ABORTION

Definition
Abortion is the expulsion or extraction from its
mother of an embryo or fetus weighing 500gm
or less when it is not capable of independent
survival (WHO).
 Etiology
1. GENETIC FACTORS
2. ENDOCRINE AND METABOLIC FACTORS
3. ANATOMICAL ABNORMALITIES
4. INFECTION
5. IMMUNOLOGICAL DISORDER
6. MATERNAL MEDICAL ILLNESS
7. BLOOD GROUP INCOMPABILITY
8. PREMATURE RUPTURE OF MAMBRANE
9. PTERNAL FACTORS: Sperm chromosamal anomaly
10.INHERITED THROMBOPHILIA
11.ENVIRONMENTAL FACTORS
12.UNEXPLAINED
SPONTANEOUS
ABORTION
Definition
It is defined as involuntary loss of the
products of conception prior to 28
weeks of gestation.
 TYPES
 Threatened
 Inevitable
 Incomplete
 Complete
 Missed
 Septic
Threatened Abortion

It is clinical entity where the process of

miscarriage has started but has not progressed to
a state from which recovery is impossible.
 Clinical Features
 Bleeding per vaginam: usually slight & brownish or bright
red in colour. The bleeding usually stops spontaneously.
 Pain:Bleeding is usually painless but there may be mild
backache or dull pain lower abdomen. Pain appears usually
following haemorrhage.
 VaginalExamination: the cervix feels soft with the os
closed. Blood may be seen at external os.
 The uterus feels soft.
Investigation

 Blood:Hb, haematocrit, ABO & Rh

gruoping
 Urine: UPT is always positive.
 TVS
 Treatment
 The only aim is to extend maximum support to the
pregnancy in order to increase chances of survival of the
pregnancy.
 Rest:The patient should be in bed for few days until
bleeding stops.
 Drug:relief of pain may be ensured by diazepam 5mg tablet
twice daily.
 Hormonal therapy : it is given empirically in an attempt to
supplement the function of the corpus luteum in its role of
supporting the early pregnancy.
 Meticulous follow up with serial USG is
necessary in order to diagnose early in the event
of the abortion becoming inevitable or missed.

 The patient is advised to continue treatment,

restrict activity and avoid lifting any heavy
weight. Sexual intercourse should be avoided.
 Inevitable Abortion
It is the clinical type of abortion where the
changes have progressed to a state from where
continuation of pregnancy is impossible.
Clinical Features

 Increased vaginal bleeding

 Aggravationof pain in the lower abdomen
which may be colicky in nature.
 Internalexamination reveals dilated os of
the cervix through which the products of
the conception are felt.
 Management
GENERAL MEASURES:
 Excessivebleeding should be promptly controlled by
administering methargine 0.2mg .
 The pain may be intense and appropriate analgesics
are prescribed.
 The woman and her family must be given
information and reassurance.
ACTIVE TREATMENT:
Before 12 weeks:
1. D & E followed by curette of the uterine cavity by blunt curette
2. Alternatively, suction evacuation followed by curette
After 12 weeks:
1. Uterine contraction- oxytocin drip (10 units in 500 ml of NS) 40 -60 drops
per minutes. If fetus is expelled & the placenta is retained
Complete Miscarriage
When the products of conception are
expelled completely en masse, it is called
complete miscarriage.
 Clinical Features
There is history of expulsion of a fleshy mass per vaginam followed by:
1. Subsidence of abdomen pain
2. Vaginal bleeding becomes trace or absent.
Internal examination reveals:
1. Uterus is smaller than period of amenorrhoea.
2. Cervical os is closed
3. Bleeding is trace

Examination of the expelled fleshy mass is found complete.

Management

 TVS is useful to see that uterine

cavity is empty, otherwise evacuation
of uterine cavity should be done.
Incomplete Abortion

When the entire products of conception

are not expelled, instead a part of it left
inside the uterine cavity is called
incomplete miscarriage.
 Clinical Features
 H/O expulsion of fleshy mass per vaginam followed by:
1. Lower abdomen pain
2. Persistence of vaginal bleeding
3. Internal examination reveals –
- uterus smaller than the period of amenorrhoea
- patulous cervical os often admitting tip of the
finger
- varyin gamount of bleeding
4. On examination , the expelled mass is found
incomplete.
 Management
 In recent cases- ERCP(Evacuation of retained products of
conception)
1. Early abortion: Dilatation and evacuation under analgesia or
general anesthesia
2. Late abortion: the uterus – evacuated under general
anesthesia & products are removed by ovum forcep 0r by
blunt curette.
In late cases, dilatation & curettage – to remove the bits
of tissues left behind and send it to histopathological
examination.

Medical Mgt:
Tab Misoprostol 200µg – vaginally every 4 hourly
Missed Abortion
When the fetus is dead and
retained inside the uterus for a
variable period, it is called missed
abortion or early fetal demise.
 Clinical Features
1. Persistence of brownish vaginal discharge
2. Subsidence of pregnancy symptoms
3. Retrogression of breast changes
4. Cessation of uterine growth
5. Non audibility of the fetal heart sound
6. Cervix feels firm
7. Immunological test for pregnancy becomes
negative
8. USG reveals an empty sac early in the pregnancy
or the absence of fetal motion or fetal cardiac
movements.
Complications

 Blood coagulation disorders

Management
 Uterus is less than 12 weeks
1. Expectant mgt: Many women expel the
conceptus spontaneously
2. Medical mgt: Prostaglandin E1 (Misoprostol) 800
mg vaginally in the posterior fornix is given &
repeated after 24 hours if needed. Expulsion
usually occurs within 48
3. Surgical mgt: Suction evacuation or dilatation &
evacuation is done when medical method fails/
 Uterus is less than 12 weeks
Induction is done by the following methods:
1. Misoprostol 200µg tablet is inseted into posterior
vaginal fornix every 4 hours for a maximum of 5
such.
2. Oxytocin- 10-20 units of oxytocin ijn 500ml of
normal saline at 30 drops per minute .
If fails- oxytocin to the maximum of
200mIU/min with monitoring
3. Surgical evacuation following medical treatment.
(ERPC)
4. Dilatation & Evacuation is done once cervix becomes
soft with the use of PGE1. otherwise mechanical
dilators or laminaria tent is used for dilataion.
 Septic Abortion
“Any abortion associated with clinical evidences of
infection of the uterus and its contents , is called septic
abortion.”
Abortion is usually considered septic when there are :
- rise of temp of at least 100.4ºF (38ºC) for 24
hours or more
- offensive or purulent vaginal discharge
- lower abdominal pain & tenderness.
Clinical Features
 Pyrexia
 Pain in abdomen
 A rising pulse rate
 Variable systemic and abdominal findings
depending upon the spread of infection
 Internal examination- purulent vaginal discharge
or a tender uterus usually with patulous os or a
boggy feel of the uterus
Investigation

1. Cervical or high vaginal swab

2. Blood – Hb, total & differential count of WBC,
ABO & Rh grouping
3. Urine analysis
4. USG
Management

 General mgt
- Hospitalization
- To take high vaginal or cervical swab for culture, drug sensitivity test and
gram stain.
- Vaginal examination
- Overall assessment of the patient
- Investigation
 Recurrent Abortion

Recurrent abortion is defined as a sequence

of three or more consecutive spontaneous
abortion before 20 weeks.
 Etiology
 FIRST TRIMESTER ABORTION
1. Genetic factors: Parental chromosomal abnormaloities
2. Endocrine and Metabolic:
- Poorly controlled diabetic patients
- Presence of thyroid auto antibodies
- LPD
- Hyper secretion of luteinising hormone
3. Infection
4. Inherited thrombophilia
5. Immunological cause
 SECOND TRIMESTER ABORTION
1. Congenital anomalies : Bicornuate,
unicornuate, septate or double uterus.
2. Intrauterine adhesions
3. Uterine fibroids
4. Endometrosis
5. Cervical incompetence
 OTHER CAUSES OF SECOND TRIMESTER MISCARRIAGE:

1. Chronic maternal illness

2. Infection
3. Unexplained
 TREATMENT
INTERCONCEPTION PERIOD
 Toalleviate anxiety and to improve the
psychology : counseling the couple
 Hysteroscopic resection for septate uterus.
 Chromosomal anomalis- Genetic counseling
 Hypersecretion of LH- supressed with GnRH
analogue
 Endocrinedysfunction: control of diabetes
and thyroid disorders
 Treat Genital Tract Infections
DURING PREGNANCY

 Reassurance and tender loving care

 USG
 Rest- adequate rest, avoid strenuous
activities, intercourse & travelling.
 Management of cervical incompetence:
Circlage operation