University of Perpetual Help-Dr. Jose G.

Tamayo Medical Center

Sto. Niño, Biñan, Laguna

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

ABORTION

LOUISE B. DEL ROSARIO

Presentor
 ABORTION
■ spontaneous or induced termination of
pregnancy before fetal viability
■ before 20 weeks gestation or with a
fetus born weighing < 500 g
■ <12 weeks gestationEARLY
■ >12 -20 weeks LATE
 ABORTION

■ Terms clinically used for pregnancy

losses:
1) Spontaneous Abortion
2) Recurrent Abortion
3) Induced Abortion
FIRST-TRIMESTER
SPONTANEOUS
ABORTION
 SPONTANEOUS ABORTION

– More than 80% of abortions occur in the

first 12 weeks of pregnancy
– At least half result from chromosomal
anomalies
– The risk of spontaneous abortion increases
with parity as well as with maternal and
paternal age
 Factors known to influence
Spontaneous Abortion
■ FETAL FACTORS
– Anembryonic (blighted ovum)- 50%
– Embryonic miscarriages – 50%
– Chromosomal anomalies - aneuploid abortions, euploid abortions

■ MATERNAL FACTORS
– Infections (Chlamydia trachomatis)
– Medical Disorders (diabetes mellitus and thyroid disease)
– Medications
– Cancer
– Surgical Procedures
– Nutrition (Dietary deficiency and obesity)
– Social and Behavioral (illicit drugs, cigarette smoking, excessive caffeine)
– Occupational and Environmental

■ PATERNAL FACTORS
– Increasing paternal age
– Chromosomal abnormalities in sperm
CLINICAL CLASSIFICATION OF
SPONTANEOUS ABORTION
■ THREATENED ABORTION
■ COMPLETE ABORTION
■ INCOMPLETE ABORTION
■ INEVITABLE ABORTION
■ MISSED ABORTION
■ SEPTIC ABORTION
 DIFFERENT TYPES OF ABORTION
Contractions Bleeding Cervical Uterus BOW Others
Dilatation & AOG

Threatened +/- +/- Closed = Intact (+) FHT

Imminent ++ + Open = Intact (+) FHT

Inevitable +++ ++ Open ‡ Ruptured (+) FHT

Incomplete +/- ++ Open ‡ Ruptured or Passage of

unappreciable meaty tissue

Complete - +/- Closed ‡ Unappreciable Absent signs

of pregnancy
Missed - Spotting Closed ‡ Unappreciable (-) FHT

Clinical Practice Guidelines on abortion 2nd Edition (2015)

SIGNS AND SYMPTOMS
OF ABORTION
 Symptoms and Signs Typically Symptoms and Signs Sometimes Probably Diagnosis
Present Present

Light bleeding Cramping Threatened miscarriage

Closed cervix
Uterus corresponds to date
Heavy bleeding
Dilated cervix
Uterus corresponds to dates
Heavy bleeding
Dilated cervix
Uterus smaller than dates
Light bleeding
Closed cervix
Uterus smaller than dates
Uterus softer than normal
Bleeding
Dilated or closed cervix
Uterus may or may
correspond to dates
Lower abdominal pain
Uterus softer than normal
Cramping Inevitable miscarriage
Lower abdominal pain
Tender uterus
No expulsion of POC
Cramping Incomplete miscarriage
Lower abdominal pain
Partial expulsion of POC
Light cramping Complete miscarriage
Lower abdominal pain
History of expulsion of POC
Cramping Septic miscarriage
Lower abdominal pain
not Tender uterus
PPOC may or may not be retained
Fetus may be alove or dead
Fever
Clinical Practice Guidelines on abortion 2nd Edition (2015)
MANAGEMENT
SURGICAL MANAGEMENT EXPECTANT
MANAGEMENT
Acceptable as standard Acceptable alternative
and traditional practice
Higher risk of incomplete
miscarriage and bleeding
Subsequent need for
surgical emptying of the
uterus.

Antibiotics are indicated management where there are signs of infections in a case of
incomplete abortion, especially when unsafe abortion is suspected.
 RECURRENT
MISCARRIAGE
RECURRENT MISCARRIAGE
■ Other terms
– recurrent spontaneous abortion
– recurrent pregnancy loss
– habitual abortion
■ Defined as three or more consecutive
pregnancy losses at ≤ 20 weeks or with a
fetal weight < 500 grams.
RECURRENT MISCARRIAGE
ETIOLOGY
■ PARENTAL CHROMOSOMAL ABNORMALITIES
– 47,XXY or Klinefelter syndrome
■ ANATOMICAL FACTORS
– Uterine leiomyomas, Congenital tract anomalies
■ IMMUNOLOGICAL FACTORS
– Systemic Lupus Erythematosus
■ ENDOCRINE FACTORS
– Uncontrolled diabetes, overt hypothyroidism
 MIDTRIMESTER
ABORTION
Midtrimester fetal loss extends from the end of the first
trimester until the fetus weighs ≥ 500 g or gestational
age reaches 20 weeks
Cervical Insufficiency
■ known as incompetent cervix
■ a discrete obstetrical entity characterized
classically by painless cervical dilatation in the
second trimester.
■ Risk factors- previous cervical trauma, in utero
exposure to diethylstilbestrol (DES)
■ Evaluation and Treatment
– Sonography is performed to confirm a living fetus
with no major anomalies
– Classic cervical incompetence is treated surgically
with cerclage, which reinforces a weak cervix by a
purse-string suture.
INDUCED ABORTION
defined as the medical or surgical termination of
pregnancy before the time of fetal viability
 INDUCED ABORTION
CLASSIFICATION
■ Therapeutic Abortion
– most common indication currently is to
prevent birth of a fetus with a significant
anatomical, metabolic, or mental deformity
■ Elective or Voluntary Abortion
– the interruption of pregnancy before
viability at the request of the woman, but
not for medical reasons
TECHNIQUES FOR
ABORTION
Manual Vacuum Aspiration
 COMPLICATIONS
■ Retained products of conception
■ Hemorrhage
■ Infections
■ Perforations
■ Cervical lacerations
References

■ William’s Obstetrics 24th Edition

■ Comprehensive Gynecology 6th Edition (2012)
■ Clinical Practice Guidelines on abortion 2nd Edition
(2015)
THANK YOU
The end