The expulsion or extraction of a fetus weighing less than 500gm. Or the termination of a fetus
before 24 weeks of gestation with no evidence of life.
15% of clinically apparent pregnancies
--symptoms and signs of pregnancy.
--slight vaginal bleeding.
--pain is absent or mild.
--uterus equal gestation age.
--cervical os closed with minimal bleeding.
--ultrasound shows viable fetus.
--there is no specific treatment, bed rest is advised
.in 50% of cases pregnancy will continue
---indicates the pregnancy is doomed to end shortly.
---vaginal bleeding usually profuse.
---severe cramping lower abdominal pain.
---dilated internal cervical os.
---any attempt to maintain pregnancy is useless.
--resuscitation + ergometrine & then evacuation
&curettage if the pregnancy is less than 12 weeks &
uterine stimulation with oxytocin if the pregnancy is
more than 12 weeks.
--retention of parts of concepts inside the uterus.
--patient usually passes part of the product.
--bleeding usually continue.
--uterine size is less than the period of pregnancy.
--cervical os is opened & products may be felt.
--ultrasound shows retained products.
--treatment is resuscitation & evacuation&
--all products has been expelled.
--bleeding diminishes & pain ceases.
--uterus size is normal or slightly enlarged.
--cervical os is closed.
--ultrasound shows empty uterine cavity
-retention of dead fetus inside the uterus.
-may be preceded by symptoms &signs of
-the symptoms & signs of pregnancy regress.
-sometimes the patient present with brownish
-the uterus ceases to grow & may diminishes in size.
-cervical os is closed.
-HCG level fall.
-ultrasound shows dead fetus or collapse gestational sac.
-hazard is from infection, DIC, & psychological distress of the
-treatment in first trimester is suction evacuation.
-in the second trimester is induction by oxytocin after
treatment with mifeprisone or prostaglandinE2.
--three or more consecutive miscarriage.
-occur in 1% of cases.
--any abortion associated with clinical
evidence of infection of the uterus & it
--any type of abortion can be complicated by
infection. However the majority are
associated with incomplete abortion
--septic abortion can complicates
spontaneous abortion, but in the majority of
cases the infection occur following illegal
induced abortion because;--
1)usually there is no proper aseptic technique
& the instruments used to induce abortion is
often unclean & may carry pathologic
organisms directly in the uterus, the blood
stream, or even the
Peritoneal cavity if the uterus is perforated.
2)usually there is incomplete evacuation
where the dead tissues in the uterus form an
ideal culture media for the flora normally
found in the lower genital tract.
3)there may be injury to the genital organs &
adjacent structures particularly the bowels.
--rare organisms include, clostridia welchi, cl. tetani,
& cl. Perferingens.
--in the majority of cases (80%) the organism is of
endogenous origin & the infection is usually
confined to the uterine cavity.
--in 15% the infection spread to the tubes, ovaries, &
--in about 5% there is generalized peritonitis &
other complications like end toxic shock
---pyrexia & tachycardia are early signs of
---rigors suggest bacteraemia.
---a sub normal temperature is a serious sign
& is most common seen with gas forming
--the patient may be seriously ill with
malaise, sweating, headache, joint pain.
--abdominal pain either localized or generalized.
--jaundice is a serious sign indicating hemolysis due
to chemical or hemolytic infection.
--hypotension may be due hypo- volumaemia . Or
endo toxin or both.
--offensive vaginal discharges is present in most
cases &signify local infection & dead tissues
--usually reveals a tender uterus, offensive vaginal discharges, dilated
cervix, & intrauterine debris.
--crepitus indicate severe gas forming infection.
--evidence of trauma can be seen.
--a pelvic abscess is indicated by bogginess or fullness &tenderness in the
pouch of Douglas. In such cases diarrhea is a common symptoms.
--generalized peritonitis is suspected if there is abdominal distension,
vomiting, or absent bowel sound.
--oligouria may be due to hypovolaemia, end toxin, or drug toxicity.
Haematuria result from glomerular damage and port wine urine is classic
feature of severe clostridial infection
1- hemorrhage due to abortion process & due to genital
injuries inflicted during the interference.
1-chronic pelvic infection.
2-infertility due to tubal blockage
--Hb, Hct, blood grouping & cross matching, &coagulation
--WBC total & differential usually there is gross
leucocytosis . A low WBCC may be an early manifestation of
--vaginal, cervical, blood & urine culture for aerobic &
--ultrasound scan for retained products.
--x-ray abdomen. Gas under the diaphragm suggest uterine
--establish a peripheral intravenous line for therapy.
--in the presence of shock a central venous pressure
line is helpful (cvp).
--antibiotic therapy appropriate to the common
organisms & known local sensitivities is commenced
--in mild cases, ampicillin or cephalosporin oral
metronidazole & or tetracycline
--in more severe cases. Intravenous therapy with gentamicin
or cephalosporin or chloramphenical is preferable.
--the antibiotics may be change if necessary when the
organisms & their sensitivity have been determined.
--in areas where tetanus is common anti tetanus serum &
tetanus toxoid may be administered.
--blood transfusion is important to correct anemia & to aid in
combat of the infection.
--surgical exploration of the uterus & evacuation of the
retained products is required as soon as possible, but should
be deferred until;--
1-acute resuscitative measures have been achieved.
2-antibiotic therapy has been established.
--in the absence of excessive bleeding or
deterioration in spite of the above therapeutic
measures an interval of 6 hrs from commencing
therapy is reasonable.
--pelvic abscess require drainage by posterior
--if trauma is identified laparotomy is usually
required & and the choice between repair of
the uterine damage & hysterectomy is often
difficult, but will be influenced by the degree
of trauma & the nature & severity of
--careful examination of the bowel & urinary
tract is essential.