (embolism).

Douche nozzle Higginson syringe

Dr. Awatif Shamata
 Methods of induction of criminal abortion

3. Abortifacient drugs (Abortifacients are those herbs that may induce

miscarriage/abortion).
✓ Ecbolics.
✓ Drastic purgatives.
✓ General protoplasmic poisons.

Dr. Awatif Shamata

 Methods of induction of criminal abortion
3. Abortifacient drugs
Specific drugs (ecbolics):
➢ Ergot.
➢ Oxytocin.
➢ Quinine.
➢ Lead.
➢ Apiol.

They act directly on the uterine muscle → contraction.

Dr. Awatif Shamata

Ergot: A fungus (Claviceps purpurea) that contaminates rye )‫ (الذره‬and wheat )‫ (القمح‬and that
produces substances (alkaloids) called ergotamines. Ergotamines constrict blood vessels and
cause the muscle of the uterus to contract. They have been much used for the treatment
of migraines. They have also been used and misused to induce abortion. In excess, ergotamines
can cause symptoms such as hallucinations, severe gastrointestinal upset, a type of
dry gangrene, and a painful burning sensation in the limbs and extremities.

Wheat infected with Ergot.

https://www.medicinenet.com/script/main/art.asp?articlekey=7548

Dr. Awatif Shamata

Oxytocin (Oxt) is a peptide hormone and neuropeptide. It is normally produced in
the hypothalamus and released by the posterior pituitary. It plays a role in social
bonding, sexual reproduction, childbirth, and the period after childbirth. Oxytocin is released
into the bloodstream as a hormone in response to stretching of the cervix
and uterus during labour and with stimulation of the nipples from breastfeeding. This helps
with birth, bonding with the baby, and milk production.

Dr. Awatif Shamata

 Quinine is an extract of cinchona tree bark, and the bark itself was used to treat malaria as
long ago as seventeenth century in Peru, South America.

Cinchona
Dr. Awatif Shamata
Apiole is a phenylpropene, also known as apiol, parsley apiol, or parsley camphor. Its
chemical name is 1-allyl-2,5-dimethoxy-3,4-methylenedioxybenzene. It is found in the essential
oils of celery )‫ (كرفس‬leaf and all parts of parsley )‫( (بقدونس‬seeds and leaves of parsley).
In medicine it has been used, as essential oil or in purified form, for the treatment of menstrual
disorders and as an abortifacient. It is an irritant and, in high doses, it can cause liver and kidney
damage. Cases of death due to attempted abortion using apiole have been reported.
Hippocrates wrote about parsley as an herb to cause an abortion. Plants containing apiole were
used by women in the Middle Ages to terminate pregnancies. Now that safer methods of
abortion are available, apiol is almost forgotten.

Dr. Awatif Shamata

 Methods of induction of criminal abortion
3. Abortifacient drugs

Drastic purgatives ‫مسهالت‬:

➢ Jalap.
➢ Colocynth
➢ Castor oil.
➢ Croton oil.

They cause uterine contraction reflex from the strong intestinal irritation
& pelvic congestion.
Dr. Awatif Shamata
Jalap is a cathartic drug ‫دواء مسهل‬, largely obsolete in Western medicine, consisting of the
tuberous roots of Ipomoea purge.

Ipomoea purge

Dr. Awatif Shamata

Carton oil ‫زيت حب الملوك‬ Castor oil ‫زيت الخروع‬
Croton oil is an oil prepared from the Castor oil is a vegetable oil pressed from
seeds of Croton tiglium castor beans.

Dr. Awatif Shamata

 Methods of induction of criminal abortion
3. Abortifacient drugs
General protoplasmic poisons:
➢ Arsenic antimony.
➢ Mercury.

They produce death of the ovum ?→ expulsion.

Arsenic exposure causes placental dysmorphogenesis and

defective placental vasculogenesis resulting in placental
insufficiency and subsequent spontaneous abortion.
https://academic.oup.com/toxsci/article/99/1/244/1635634
Dr. Awatif Shamata
Methods of induction of criminal abortion

Dr. Awatif Shamata

 Diagnosis of abortion
1. History: complete history about the case.
2. Examination:
✓ General examination.
✓ Systemic examination.
✓ Local examination.
3. Investigation:

Dr. Awatif Shamata

 Examination:
General examination?
Signs of pregnancy:
• Hyperpigmentation (Melasma).
• Breast engorgement or tenderness.
• Abdominal wrinkled.

Systemic examination?
Abdominal examination:
• Enlargement uterus.

Local examination?
Dr. Awatif Shamata
 Local examination:
• Offensive vaginal discharge.
• Irritation, bruise, laceration in vagina.
• Bloody vaginal discharge.
• Dilated soft external os.
• Recent cervical lacerations with bloody discharge.

Dr. Awatif Shamata

 Local examination:
❖ Foreign body may be found in vagina or protruding from cervix.
❖ Embryonic tissues may be found in the vagina or protruding from it.
❖ Soapy fluid/ blood stained fluid coming out of vagina.
❖ Blood clots at the scene.

Post-mortem case

Dr. Awatif Shamata

 Investigation:
Blood pregnancy test???
Urine pregnancy test???

Pregnancy hormone: Human Chorionic Gonadotropin

HCG

Dr. Awatif Shamata

 Complications of abortion

3. Neurogenic shock 4. Sepsis 5. Acute poisoning

1. Hemorrhage: 2. Embolism:
✓ Primary hemorrhage. ✓ Amniotic fluid embolism.
✓ Secondary hemorrhage. ✓ Air embolism.
✓ Soap or glycerin embolisms.
✓ Thrombo-embolism.
Dr. Awatif Shamata
 Complications of abortion

Hemorrhage

❑ Primary hemorrhage: ❑ Secondary hemorrhage (delayed

May be fatal. hemorrhage):
Bleeding may be intrauterine (due to May occur few days after abortion,
detachment of placenta) or due to sepsis, which causes
intraperitoneal (due to instrumental dislodgment of the formed clots.
perforation of the uterus).

Dr. Awatif Shamata

 Complications of abortion

Embolism
Embolism:
❑ Amniotic fluid embolism.
❑ Air embolism: injection of fluid into the uterus (with a Higginson
syringe) is a common cause.
❑ Soap or glycerin embolisms.
❑ Thrombo-embolism.

Dr. Awatif Shamata

Complications of abortion

Dr. Awatif Shamata

 Complications of abortion

Neurogenic shock
Sudden death from reflex vagal inhibition of the heart may follow the mere
touching of the cervix with an instrument (e.g. dilator, curette) or too hot or too
cold fluid.

Dilatation of the cervix of an un-anaesthetized woman.

Dr. Awatif Shamata

 Complications of abortion

Sepsis (delayed complication)

This may be due to retention of products of conception or uses of septic
instrument (non-sterile instrument) and lack of antibiotic prophylaxis.

Dr. Awatif Shamata

Dr. Awatif Shamata