DEFINITIONS OF ABORTION

 A medical term for any interruption of a pregnancy before a fetus is viable (Pillitteri, 2018)
 Age of Viability: 20-24 weeks (Pillitteri pg. 529, vol. 1)

1. The expulsion of the fetus and other products of conception from the uterus before the fetus is
capable of living outside the uterus.
2. A procedure to end a pregnancy.
3. A non-induced embryonic of fetal death or passage of POC before 20 weeks of gestation.
4. Expulsion of fetus or embryo from the uterus during the first half of gestation or 20 weeks or less,
or in absence of accurate dating criteria, born weighing <500 grams.

ABORTION

INDUCED

 Ipinalaglag / Induced / Elective

Termination / Therapeutic
 INTENTIONAL (sinadya)
 Planned

 Unskilled (HILOT)
 Medically Induced

MULTI-SYSTEM FACTORS
MISCARRIAGE

 Immunologic
 Genetic
 Metabolic / Endocrine
 Hematologic
 Structural
Substances that can pass UTEROPLACENTAL
CIRCULATION:
1. Oxygen and Carbon Dioxide Diffuses
2. Nutrients and other molecules: CHO,
CHONS. Lipids, minerals, vitamins. electrolytes
and water. HOW? Via
OSMOSIS.
3. Drugs (Teratogenic)
4. Alcohol
5. Nicotine
6. Viruses
7. Antibodies
Abortion
 The standard medical definition of
abortion is the termination of the
pregnancy when the fetus is not viable.
Termination of pregnancy whether
spontaneous or induced.
 Miscarriage - a term used to state that
the loss is spontaneous or unintended.
Can be caused by Placental,
Maternal, or Fetal factors.
 Induced abortion - destruction of
embryo or fetus. It Is intended to end the
pregnancy to save or preserve the life of
the mother. It has deliberate steps to end
a pregnancy.
Clinical Types of Abortion (a continuum)
1. Threatened Abortion
 Very common in the first trimester of
pregnancy.
 Signs and symptoms are
• Vaginal Bleeding
• Abdominal pain or cramping (more severe
cramps lead to inevitable abortion.
• No cervical Dilation or change in cervical
consistency
• No POC passage (kasi closed ang cervix)
*Tests: Ultrasonography - detection of the
gestational sac. If GS is not intact it can be an
Ectopic Pregnancy because UTERINE cavity is
empty. HCG testing levels, normal hcg levels:
fransvaginal: 1500-2400 mlu/ML.
transabdominal: 3000mlU/ML
*25-30% of all pregnancies have some
bleeding due to implantation bleeding.
2. Imminent or Inevitable Abortion
 Vaginal Bleeding (more profuse than
threatened abortion)
 Open Cervical OS
 POC passage
 More cramping is present than
Threatened Abortion
*Products of conception are located in the lower
uterine segment or in the cervical canal.
3. Incomplete Abortion
 Vaginal Bleeding (Heavy bleeding)
 Open Cervical OS
 Passage of POC is Incomplete
 Intense Cramping
*On ultrasound, POC is still present on the
uterus.
Incomplete expulsion of POC.
4. Complete Abortion
 Vaginal Bleeding ~ Open Cervical OS
 POC passage (complete passage)
 Abdominal Pain
*Ultrasound detects that the Uterine Cavity is
Empty.
*After the tissue/ POC passed, the patient will
later notice that the pain subsides, VB
significantly diminishes, No tenderness in the
uterus or abdomen.
5. Missed Abortion (undetected)
Non-viable intrauterine pregnancy that has been
retained within the uterus without spontaneous
abortion. No symptom besides amenorrhea, the
patient finds out that the pregnancy stopped
developing earlier when FHT is not observed or
heard at the appropriate time.
 NO vaginal Bleeding or Scanty only
 NO abdominal pain or pressure
 NO Passage of POC
 NO cervical Changes
*Missed abortion may later cause bleeding
because the POC is retained inside the uterus,
that later will cause expulsion of POC, until
complete abortion or expulsion of POC is done.
Mag progress din into complete abortion para
hindi magkaroon ng complications. Kapag hindi
naexpell lahat ng POC, it may cause deadly
complications.
6. Septic Abortion (d/t/ self induced/hilot)
 Usually caused by an induced abortion
done by unskilled practitioners using
a non-sterile technique.
 Typical causative organisms include
Escherichia coli, Enterobacter
aerogenes, Proteus vulgaris, hemolytic
streptococci, staphylococci, and some
anaerobic organisms (eg, Clostridium
perfringens). One or more organisms
may be involved.
 Symptoms and signs (e.g., chills, fever,
vaginal discharge, peritonitis, vaginal
bleeding) typically appear within 24 to
48 hours after an abortion.
Miscarriage in 1st Trimester
1. Chromosomal Aberrations (most common)
- a condition in which part of a chromosome has
broken off and reattached to another location.
Genetic translocation has all the genetic material
necessary for growth, but when the parents' cells
divide to create an egg or sperm cells for
reproduction, it usually ends up with an extra
genetic material or missing genetic material.
• Parents who has Translocation are normal
people, but their gametes has defects on its
chromosomes resulting in abnormal
development that causes abortion.
• 50-70% of miscariages are caused by
CHROMOSOMAL ABNORMALITIES.
• Chromosomal Abnormalities are associated
with the increasing age of a woman.
Significant number of miscarriages are caused
by a disorder where there are 3 copies of a
chromosome instead of two copies or also called
as TRISOMY.
2. Endocrine and Metabolic Disorders
 Uncontrolled Diabetes Mellitus
/Gestational Diabetes *People who
have uncontrolled DM, have elevated
blood sugar levels which is a result of an
increase in insulin resistance.
*Insulin resistance- Insulin resistance (IR) is a
pathological condition in which cells fail to
respond normally to the hormone insulin. It
occurs when blood cells begin to reject insulin
because of poor dietary choices or inability of
cells to convert glucose into energy (glycolysis).
 Elevated Levels of insulin interferes
with the normal balance between
clotting factors and anti-clotting
proteins.
 Elevated insulin levels results in very
high chance of blood clotting at the
interface between the uterine lining and
the placenta, THAT LEADS TO
PLACENTAL INSUFFICIENCY &
FAILURE OF THE PLACENTA TO
SUPPLY NUTRIENTS TO THE
FETUS AND REMOVE TOXIC
WASTES THAT LEADS TO
MISCARRIAGE.