ABORTION PERPETUAL SUCCOUR HOSPITAL SHEILA  ANG MD MARCH 24,2008
<ul><li>ABORTION </li></ul><ul><li>is pregnancy termination prior to 20 weeks gestation or less than 500 g bw.either spont...
<ul><li>Induced Abortion </li></ul><ul><li>is the removal or expulsion of an embryo or fetus by medical , surgical or othe...
ETIOLOGY <ul><li>FETAL FACTORS </li></ul><ul><li>1.Abnormal zygotic development </li></ul><ul><li>>zygote ,embryo , early ...
<ul><li>Monosomy – (45x) 2 nd  most frequent abnormality ,usually incompatible w life </li></ul><ul><li>Triploidy --  is o...
Maternal  factors <ul><li>1.Infections </li></ul><ul><li>>vaginal colonization of group b strep,hiv,toxoplasma g. </li></u...
<ul><li>3.Uterine defects </li></ul><ul><li>uterine myomas </li></ul><ul><li>ashermans syndrome </li></ul><ul><li>incompet...
TYPES OF ABORTIONS <ul><li>1. Threatened Abortion </li></ul><ul><li>bleeding occurs in the 1 st  half of gestation or when...
<ul><li>MGT: </li></ul><ul><li>1.bedrest </li></ul><ul><li>2.acetaminophen based analgesia </li></ul><ul><li>3.vaginal son...
<ul><li>2.Inevitable  Abortion </li></ul><ul><li>gross rupture of membranes evidence by leaking amniotic fluid in the pres...
<ul><li>Mgt </li></ul><ul><li>bedrest </li></ul><ul><li>sudden gush of fluid w/o pain,fever,or bleeding </li></ul><ul><li>...
<ul><li>3.Complete Abortion </li></ul><ul><li>complete detachment and expulsion of the product of conceptus,when the place...
<ul><li>4.Incomplete Abortion </li></ul><ul><li>the internal cervical os remains open and allows passage of blood.the fetu...
<ul><li>5.Missed Abortion </li></ul><ul><li>the uterus retains dead products of conception behind a closed cervical os for...
<ul><li>After fetal death </li></ul><ul><li>uterus remains stationary in size breast  changes regresses,lose extra pounds,...
<ul><li>6.Recurrent Abortion </li></ul><ul><li>refers to three or more consecutive spontaneous abortions. </li></ul><ul><l...
<ul><li>15 % of women who had recurrent abortion had this autoimmune fx.causes arterial venous thrombosis , thrombocytopen...
<ul><li>Tx </li></ul><ul><li>a combination of heparin 5000 u sq twice daily & low dose aspirin 80mg/day continue till deli...
<ul><li>Prognosis </li></ul><ul><li>Majority will have successful outcome </li></ul><ul><li>30%-risk of subsequent abortio...
<ul><li>Induced  Abortion </li></ul><ul><li>is the medical or surgical termination of pregnancy before the time of fetal v...
<ul><li>1 st  trimester </li></ul><ul><li>1.Suction Aspiration </li></ul><ul><li>2.D & C </li></ul><ul><li>3.RU 486 </li><...
<ul><li>2 nd  trimester </li></ul><ul><li>D & E  </li></ul><ul><li>like d/c the womans cervix must be dilated more widely ...
<ul><li>3 rd  trimester </li></ul><ul><li>Saline Amniocentesis (salt poisoning) </li></ul><ul><li>a large needle is insert...
<ul><li>Hysterotomies </li></ul><ul><li>identical to c/s but the intent is to destroy the child . the umbilical cord is cl...
 
<ul><li>&quot;It is a poverty to decide that a child must die so that you may live as you wish.“ </li></ul><ul><li>( Mothe...
 
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Abortion

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Abortion

  1. 1. ABORTION PERPETUAL SUCCOUR HOSPITAL SHEILA ANG MD MARCH 24,2008
  2. 2. <ul><li>ABORTION </li></ul><ul><li>is pregnancy termination prior to 20 weeks gestation or less than 500 g bw.either spontaneously or intentionally. </li></ul><ul><li>Spontaneous Abortion </li></ul><ul><li>expulsion of a fetus or embryo before the 20 th week or cmonly knwn as miscarriage maybe due to trauma or natural causes. </li></ul>
  3. 3. <ul><li>Induced Abortion </li></ul><ul><li>is the removal or expulsion of an embryo or fetus by medical , surgical or other means at any point during pregnancy </li></ul>
  4. 4. ETIOLOGY <ul><li>FETAL FACTORS </li></ul><ul><li>1.Abnormal zygotic development </li></ul><ul><li>>zygote ,embryo , early fetus ,placenta </li></ul><ul><li>1.Aneuploid abortion </li></ul><ul><li>autosomal trisomy – most common identified chromosomal anomaly(nondisjunction) </li></ul>
  5. 5. <ul><li>Monosomy – (45x) 2 nd most frequent abnormality ,usually incompatible w life </li></ul><ul><li>Triploidy -- is often asso w hydropic placental (molar) degeneration </li></ul><ul><li>Euploid Abortion – abortion occurred before 8 wks,bt usually peaked at 13 wks,incidence increase dramatically after maternal age exceeded 35 yrs. </li></ul>
  6. 6. Maternal factors <ul><li>1.Infections </li></ul><ul><li>>vaginal colonization of group b strep,hiv,toxoplasma g. </li></ul><ul><li>2.Lifestyle </li></ul><ul><li>>Tobacco- 14 cigarette/day </li></ul><ul><li>>Alcohol-frequent use during the 1 st 8 wks </li></ul><ul><li>>Caffeine->5 cups/day(500mg caffeine /day) </li></ul>
  7. 7. <ul><li>3.Uterine defects </li></ul><ul><li>uterine myomas </li></ul><ul><li>ashermans syndrome </li></ul><ul><li>incompetent cervix </li></ul>
  8. 8. TYPES OF ABORTIONS <ul><li>1. Threatened Abortion </li></ul><ul><li>bleeding occurs in the 1 st half of gestation or when bloody vaginal discharge or spotting appears through a closed cervical os.cramping abdml pain lasting (hrs-days),low backache,or feeling of pelvic pessure. </li></ul>
  9. 9. <ul><li>MGT: </li></ul><ul><li>1.bedrest </li></ul><ul><li>2.acetaminophen based analgesia </li></ul><ul><li>3.vaginal sonography </li></ul><ul><li>4.hcg monitoring </li></ul><ul><li>Repeat evaluation after 1-2 wks </li></ul><ul><li>If bleeding causes anemia/hypovolemia-evacuation </li></ul>
  10. 10. <ul><li>2.Inevitable Abortion </li></ul><ul><li>gross rupture of membranes evidence by leaking amniotic fluid in the presence of cervical dilatation. </li></ul><ul><li>uterine contractions begin promptly,resulting in abortion or infection develops. </li></ul>
  11. 11. <ul><li>Mgt </li></ul><ul><li>bedrest </li></ul><ul><li>sudden gush of fluid w/o pain,fever,or bleeding </li></ul><ul><li>after 48 h may resume usual activities except any form of vaginal penetration. </li></ul><ul><li>> evacuation </li></ul>
  12. 12. <ul><li>3.Complete Abortion </li></ul><ul><li>complete detachment and expulsion of the product of conceptus,when the placenta,in whole or in part, detaches from the uterus.bleeding ensues with internal cervical os closure. </li></ul>
  13. 13. <ul><li>4.Incomplete Abortion </li></ul><ul><li>the internal cervical os remains open and allows passage of blood.the fetus & placenta may remain entirely in utero or may partially extrude through the dilated os. </li></ul><ul><li>Mgt: </li></ul><ul><li>dilatation & curettage </li></ul>
  14. 14. <ul><li>5.Missed Abortion </li></ul><ul><li>the uterus retains dead products of conception behind a closed cervical os for days – wks </li></ul><ul><li>Early preg-amenorrhea,nausea/vomiting,breast changes and growth of the uterus </li></ul>
  15. 15. <ul><li>After fetal death </li></ul><ul><li>uterus remains stationary in size breast changes regresses,lose extra pounds,except persistent amenorrhea </li></ul><ul><li>Mgt </li></ul><ul><li>curettage </li></ul><ul><li>misoprostol causing spontaneous resolution in < 8 wks aog </li></ul>
  16. 16. <ul><li>6.Recurrent Abortion </li></ul><ul><li>refers to three or more consecutive spontaneous abortions. </li></ul><ul><li>The ACOG recognizes 2 types of testing the investigation of recurrent miscarriage </li></ul><ul><li>1.parental cytogenetic analysis </li></ul><ul><li>2.lupus anticoagulant & anticardiolipin ab assays </li></ul>
  17. 17. <ul><li>15 % of women who had recurrent abortion had this autoimmune fx.causes arterial venous thrombosis , thrombocytopenia , and fetal losses during 2 nd half of px. </li></ul><ul><li>>women w/ both hx of fetal loss & high levels of this ab suffers a 70% abortion recurrence. </li></ul>
  18. 18. <ul><li>Tx </li></ul><ul><li>a combination of heparin 5000 u sq twice daily & low dose aspirin 80mg/day continue till delivery. </li></ul>
  19. 19. <ul><li>Prognosis </li></ul><ul><li>Majority will have successful outcome </li></ul><ul><li>30%-risk of subsequent abortion in women who previously delivered liveborn infant. </li></ul><ul><li>46%-in women who had liveborn infants & at least one spontaneous fetal loss. </li></ul>
  20. 20. <ul><li>Induced Abortion </li></ul><ul><li>is the medical or surgical termination of pregnancy before the time of fetal viability. </li></ul><ul><li>Indication: </li></ul><ul><li>1.Heart dses </li></ul><ul><li>2.Cervical ca </li></ul><ul><li>3.Rape or incest </li></ul><ul><li>4.Significant or mental deformity </li></ul>
  21. 21. <ul><li>1 st trimester </li></ul><ul><li>1.Suction Aspiration </li></ul><ul><li>2.D & C </li></ul><ul><li>3.RU 486 </li></ul><ul><li>4.Methotrexate </li></ul>
  22. 22. <ul><li>2 nd trimester </li></ul><ul><li>D & E </li></ul><ul><li>like d/c the womans cervix must be dilated more widely to removed larger pieces of the unborn child </li></ul>
  23. 23. <ul><li>3 rd trimester </li></ul><ul><li>Saline Amniocentesis (salt poisoning) </li></ul><ul><li>a large needle is inserted through the abdominal wall into the babys amniotic sac.a concentrated salt soln is injected.causing hemorrhage , vessel rupture, burns the outer skin. </li></ul>
  24. 24. <ul><li>Hysterotomies </li></ul><ul><li>identical to c/s but the intent is to destroy the child . the umbilical cord is clamped w/ch suffocates the baby.wyl the baby is under sedation they put a towel over his face so the bb cant breathed. </li></ul>
  25. 26. <ul><li>&quot;It is a poverty to decide that a child must die so that you may live as you wish.“ </li></ul><ul><li>( Mother Teresa ) </li></ul>

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