Abortion

Causes & Types

Presented By
Deepak
 Definition

“Abortion is the expulsion or extraction from its

mother of an embryo or fetus weighing 500 gm or
less when it is not capable of independent
survival.” Acc. To WHO
 Incidence of Abortion
10-20% of all the clinical pregnancies end in
miscarriage and 10% are induced illegally. 75% of
the abortions occur before 16th week and of those
about 75% occur before the 8th week of pregnancy.
 Abortion Rate and Ratio

Abortion rate – number of abortions per 1000

women between 15 and 44 years of age.

Abortion ratio – number of abortions out of 100

known pregnancies (excluding miscarriages and
stillbirths)
 Abortion rate and ratio continue…

The number of abortions performed worldwide

has remained stable in recent years, with
41.6 million having been performed in 2003 and
43.8 million having been performed in 2008. The
abortion ratio worldwide was 28 per 1000 women,
though it was 24 per 1000 women for developed
countries and 29 per 1000 women for developing
countries.
 Abortion rate and ratio in india

No. of abortions in india is found to be 596,345

and the abortion rate is 10.4 and abortion ratio is
o.o2. (2008)
 Causes of abortions
Genetic Factors
Endocrine and
metabolic factors

Anatomic factors

Infection

Immunological

Other factors
 Genetic Factors
Autosomal trisomy (50%)

Polyploidy (22%)

Monosomy (20%)

Structural chromosomal rearrangements(2-4%)

Mosaic and double trisomy(4%)

Endocrine and Metabolic Factors
Luteal Phase Defect

Deficient Progesterone

Thyroid Abnormalities

Diabetes Mellitus

Polycystic ovary disease

 Anatomic Factors
Bicornuate Uterus

Septate Uterus

Unicornuate Uterus

Uterine Fibroids

Uterine Adhesions

Incompitent Cervix
 Infection
Viral
 Rubella
 Cytomegalo
 Variola
 HIV
Bacterial
 Ureaplasma
 Chlamydia
 Brucella
Parasitic
 Toxoplasma
 Malaria
 Immunological
Autoimmune Disorders
 Antinuclear Antibodies
 Antiphospholipid Anyibodies
 Lupus Anticoagulant
 Anticardiolipin Antibodies

Alloimmune Diseases
 Human Leukocyte Antigen
 Other Causes
Maternal medical illness
Rh incompatibility
Inherited thrombophilia
Cigarette smoking
Alcoholism
X- irradiation
Antineoplastic drugs
Drugs chemicals and noxious agents
 Mechanism of Abortion
Before 8 weeks: The ovum surrounded by the villi
with the decidual coverings, is expelled out intact.

8-14 weeks: Expulsion of fetus commonly occur

leaving behind the placenta and the membranes.

Beyond 14 weeks: the process of expulsion is similar

to that of a mini labour. The fetus is expelled first
followed by expulsion of placenta.
 Types of abortions

Abortion

Spontaneous induced

Isolated
Threatened Inevi tabl e Complete Incomplete
Recurrent
Missed Septi c
Legal Illegal
 Spontaneous abortion

spontaneous abortion is the spontaneous end of

a pregnancy at a stage where
the embryo or fetus is incapable of surviving
independently, generally defined in humans at
prior to 20 weeks of gestation.
 Threatened Abortion

It is clinical entity where the process of abortion

has started but has not progressed to a state from
which recovery is impossible.
 Clinical Features of Threatened
Abortion
Bleeding Per Vagina
The bleeding is usually slight and bright red in colour.
On rare occasion, the bleeding may be brisk and
sharp, specially in the second trimester, suggestive of
low implantation of placenta. The bleeding usually
stops spontaneously.
Pain
Bleeding is usually painless but there may be mild
backache or dull pain in lower abdomen. Pain appears
usually following haemorrhage.
 Investigations
Routine investigations
 Blood and urine
Ultrasonography
 A well formed gestational ring with central echoes from
the embryo.
 Fetal cardiac motion
 A blighted ovum
Pelvic examination
 Speculum examination
 Digital examination
 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 Of Inevitable
Abortion
Increased vaginal bleeding

Aggravation of pain in lower abdomen

Deteriorated general condition of patient

Dilated internal os of cervix

 Complete Abortion

When the product of conception are expelled en

masse, it is called complete abortion
 Clinical Features
History of expulsion of fleshy mass per vaginam
followed by:
Subsidence abdominal pain
Vaginal bleeding becomes trace or absent
Uterus is smaller than the period of amenorrhoea
and a little firmer
Cervical os is closed
Examination of expelled fleshy mass is found
intact.
 Incomplete Abortion

When the entire products of conception are not

expelled, instead a part of it is left inside the
uterine cavity, it is called incomplete abortion.
 Clinical Features
History of expulsion of fleshy mass per vaginam
followed by:
Colicky lower abdomen pain
Persistent vaginal bleeding of varying magnitude
Uterus is smaller than the period of amenorrhoea
and a little firmer
Patulous Cervical os often admitting tip of finger
Examination of expelled fleshy mass is found
incomplete.
 Missed abortion

When the fetus is dead and retained inside the

uterus for a variable period, it is called missed
abortion, silent miscarriage or early fetal demise.
 Pathology Of Missed Abortion
Beyond 12 weeks
Liquorfetus
retained amnii
becomes
gets absorbed
macerated

Pl
ac
en
ta
be
co
m
es
pa
le,
th
in
an
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ad
he
re
nt
Clinical features of missed abortion
Persistence brownish vaginal discharge
Subsidence of pregnancy symptoms
Retrogression of breast changes
Cessation of uterine growth
No audible fetal heart sound
Absent fetal movement
Firm cervix
Immunological test for pregnancy becomes
negative
Ultrasonography reveals empty sac pregnancy
 Septic abortion
Any abortion associated with clinical evidences of
infection of the uterus and its contents, is called
septic abortion. Abortion is consider septic when
there are:

Rise of temperature of at least 100.4◦F for 24 hour or

more

Offensive or purulent vaginal discharge

Lower abdominal pain and tenderness

Mode of Infection in Septic Abortion

Micro-organisms involved in sepsis are usually

endogenous as they are normally present in the
vagina. The micro-organisms are:
Anaerobic- Streptococci, Cl. Welchii, Tetanus
bacillus
Aerobic- E.coli, Klebsiella, Staphylococcus,
Pseudomonas, Haemolytic Streptococcus.
Clinical Features of Septic Abortion
Pyrexia
Pain abdomen
Rising pulse rate
Variable systemic and abdominal findings
Purulent vaginal discharge
Patulous cervical os
Boggy or tender uterus
 Clinical Grading
Grade I- The infection is localized in the uterus.

Grade II- The infection spreads beyond the uterus

to the parametrium, tubes and ovaries or pelvic
peritoneum.

Grade III- Generalized peritonitis and/or

endotoxic shock or jaundice or acute renal failure.
 Investigations
Routine investigations
 Cervical or high vaginal swab
 Blood test
 Urine for culture
Special investigations
 Ultrasonography
 Serum electrolyte
 Blood culture
 Coagulation profile
 Complications of Septic Abortions
Immediate
 Haemorrhage
 Injury
 Generalized peritonitis
 Endotoxic shock
 Acute renal failure
 Thrombophlebitis
Remote
 Chronic debility
 Chronic pelvic pain and backache
 Dyspareunia
 Ectopic pregnancy
 Secondary infertility
 Depression
 Recurrent abortion

Recurrent abortion is defined as sequence of

three or more consecutive spontaneous abortions
before 20 weeks.
Diagnosis of Recurrent Abortion
History of repeated mid trimester abortions without apparent
cause, starting with liquor amnii followed by painless expulsion
of the products of conception is very much suggestive.
Internal examination
Interconceptional period
Bimanual examination reveals presence of unilateral or bilateral
tear and/or gaping of the cervix up to the internal os.
During pregnacy
Periodic inspection of the cervix through speculum from 10 th
week onwards at weekly interval is to be done .
Detection of dilatation of the internal os with herniation of the
membranes is diagnostic
Investigations for Recurrent Abortion
A through medical, surgical and obstetric history
Blood test
Autoimmune screening
Serum LH
Ultrasonography
Hysterosalpinoggraphy
Hysteroscopy or laproscopy
Karyotyping
Endocervical swab
 Induced Abortion
Deliberate termination of pregnancy before the
viability of fetus is called induced abortion. It
may be legal or illegal.

In India, the abortion was legalized by “ Medical

Termination Of Pregnancy Act” of 1971 and has
been enforced in the year April 1972. the
provisions of act have been revised in 1975.
Any Questions
Bibliography
Dutta. D .C. Text Book of Obstetrics including
perinatology and contraception. 6th edition. New
central book agency. 2004; 159-74.
http://www.medilexicon.com/medicaldictionary.ph
p?t=75854
http://www.nationmaster.com/red/pie/hea_abo-
health-abortions
http://www.johnstonsarchive.net/policy/abortion/a
b-india.html
http://www.ourmiscarriage.com/cause_of_miscarri
age.html