This document defines abortion and miscarriage as pregnancy loss before 28 weeks or a fetal weight of 1000 grams. It classifies abortions as either induced, which are intentional terminations, or spontaneous, which occur despite the willingness to continue the pregnancy. The main causes of spontaneous abortions discussed are genetic abnormalities, endocrine/metabolic factors, mechanical issues, infections, immunological conditions, drug/alcohol use, and sometimes unknown causes. Clinical presentations vary based on factors like bleeding, pain, cervical dilation, and ultrasound findings. Complications can include hemorrhage, injury, infection, and infertility.

1. ABORTIONS/MISCARRIAGE(PART 01)
BY NAWA .M.S

2. OUTLINE
• Definition
• Types/Classification
• Causes
• Clinical presentation/investigations
• Complications

3. DEFINITIONS
• An abortion(miscarriage) is pregnancy loss before the age of
fetal viability(28 weeks) or before weight of fetus is 1000 grams.
• WHO/CDC DEFINITION: pregnancy loss before 20 weeks or
before fetal weight is 500grams.

4. TYPES/CLASSIFICATION
• Can be:
• 1.) INDUCED:
• Intentional termination of a pregnancy
• is further subdivivided into:
• Elective abortion- is performed for a woman’s desire.
• Therapeutic abortion- is performed for reasons of maintaining the health of the
mother and also to prevent serious or permanent bodily injury to the mother as well as
to prevent a viable birth of a fetus with significant anatomical or mental deformities.
• Safe abortion- is performed by a person with appropriate skills and in an
environment which meets minimal medical standards.
• Unsafe abortion- is performed by a person who lacks appropriate skills or in an
environment that does not conform to minimal medical standards.

5. • 2.) SPONTANEOUS ABORTIONS:
• Patient is willing to continue the pregnancy but due to some clinical condition or
disorder, she is unable to continue the pregnancy and hence, the pregnancy
spontaneously terminates.
• Can be:
• Threatened abortion: a process of abortion has started but it is at stage where it
can be reversed.
• Inevitable abortion: a stage in the abortion when it is not possible for the the
pregnancy to continue(cannot be reversed).
• Incomplete abortion: some products of conception are coming out from the
uterine wall and others are retaine inside(the process is incomplete).
• Complete abortion: all products of conception have been expelled from the
uterus.
• Septic abortion: an abortion complicated by infection
• Missed abortion: retention of dead products of conception for several
weeks(fetus has died in utero but has not been expelled)

6. CAUSES
• 1.) GENETIC CAUSES
• Most common cause of spontaneous abortion in 1st trimester
• are ANEUPLOIDY(addition of extra chromosome or loss of
chromosome)
• aneuploidies can be: trisomies( 13, 16,18, 21 and 22 are the
most common of these), monosomy x(45, x), triploidy(incomplete
hydatidiform mole) and tetraploidy.
• note: the most common individual anomaly is monosomy x
and most common trisomy is trisomy 16.

7. • 2.) ENDOCRINE AND METABOLIC CAUSE
• Second most common cause 1st trimester spontaneous
abortions
• Luteal phase defect
• hyperthyroidism
• hypothyroidism
• diabetes mellitus
• hyperprolactinemia

8. • 3.) MECHANICAL CAUSES
• Most common cause of 2nd trimester spontaneous abortions
• can be:
• structural uterine anomalies: septate uterus, uterine
fibroid, bicornuate uterus, uterine scarring(asherman syndrome).
• cervical incompetence: congenital or acquired
• uterine overdistension: multiple pregnancy,
polyhydramnios

9. • 4.) INFECTION
• will lead to 2nd trimester spontaneous abortion than 1st
trimester.
• can be:
• bacterial: ureaplasma urealyticum,mycoplasma hominis,
chylamydia trachomatis, listeria monocytogenes, hemophilus
influenzae, campylobacter jejuni and group A streptococcus,
Treponema pallidum(maternal syphilis).
• note: hemophilus influenzae, campylobacter jejuni and group A
streptococcous are one of the organisms reported in septic
abortions.
• viral: rubella, Cytomegalo virus, herpes.

10. • 5.) IMMUNOLOGICAL CAUSES
• inherited theombophilias- deficiencies in protein C/S and
antithrombin III.
• antiphospholipid antibody syndrome(APLA)
• HLA system with rejection of paternal antigens

11. • 6.) DRUG USE
• Smoking
• Alcohol use during the first 8 weeks of pregnancy,
• Coffee consumption at least four(4) times a day.
• Intrauterine devices(IUD) after contraceptive failure-
associated with septic abortions.

12. • 7.) UNKNOWN CAUSES
• 15%-20% CaseS of spontaneous abortions, the cause is not
known.

13. T1= 1st trimester, T2= 2nd Trimester, RPL= recurrent pregnancy loss, H/O= history of

15. CLINICAL PRESENTATION/INVESTIGATIONS
• 1.) THREATENED ABORTION
• Symptoms:
• minimal or no abdominal pain
• minimal per vaginal bleeding
• Signs:
• general stable condition
• closed cervical Os
• uterus size corresponds to gestational age
• live fetus
• Investigations: Hb, ABO and rhesus blood group, ultrasound for
viability.

16. • 2.) INEVITABLE ABORTION
• Symptoms:
• severe abdominal/pelvic pain
• moderate to severe per vaginal bleeding
• Signs:
• open cervical Os
• uterine size corresponds to gestational age
• presence of contractions
• Investigations: Hb, ABO and rhesus blood group

17. • 3.) INCOMPLETE ABORTION
• Symptoms:
• severe abdominal pain/pelvic pain
• moderate to severe per vaginal bleeding
• Signs:
• uterus size is smaller than the gestational age
• some products of conception located in cervical Os
• open cervical Os
• Investigations: Hb, ABO and rhesus blood group and x-
match

18. • 4.) COMPLETE ABORTION
• Symptoms:
• minimal per vaginal bleeding
• Signs:
• closed cervical Os
• uterus size is smaller than gestational age
• Investigations: Hb, ABO and rhesus blood group< ultrasound

19. • 5.) MISSED ABORTION
• Symptoms:
• loss of pregnancy symptoms
• Signs:
• uterus size is smaller than gestational age
• absent fetal movements
• absent fetal heart sound
• closed cervical Os
• Investigations: Hb, ABO and rhesus blood group, bedside
clotting test, ultrasound.

20. • 6.) SEPTIC ABORTION
• Causes: unsafe abortion, prolonged retention of product of conception, incomplete
and unsterile evacuation of the uterus, anaerobic bacteria(two-third cases) and
coliforms.
• Symptoms:
• abdominal pain
• purulent vaginal discharge
• Signs:
• fever(temperature > or = 38 degree celsius)
• Tachycardia(heart rate of >100 bpm)
• pelvic tenderness
• soft cervix and maybe dilated.
• Investigations: FBC, ABO and rhesus blood group, bedside clotting time and
endocervical swab or high vaginal swabs, blood culture, serum electrolytes.

21. GRADING OF SEPTIC ABORTION
• Is dependant on the spread of infection
• GRADE 1- infection is localised in the uterus
• GRADE 2- infection spreads beyond uterud to parametrium,
tubes, ovaries or pelvic parametrium.
• GRADE 3- they is generalised peritonitis, endotoxic shock,
acute renal failure, jaundice.

24. COMPLICATIONS
• hemorrhage
• injury to uterus and adjoing organs
• septic shock
• generalised peritonitis
• acute renal failure
• thrombophlebitis
• dyspareunia
• ectopic pregnancy
• secondary infertility

25. REFERENCES
• WILLIAMS MANUAL OF PREGNANCY
COMPLICATIONS(23RD EDITION) BY KENETH .J. LEVENO,
MD, E’TAL..
• ONE TOUCH OBSTETRICS AND GYNECOLOGY FOR
NEET/NEXT/FMGE/INI-CET(1ST EDITION) BY DR SAKSHI
ARORA HANS.
• GYNECOLOGY BY TEN TEACHERS(20TH EDITION) BY
HELLEN BICKERSTAFF AND LOUIS C KENNY.
• ABORTIONS BY DR I.S.H HANSINGO

26. • THANK YOU
• NEXT SLIDE: MANAGEMENT OF
ABORTIONS/MISCARRIAGES..