• Like
Abortion
Upcoming SlideShare
Loading in...5
×
Uploaded on

grandrounds

grandrounds

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
No Downloads

Views

Total Views
5,643
On Slideshare
0
From Embeds
0
Number of Embeds
1

Actions

Shares
Downloads
471
Comments
0
Likes
6

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. ABORTION PERPETUAL SUCCOUR HOSPITAL SHEILA ANG MD MARCH 24,2008
  • 2.
    • ABORTION
    • is pregnancy termination prior to 20 weeks gestation or less than 500 g bw.either spontaneously or intentionally.
    • Spontaneous Abortion
    • expulsion of a fetus or embryo before the 20 th week or cmonly knwn as miscarriage maybe due to trauma or natural causes.
  • 3.
    • Induced Abortion
    • is the removal or expulsion of an embryo or fetus by medical , surgical or other means at any point during pregnancy
  • 4. ETIOLOGY
    • FETAL FACTORS
    • 1.Abnormal zygotic development
    • >zygote ,embryo , early fetus ,placenta
    • 1.Aneuploid abortion
    • autosomal trisomy – most common identified chromosomal anomaly(nondisjunction)
  • 5.
    • Monosomy – (45x) 2 nd most frequent abnormality ,usually incompatible w life
    • Triploidy -- is often asso w hydropic placental (molar) degeneration
    • Euploid Abortion – abortion occurred before 8 wks,bt usually peaked at 13 wks,incidence increase dramatically after maternal age exceeded 35 yrs.
  • 6. Maternal factors
    • 1.Infections
    • >vaginal colonization of group b strep,hiv,toxoplasma g.
    • 2.Lifestyle
    • >Tobacco- 14 cigarette/day
    • >Alcohol-frequent use during the 1 st 8 wks
    • >Caffeine->5 cups/day(500mg caffeine /day)
  • 7.
    • 3.Uterine defects
    • uterine myomas
    • ashermans syndrome
    • incompetent cervix
  • 8. TYPES OF ABORTIONS
    • 1. Threatened Abortion
    • 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.
  • 9.
    • MGT:
    • 1.bedrest
    • 2.acetaminophen based analgesia
    • 3.vaginal sonography
    • 4.hcg monitoring
    • Repeat evaluation after 1-2 wks
    • If bleeding causes anemia/hypovolemia-evacuation
  • 10.
    • 2.Inevitable Abortion
    • gross rupture of membranes evidence by leaking amniotic fluid in the presence of cervical dilatation.
    • uterine contractions begin promptly,resulting in abortion or infection develops.
  • 11.
    • Mgt
    • bedrest
    • sudden gush of fluid w/o pain,fever,or bleeding
    • after 48 h may resume usual activities except any form of vaginal penetration.
    • > evacuation
  • 12.
    • 3.Complete Abortion
    • 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.
  • 13.
    • 4.Incomplete Abortion
    • 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.
    • Mgt:
    • dilatation & curettage
  • 14.
    • 5.Missed Abortion
    • the uterus retains dead products of conception behind a closed cervical os for days – wks
    • Early preg-amenorrhea,nausea/vomiting,breast changes and growth of the uterus
  • 15.
    • After fetal death
    • uterus remains stationary in size breast changes regresses,lose extra pounds,except persistent amenorrhea
    • Mgt
    • curettage
    • misoprostol causing spontaneous resolution in < 8 wks aog
  • 16.
    • 6.Recurrent Abortion
    • refers to three or more consecutive spontaneous abortions.
    • The ACOG recognizes 2 types of testing the investigation of recurrent miscarriage
    • 1.parental cytogenetic analysis
    • 2.lupus anticoagulant & anticardiolipin ab assays
  • 17.
    • 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.
    • >women w/ both hx of fetal loss & high levels of this ab suffers a 70% abortion recurrence.
  • 18.
    • Tx
    • a combination of heparin 5000 u sq twice daily & low dose aspirin 80mg/day continue till delivery.
  • 19.
    • Prognosis
    • Majority will have successful outcome
    • 30%-risk of subsequent abortion in women who previously delivered liveborn infant.
    • 46%-in women who had liveborn infants & at least one spontaneous fetal loss.
  • 20.
    • Induced Abortion
    • is the medical or surgical termination of pregnancy before the time of fetal viability.
    • Indication:
    • 1.Heart dses
    • 2.Cervical ca
    • 3.Rape or incest
    • 4.Significant or mental deformity
  • 21.
    • 1 st trimester
    • 1.Suction Aspiration
    • 2.D & C
    • 3.RU 486
    • 4.Methotrexate
  • 22.
    • 2 nd trimester
    • D & E
    • like d/c the womans cervix must be dilated more widely to removed larger pieces of the unborn child
  • 23.
    • 3 rd trimester
    • Saline Amniocentesis (salt poisoning)
    • 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.
  • 24.
    • Hysterotomies
    • 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.
  • 25.  
  • 26.
    • &quot;It is a poverty to decide that a child must die so that you may live as you wish.“
    • ( Mother Teresa )
  • 27.