Abortion

Download as pptx, pdf, or txt
Download as pptx, pdf, or txt
You are on page 1of 15

ABORTION

Presenter: Dr. Sweta shah


(MD Obs & Gynae)
Contents
• Definition.
• Causes of abortion.
• Types of abortion.
• Patient presentation on different types of abortion.
• Management.
• Medical termination of pregnancy.
• Methods
• Legal norms.
DEFINITION
• Abortion is the expulsion or extraction of an embryo or fetus at less
than 20 weeks of gestation or weighing 500 g or less when it is not
capable of independent survival.

• INCIDENCE: 10-20%
CAUSES OF ABORTION
Fetal cause Maternal cause
Genetic factors  Infections: rubella,CMV,malaria,brucella.
FIRST TRIMESTER: (aneuploidy,trisomy) leads to  Medical disorders: Hypertension,chronic renal
50% cases of abortion. disease, cyanotic heart disease.
 Endocrine problems: hypothyroidism,poorly
controlled diabetes mellitus,PCOD,LPD
 Immunological: APLA syndrome, Inherited
thrombophilias.
 Environmental factors: Alcohol,
smoking,exposure to radiation.
 Unexplained.

FETAL CAUSE MATERNAL CAUSE


Chromosomal abnormality Anatomic abnormalities: cervical
SECOND TRIMESTER: incompetence,mullerian fusion
defects,uterine synechia,uterine fibroid.
Infection
TYPES
Management of different types of abortion
Threatened abortion:
• Rest: The patient should be in bed for few days until bleeding stops.
Prolonged restriction of activity has.
• Drugs: Progesterone (can be given orally or intramuscularly)

Advice on discharge: bed rest, avoid coitus, followed up with serial


USG.
Complete abortion:
Transvaginal sonography is useful to see that uterine cavity is empty.
 Usually requires no treatment.

Incomplete abortion:
 Medical management of incomplete miscarriage may be done. Tablet
Misoprostol 200 µg is used vaginally every 4 hours.
 Surgical management: dilatation and evacuation.
Missed abortion:

If uterus in less than 12 weeks size.


 Expectant management—wait and watch as many women expel the
conceptus spontaneously.
 Medical management: Prostaglandin E1 (Misoprostol) 800 mg
vaginally in the posterior fornix is given and repeated after 24 hours if
needed. Expulsion usually occurs within 48 hours.
 Surgical: Suction evacuation or dilatation and evacuation is done
either as a definitive treatment or it can be done when the medical
method fails.
If uterus is more than 12 weeks size:

• Medical management: prostaglandin, mifepristone, oxytocin can be


used.

• Surgical:dilatation and evacuation.


Inevitable abortion:

 Before 12 weeks:
(1) Dilatation and evacuation followed by curettage of the uterine cavity by blunt
curette.
(2)Suction evacuation followed by curettage.

 After 12 weeks:
(1) The uterine contraction is accelerated by oxytocin drip.
(2) The fetus is expelled and the placenta is retained, it is removed by ovum
forceps, If the placenta is not separated, digital separation followed by its
evacuation is to be done.
• Methods of performing medical termination of pregnancy are:

First trimester (upto 12 weeks) Second trimester (13-20 weeks)

Medical  Misoprostol
 Mifepristone  Dilatation and evacuation using ovum
 Misoprostol(PGE1) forcep
 Methotrexate  Intrauterine instillation of hyperosmotic
solutions
 Oxytocin infusion.
 Hysterotomy

Surgical
 Menstrual regulation
 Manual vacuum aspiration
 Suction and evacuation
 Dilatation and curettage
 Recurrent abortion

• It is defines ad a sequence of three or more consecutive pregnancy


loss before period of viability.

• Cause (most common): 1st trimester: chromosomal abnormality.


: 2nd trimester: cervical incompetence.
THANK YOU

You might also like