3.
Inevitable abortion- is when the
ABORTION- the expulsion of the
products of conception before the
embryo or fetus is viable. any
interruption of human pregnancy
prior to the 20 to 24 weeks of
gestation or the delivery of a fetus
weighing less than 500 grams..
early abortion- before 12 weeks
late abortion- 12 weeks onwards
1. SPONTANEOUS ABORTION- is a
type of abortion that occur without
medical or mechanical intervention
2. THREATENED ABORTION- is a
condition of pregnancy, occurring
before the 20th week of gestation
in which the patient usually
experiences vaginal bleeding with
or without cramps. and the cervix
is closed.
MANAGEMENT THREATENED
ABORTION
1. Conservative with bed rest and
reassurance till bleeding stops.
2. Sexual intercourse best
avoided.
3. Follow up with ultrasound-
presence of fetal cardiac activity
predicts good outcome in 95% of
cases.
4. Hormone therapy -400mg
natural progesterone orally or
vaginally
bleeding continues and becomes
heavy, the cervix is dilating and the
contents of the uterus are being
expelled. pregnant women will
experience lower abdominal
cramping and bleeding.
4. COMPLETE ABORTION- is when
all the products of conception are
expelled. (history of bleeding, pain,
passage of tissue) (at present, none
to mild cramping, closed cervix
light bleeding)
5. INCOMPLETE ABORTION- is a
name given to abortion where the
uterus retains part or all of the
placenta. bleeding 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, cramp and cervical
dilatation may also Occur
6. MISSED ABORTION- is a case in
which an intrauterine pregnancy is
present but is no longer developing
normally. a missed abortion is
usually indicated by the
disappearance of the signs of
pregnancy except for the continued
absence of menstrual periods.
MISSED ABORTION also known as
early pregnancy failure
* This drugs causes uterine
contraction and birth
* Misoprostol Cytotec
* Mifepristone
SIGNS
1. ABSENCE OF FHT
2. SIGNS OF PREGNANCY
DISAPPEAR
* UTERUS FAILS TO ENLARGE
* FHT ARE NOT HEARD
* NEGATIVE HCG
* UTZ SHOWS NO CARDIAC
* ACTIVITY
7. SEPTIC ABORTION- IS A
SPONTANEOUS OR THERAPEUTIC
ABORTION COMPLICATED BY A
PELVIC INFECTION.
Signs and Sympotoms
1. FOUL SMELLING VAGINAL
DISCHARGE
1. UTERINE CRAMP
2. FEVER, CHILLS, PERITONITIS
3. LEUKOCYTOSIS - high white
blood cell count.
4. SIGNS OF SEPTIC SHOCK
8. INDUCED ABORTION- is a type of
abortion that uses drugs or
instruments to stop the normal
course of pregnancy.
9. RECURRENT /HABITUAL
ABORTION- any case in which there
have been three consecutive
spontaneous abortions. also called
habitual abortion.
CAUSES OF ABORTION
A. FETAL
1. CHROMOSOMAL ANOMALIES-
50%-80% OF ABORTIONS IN THE
FIRST
12 WEEKS OF PREGNANCY RESULT
FROM CHROMOSOMAL
ANOMALIES
2. DISEASES OF THE FERTILIZED
OVUM.
3. HYPOXIA.
B. MATERNAL
1. infections e.g. influenza,
malaria, syphilis ,hiv
2. disease such as chronic
nephritis.ib
2. drug intake during pregnancy
3. rh and abo incompatibility
4. incompetent cervix
5. uterine malformation
6. aquired uterine defeci as
uterine fibroid or adhesions
9. trauma - criminal
interference
10. endocrine disorder as
hypothyrodism, diabetes mellitus
12. severe malnutrition
Signs of abortion
1. Vaginal bleeding or spotting,
mild to severe
2. Uterine or abdominal
Cramps
3. Passage of tissues or products of
conception
4. Signs related to blood loss
(tachycardia, pallor, etc.)
Complications
1. Hemorrhage
2. Infection
3. Disseminated intravascular
4. Coagulation (missed abortion]
(disturbance of the blood clotting
mechanism, several clots in some
vessels, several bleedings in other
areas of the body)
Inevitable abortion
1. Immediate evacuation of
pregnancy.(if duration of
pregnancy is less than 12
Weeks- suction evacuation and
greater than 12 weeks
Oxytocin infusion.)
2. Shock-resuscitation with iv fluids
and blood transfusion.
Incomplete abortion
1. Resuscitation if patient is in
shock and evacuation by suction
Evacuation. (if duration of
pregnancy is less than 12 weeks-
suction evacuation and greater
Than 12 weeks oxytocin infusion.
2. If the opening is closed pge1
tablets are kept in vagina for
ripening the cervix.
* PGEI
* Misoprostol or Cytotec available
dose 100 to 200 mg tablets can be
administeled orally or vaginally -
given to terminate pregnancy
RhoGAM: an immunoglobulin
which suppresses Anti-D antibody
formation in an Rh - mother with a
confirmed or suspected Rh + infant.
This decreases the risk of antibody
formation form 12-13% to 1-2%.
Complete abortion
1. Conservative treatment
Missed abortion
1. uterus evacuated as soon as
possible. A donor should be kept
ready.
2. if uterine size is less than 12
Weeks of gestation pge1 tablets
Kept in vagina
* ventilation.
* NSG Interventions
* Do not allow bathroom privilege
* After bedpan use, inspect
contents carefully for intrauterine
material.
* Note the amount, color, and odor
of vaginal bleeding.
* Assess vital signs every 4 hours
for 24 hours or more frequency,
depending on the extent of
bleeding.
* Monitor urine output closely.
* Check the patient's blood type
and administer RhoGAM as
ordered.
* Provide emotional support and
counseling during the grieving
process.
* Encourage the patient and her
partner to express their feelings.
* Proper perineal wash front to
back to avoid bacteria like
enterococci, staphylococci
Septic abortion
1. mild cases-broad spectrum
2. Antibiotics are started and
uterus evacuated severe cases-
maintenance of perfusion and
3. blood transfusion
4. oxygen given by nasal catheter.
5. Ampicillin,gentamycin and
metronidazole/thirdgeneration
cephalosporine like cefotaxime or
cefuroxime with metronidazole or
clindamycin.
6. Evacuation of uterusafter
infection is controlled.
Recurrent miscarriage
1. Due to cervical incompetence
A. Cervical cerclage
B. Sonography is done to confirm
Live fetus
C. If there is infection, it should be
treated and sexual intercourse
should be avoided
Contraindications-bleeding,
contractions, ruptured membranes
1. Mcdonald's cerclage
Patient is in lithotomy position and
cervix is exposed with sim's
speculum. The cervical lips are held
with sponge holding forceps and a
purse string suture with a non
absorbable material like black silk is
taken all around the cervix.
2. Modified shirodkar's cerclage
small transverse incision is made
on anterior lip of cervix at
cervicovaginal junction 2cm
Above the external os. Bladder is
then pushed up and a suture of
black silk or mersilene tape is
passed from anterior to posterior
aspect submucosally using
Shirodkar's Or Any Curve Bodied
Needle.
APAS -Antiphospholipid syndrome
is a condition in which the immune
system mistakenly creates
antibodies that attack tissues in the
body. These antibodies can cause
blood clots to form in arteries and
veins. Blood clots car-form in the
legs, lungs and other organs, such
as the kidneys and spleen.
* ABO incompatibility is the most
common maternal-fetal blood
group incompatibility and the most
common cause of hemolytic
disease of the newborn (HDN).
* ABO incompatibility is one of the
most common reasons of bilirubin
encephalopathy,
* A-B-O incompatibility occurs
when:
* the mother is type O and the
baby is B, A, or AB.
* the mother is type A and their
baby is B or AB.
* the mother is type B and their
baby is A or AB.
*
* A D&C is a minor surgical
procedure to remove tissue from
your uterus. A gynecologist or
obstetrician performs this surgery
in their office or a surgery center
* A miscarriage.
* Leftover tissue in your uterus
after an abortion.
* Unexplained bleeding between
menstrual periods.
* stepsdilate your cervix using a
laminaria stick.

* may give you medication to relax

and sedate you,

* Suction DE.C

During the procedure, you lie on a

table with your feet in stirrups, like
during a gynecologic exam. Your
provider will:

* Insert a speculum into your

vagina. This smooth device, shaped
like a duck's bill, helps open your
cervix.

* Use a clamp to hold your cervix in

place.

* Make sure your cervix is

sufficiently dilated, using a series of
rods to open it slowly.

* Use a curette, a type of suction or

scraping device, to clean out tissue
from your uterus.

* Send a sample of the tissue to a

laboratory for analysis.