Abortion

Definition
• Termination of preg by any means
before the period of viability

(<20 wks; <500gms)

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 Abortion
• Incidence 10-15%

• Types spontaneous
induced

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 Abortion
• Etiology
fetal factors :
chromosomal aberrations(30-45%) &
structural anomalies

maternal factors :
infections :HSV, CMV , Rubella ,toxo
hyperpyrexia →fetal anoxia

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 Maternal causes contd
• Systemic diseases : DM,
autoimmune diseases
• uterine causes :cong.
Malformations of ut , cervical
incompetence
• immunological factors :APA syndrome

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 Signs& symptoms
• Pain
• Bleeding
• Dilatation of cx
• Expulsion of part or entire product of
conception

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 Types of abortions
(depending on signs &symptoms)
• threatened abrn
amenorrhea, lower abd. Pain, low
back ache, slight bleeding p/v
soft ut&cx, MA =GA
USG -viable preg

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 Abrns contd
• Inevitable abrns : complete separation of
embryo from uterine wall.
Bound to be expelled.
Symptoms and signs
Severe pain/bleeding p/v / dilated cervix

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• Incomplete abortion
When the products of conception is partially
expelled and partially retained.
h/o bleeding/passage of products and clots/os
open
• Complete abortion
Complete expulsion of products of conception.
Pain and bleeding subsides .os closed

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• Missed abortion
Early symptoms of abortion subsides without
passage of products of conception.
Ovum dies and retained in the uterus.
Early pregnancy-products of conception
changed into a brownish /shaggy mass-
carneous mole.
If occurring late shriveled sac with
macerated fetus
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 Differential dx
• DUB
• Implantation bleeding
• Ectopic pregnancy
• Molar pregnancy

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 Treatment

Threatened abortion
Rest
• Prognosis
75% continues normally after threatened
abortion
Slightly increased risk of PTL/IUGR/APH

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 Contd..
• Inevitable abortion
Wait for spontaneous expulsion /if bleeding
profuse –evacuation.

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 Contd..
• Evacuation of uterus under aseptic conditions
Manual/instrumental under anesthesia
• Manual cervix should be dilated .GA <12 -
14weeks.using fingers/ovum forceps/sponge
forceps. Cervix if not fully dilated-using Hegars.
• Instrumental suction evacuation-vacuum
syringe/suction apparatus
• Supportive measures
• antibiotics

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• Missed abortion
If not evacuated within 5-6 weeks there is
chance of developing coagulation
disorders.
Can be evacuated by medical or surgical
means
Medical PG

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Septic abortion

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 Diagnosis
• History
• Investigations :r/o DM,syphilis, other
infectios (TORCH)
• HSG
• Karyotyping of parents in rec. abrns
• LAC, Anticardiolipin ab
• USG

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 Cervical incompetence
Congenital/acquired lack of sphincteric
action of internal cervical os.
h/o sudden rupture of bag of water followed
by painless expulsion of immature fetus
and placenta
Dx easy passage of no 8 or 10 Hegars
Easy pulling of inflated balloon catheter
TVS--.funneling of internal os
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 Cervical incompetence
• Treatment
Reinforcing of weak cervix with a suture.14-
24 weeks (cerclage)
• Procedures
Mc Donald’s
Shirodkar’s
Modified Shirodkar’s
Success rate 80-90 % with cerclage

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