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Management of abortion
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Management of abortion

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  • 1. MANAGEMENT OFABORTION
  • 2. Threatened Abortion Conservative with bed rest and reassurance till bleeding stops. Sexual intercourse best avoided. Follow up with ULTRASOUND-presence of fetal cardiac activity predicts good outcome in 95%of cases. Hormone therapy -400mg natural progesterone in 2divided doses orally or vaginally on empirical basis. Anti D if mother is Rh negative and pregnancy is beyond 12 weeks.
  • 3. Inevitable Abortion Immediate evacuation of pregnancy.(If duration of pregnancy less than 12 weeks- suction evacuation and greater than 12 weeks oxytocin infusion.) Shock-resuscitation with i/v fluids and blood transfusion. Prophylactic antibodies and anti-D.
  • 4. Suction abortion
  • 5. Incomplete Abortion Resuscitation if patient is in shock and evacuation by suction evacuation. If the os is closed PGE1 tablets are kept in vagina for ripening the cervix. Prophylactic antibodies and anti D
  • 6. Complete abortion Conservative Anti D not indicated if pregnancy is less than 12 weeks and there was no operative intervention.
  • 7. Missed Abortion Uterus evacuated as soon as possible. A donor should be kept ready. If uterine size is less than 12 weeks of gestation PGE1 tablets kept in vagina results in spontaneous expulsion without the need of surgical intervention. If more than 12 weeks, 6th or 12th hourly PGE1 tablets used vaginally results in spontaneous expulsion or extra amniotic ethacridine acetate. Anti D and antibiotics.
  • 8. Septic Abortion Police notification if a criminal abortion is suspected. Mild cases-broad spectrum antibiotics are started and uterus evacuated. Severe cases-maintenance of perfusion and ventilation. I/v infusion and CVP line is inserted Blood transfusion Oxygen given by nasal catheter.
  • 9. CVP line
  • 10. Septic Abortion(cont……..) Antibiotics commenced after taking a high vaginal swab. Ampicillin,Gentamycin and Metronidazole/third generation cephalosporin like cefotaxime or cefuroxime with metronidazole or clindamycin. Evacuation of uterus after infection is controlled.
  • 11. Recurrent Miscarriage Due to cervical incompetenceM anagem is be cervical cerclage if there is a well ent docum ented history otherwise serial follow up is done with transvaginal ultrasound for early signs of incom petence.Cervical cerclage is usually delayed upto 12-14 weeks so that m iscarriage due to other causes can be eliminated.Sonography is done to confirm live fetus and if there is infection,it should be treated and sexual intercourse should be avoided.Contraindications-B leeding,contractions/ ruptured m branes. em
  • 12. Cerclage
  • 13. 1.McDonald’s CerclagePatient is in lithotomy position and cervix isexposed with Sim’s speculum.The cervical lipsare held with sponge holding forceps and apurse string suture with a non absorbablematerial like black silk is taken all around thecervix.Disadvantage –suture may be below internal os.
  • 14. McDonald’s cerclage
  • 15. 2.Modified Shirodkar’scerclage.Small transverse incision is made onanterior lip of cervix at cervicovaginaljunction 2cm above the external os.Bladderis then pushed up and a suture of black silkor mersilene tape is passed from anterior toposterior aspect submucosally usingShirodkar’s or any curve bodied needle.2ends of the suture are pulled and tiedposteriorly.Anterior incision is closed with
  • 16. Shirodkar’s cerclage
  • 17. 3.Transabdominal cerclageDone in cases of repeated failure ofvaginal approach and cervix is inaccessibleDisadvantage-Caesarean sectionIn case of miscarry cerclage has to beremoved at laparotomy.
  • 18. Post operative care Bed rest for 48 hours Antibiotic cover Avoid sexual intercourse Cerclage is removed at 37 weeks or at the onset of labour ,if not it can result in rupture uterus.
  • 19. Other cases of recurrentmiscarriage Chromosomal abnormalities-karyotyping of both parents and prenatal diagnosis in the next pregnancy. Uterine factors-hysteroscopic resection in case of a septum or division of the adhesion in Asherman’s syndrome. Myomectomy in case of fibroid. APLA Syndrome-Combination of low dose aspirin and low MW heparin as soon as pregnancy is confirmed.Aspirin preconceptionally. Inherited thrombophilia-Low dose aspirin and heparin.
  • 20. Induced abortion THE MEDICAL TERMINATION OF PREGNANCY ACT, 1971 (Act No. 34 of 1971) (10th August 1971)   An Act to provide for the termination of certain pregnancies by registered Medical Practitioners and for matters connected therewith or incidental thereto.   Be it enacted by Parliament in the Twenty-second Year of the Republic of India as follows :-   1.         Short title, extent and commencement –   This Act may be called the Medical Termination of Pregnancy Act, 1971. It extends to the whole of India except the State of Jammu and Kashmir. It shall come into force on such date as the Central Government may, by notification in the Official Gazette, appoint.   2.         Definitions - In this Act, unless the context otherwise requires, -   “guardian” means a person having the care of the person of a minor or a lunatic;   “lunatic” has the meaning assigned to it in section 3 of the Indian Lunatic Act, 1912 ( 4 of 1912);   “minor” means a person who, under the provisions of the Indian Majority Act, 1875 ( 9 of 1875), is to be deemed not to have attained his majority;
  • 21.  (d)               “registered medical practitioner” means a medical practitioner who possesses any recognized medical qualification as defined in clause (h) of section 2 of the Indian Medical Council Act, 1956, (102 of 1956), whose name has been entered in a State Medical Register and who has such experience or training in gynaecology and obstetrics as may be prescribed by rules made under this Act.  Place where pregnancy may be terminated - No termination of pregnancy shall be made in accordance with this Act at any place other than - a hospital established or maintained by Government, or a place for the time being approved for the purpose of this Act by Government.