ABORTION, ANC, AND

CS
FOCUS+ LECTURE SERIES
ABORTION

• Pregnancy loss before the age of foetal viability.

• Expulsion or extraction from its mother of a foetus weighing less than 500g.
• May be spontaneous or induced.
• Spontaneous abortion is the most common complication of pregnancy.
• Spectrum of spontaneous abortion: threatened, complete, incomplete, inevitable, missed,
septic, recurrent abortion.
• Up to 25% of pregnancies are lost before being chemically or clinically evident
ABORTION

• Up to 15% of clinically evident pregnancies end in spontaneous abortion.

• 80% of spontaneous abortions occur in the first trimester.’
• Chromosomal abnormalities are the most common cause of first trimester abortion.
• An abnormal karyotype is present in up to 50% of first trimester spontaneous abortions.
• As a group autosomal trisomies are the commonest chromosomal anomaly found,
trisomy 16 being the most common.
• Turner’s syndrome is the single most common chromosomal anomaly.
CLINICAL FEATURES OF ABORTION

• Unlike in ectopic pregnancy, vaginal bleeding precedes abdominal pain.

• In threatened abortion, there is bleeding PV, with some or no abdominal pain, the cervical
os is closed, and the uterus is normal sized.
• In complete abortion, all products of conception (POC) have been expelled. The cervical
os is therefore closed, and there is minimal or no abdominal pain, minimal or no vaginal
bleeding.
• In incomplete abortion, there is expulsion of some but not all of the POC from the
uterus. Bleeding and pain persists until all the products have been expelled, often
requiring evacuation.The cervical os is open.
CLINICAL FEATURES OF ABORTION

• In inevitable abortion, the products of conception are yet to be expelled, but the cervical
os is open, with bleeding and pain.
• Missed abortion: product of conception is retained within the uterus after embryonic or
fetal demise. There is cessation of pregnancy symptoms, uterus is often smaller than
expected for date; often, there are no symptoms, but there may be bleeding and pain. The
cervical os is closed.
• Septic abortion: retained POC becomes infection, or following unsafe abortion. Often
polymicrobial. Fever, chills, malaise, abdominal pain, bleeding PV, foul smelling vaginal
discharge.
ETIOLOGY OF ABORTION

• Genetic causes
• Anatomic factors: cervical incompetence, uterine anomalies
• Infections
• Endocrine causes: poorly controlled DM, thyroid disorders, hyperprolactinemia
• Thrombophilia/Immunologic causes
• Toxins: alcohol, tobacco, illicit drugs
• Trauma
TREATMENT, ABORTION LAW IN NIGERIA AND
POST ABORTION CARE (PAC)
• Treatment: depends on type and cause.
• Restrictive abortion law, only if there is congenital anomaly incompatible with fetal life or
the mother’s life is threatened.
• PAC is care given to a woman who had an abortion, to prevent maternal mortality and
reduce maternal morbidity.
• Components of PAC: treatment, counselling, contraception, reproductive and other
health service, community and service provider partnership.
SBA

• Which one of the following is true regarding septic abortion?

a. It is a more common cause of maternal death than malaria
b. Should be treated by immediate curettage in all cases
c. Married women are more affected than teenagers
d. May predispose to primary infertility in affected patients
e. Is frequently due to a combination of staphylococcus and streptococcus
SBA

• The commonest cause of first trimester miscarriage is:

a. Chromosomal abnormalities
b. Syphilis
c. Rhesus isoimmunization
d. Cervical incompetence
e. Luteal phase deficiency
SBA

• 14 weeks pregnant woman had abortion and she was told that it is a complete abortion.
This is true regarding complete abortion:
a. Uterus is usually bigger than date
b. Cervical os is opened with tissue inside the cervix
c. Need to have evacuation of the uterus
d. After complete abortion there is minimal or no pain and minimal or no bleeding
e. Follow up with β-HCG for one year
ANTENATAL CARE (ANC)

• Antenatal care is a specialized pattern of care organized for pregnant women to enable
them attain and maintain a state of good health throughout pregnancy and improve their
chances of having safe delivery of healthy infants at term.
• It is a planned programme of information, education and medical management of the
pregnant woman aimed at making pregnancy and child birth a safe and satisfying
experience.
• ANC models: traditional ANC, WHO focused antenatal care (FANC), WHO 2016 model,
reinforced in 2018.
AIMS OF ANC

• Identification of pre-existing maternal health conditions.

• Screening/prevention of maternal/fetal problems.

• Management of maternal/fetal problems.

• Birth preparedness and complication readiness.

• Preparation of the couple for child rearing.

TRADITIONAL ANC

• Traditional ANC: 4weekly visits until 28 weeks, 2weekly visits from 28 weeks to 36
weeks, weekly visits from 36 weeks until delivery.

• More visits are scheduled for high risk pregnancies and as otherwise indicated.

• Postnatal visit at 6 weeks postpartum.

• Many of its components have not been subjected to rigorous scientific evaluation to
determine their effectiveness.
FANC

• Introduced in 2002, an evidence-based, goal-oriented, and family centered pattern of care,

which emphasizes quality over quantity as a means of achieving safe motherhood.
• Limits number of visits, restricts tests, clinical procedures and follow-up actions to those
that have been shown to improve outcomes for women and newborns.
• Four visits- First visit; 8-12 weeks; second visit: 24-26 weeks; third visit: 32 weeks; fourth
visit: 36-38 weeks.
• Postpartum visit within one week of delivery.
KEY COMPONENTS OF ANC

• Nutritional interventions
• Lifestyle advice
• Maternal assessment
• Foetal assessment
• Preventive measures
• Mgt of common physiological symptoms of pregnancy
• Birth preparedness and complication readiness.
SBA

• The focused antenatal visit is how many visits in Nigeria?

a. 5
b. 4
c. 6
d. 8
e. 9
SBA

• The goals of focused antenatal care include all except:

a. Psychotherapy with the mother
b. Early detection of pre-existing disease
c. Early detection and prompt management of complication
d. Preparedness for child delivery
e. Complication readiness
SBA

• Which of the following is false of antenatal care?

a. Has been shown to categorically improve pregnancy outcomes
b. Is essentially a screening process
c. Antenatal education is a component
d. Unbooked pregnancies have the worst outcome
e. The key to good care is history taking.
CAESAREAN SECTION (CS)

• An intentional surgical incision on the abdomen and uterus to deliver the fetus, placenta
and membranes.
• Category 1 (Emergency CS): There is foetal or/and maternal compromise that is
immediately life threatening. Eg abruptio placentae, cord prolapse, scar rupture. Deliver
within 30minutes.
• Category 2 (Urgent CS): There is foetal or/and maternal compromise that is not
immediately life threatening. Eg deteriorating CTG, borderline scalp pH. Deliver within
60-75 minutes.
CS

• Category 3 (Scheduled CS): Currently no foetal/or maternal compromise but requires

early deliver. Eg ruptured fetal membranes at term.
• Category 4 (Elective CS): Delivery is times to suit the mother ad maternity staff. Eg 2
previous lower segment CS.
• Types: Lower uterine segment, classical, De Lee, perimortem CS
• Indications: Repeat CS, CPD, abnormal Fetal lie and malpresentation, FHR abnormalities
• Complications: maternal/foetal, intra-op, immediate/early post-op and long term
complications
SBA

• What category of CS is abruptio placentae with a live fetus?

a. 1
b. 2
c. 3
d. 4
e. 5
SBA

• Which is the commonest indication for CS?

a. Previous CS
b. CPD
c. Fetal malpresentation
d. FHR abnormality
e. None of the above
SBA

• Delivery in category 1 CS should be completed within:

a. 30 minutes
b. 1 hour
c. 75 minutes
d. 1-2 weeks
e. At the convenience of the mother and hospital staff