Abortion presentation

1. PRESENTATION ON ABORTION
BY
F.C. CHAMPO
BSC III STUDENT
COMPUTOR NO 26069202
SCHOOL OF MEDICINE
PBN DEPARTMENT
UNIVERSITY OF ZAMBIA

2. GENERAL OBJECTIVE
 TO EQUIP STUDENTS WITH SKILL AND
KNOWLEDGE TO IDENTIFY TYPES OF
ABORTIONS AND TO ENABLE THEM
PROVIDE COMPREHENSIVE SERVICES
THAT WILL MEET THE CLIENTS NEEDS.

3. SPECIFIC OBJECTIVES
AT THE END OF THE LECTURE
SSBAT:
 Define abortion
 State the different causes of abortion
 State clinical types of abortions
 List the signs and symptoms of an abortion
 Outline the immediate management of
woman with an abortion
 State the complications that can occur due to
an abortion

4. INTRODUCTION
 Uterine abortion is the commonest cause
of vaginal bleeding in early pregnancy
 It complicates 10-15% of all pregnancies
 However bleeding in early pregnancy can
be caused by other pregnancy
complications such as ectopic pregnancy,
and molar pregnancy being the most
serious

5. INTRODUCTION contd…
Others are;
 Mucous polyp
 Carcinoma
 Vulva or vaginal lesions e.g. varicose veins

6. INTRODUCTION contd…
 All these conditions may cause bleeding in early
pregnancy
 Abortion is important not only because of the
loss of the wanted pregnancy, but because it’s
an important cause of maternal death from the
haemorrhage and sepsis which may follow a
mismanaged abortion
 Abortion accounts for 95% of cases of bleeding
in early pregnancy.

7. Definition
 Abortion is an expulsion of products of
conception before the 28th week of
gestation and before viability of the fetus
(Hossan 1982)
 Abortion is loss of pregnancy before the
28th week or loss of fetus weighing less
than 500g (WHO)

8. Definition contd…
 An abortion can either be induced or
spontaneous
 Induced abortions may be therapeutically
indicated or elective that is for either
social or personal reasons
 Spontaneous abortions start because of
some physiological cause

9. CAUSES OF ABORTION
 There are recognizable factors that
predispose a woman to spontaneous
abortion;
 Chromosomal anormalies: account for
50-60% for early spontaneous abortions
 These may either involve number of
chromosomes, monosomy,trisomy, triploidy
or structural defects e.g. translocation,
inversion e.t.c. (Kajii, Ferrier etal, 1980).

10. CAUSES OF ABORTION contd…
 Noxious agents e.g. viruses,
chemicals, cytotoxic drugs, radiation
may be embryotoxic
 Maternal infections: several agents
have been suspected e.g. listeria
monocytogenes, mycoplasma hominis,
urea plasma urealyticum, malaria e.t.c.

11. CAUSES OF ABORTION contd
 Maternal chronic disease:
tuberculosis, sickle cell disease, chronic
renal disease, hypothyroidism.
 Abnormalities of the generative
organs e.g. retroversion or prolapse,
incompetent cervix, congenital
abnormalities of the uterus e.g. septate
uterus, bicornuate uterus.

12. CAUSES OF ABORTION contd
 Unsuccessful implantation: subtle
changes in the delicate processes that lead to
successful implantation may cause early
abortion e.g. abnormalities in the hormonal
control of tubal motility or development of
the decidua e.t.c.
 Abdominal surgery: trauma of surgery may
initiate abortion e.g. myomectomy,
appendicitis or peritonitis (laparatomy)

13. CAUSES OF ABORTION contd
 Other causes;
 Advanced maternal age
 Poor obstetric history
 Infertility
 Concurrent medical disorders like diabetes
mellitus, cystic fibroids, and systemic lupus
erythematosus.

14. CAUSES OF ABORTION contd
 In a way causes of abortion can be
classified into maternal and fetal causes as
they have been tabulated above
 Often the cause of abortion cannot be
found
 And fetal causes are the commonest
cause of early abortion in cases of fetal
abnormalities

15. CLINICAL TYPES OF ABORTION
SPONTANEOUS
 Threatened
 Inevitable
 Complete
 Incomplete
 septic
 Missed
 Habitual

16. CLINICAL TYPES OF ABORTION contd…
INDUCED
 Therapeutic
 Septic
 Complete
 Incomplete

17. CLINICAL TYPE PRESENTATION
1. THREATENED ABORTION
 Per vaginal bleeding of uterine origin
 Cervix is closed
 Bleeding may be heavy or slight
 Intermittent or continous bleeding
 May or may not be accompanied by mild
cramping and back pain
 Pregnancy test is usually positive

18. CLINICAL TYPE PRESENTATION contd…
2. INEVITABLE ABORTION
 Progressive dilatation of the cervix
 Pregnancy is more advanced < 12 weeks
 Bleeding is heavier
 Abdominal pain is more severe, colicky in nature and
situated in the supra pubic area
 Amniotic membranes may be felt bulging into the
cervical canal or may be already ruptured and fetal
parts palpable
 May be complete or incomplete

19. CLINICAL TYPE PRESENTATION
contd
3. COMPLETE ABORTION
 The term “complete abortion” signifies that all
products of conception have been expelled.
 Uterus becomes smaller on palpation
 On vaginal examination cervix is closed
 Patient usually notices expulsion of the tissue or even
fetus and placenta
 Abdominal pain subsides
 Bleeding may stop or slows down considerably

20. CLINICAL TYPE PRESENTATION
contd…
4. INCOMPLETE ABORTION
 Expulsion of products of conception is
incomplete
 Abdominal pain continues although may
be less severe
 Bleeding continues and becomes heavier
 Uterus enlarged, palpable and may feel
boggy

21. CLINICAL TYPE PRESENTATION
contd
5. INCOMPLETE ABORTION contd…
 Cervix may either be dilated or closed,
but will feel patulous
 Signs of shock if severe bleeding
 Placenta and fetus may appear to have
been expelled intact, but some
trophoblastic or placental tissue remain
adhering to the uterine wall causing
profuse bleeding
 Products of conception may be felt or seen

22. CLINICAL TYPE PRESENTATION
contd
6. MISSED ABORTION
 Refers to cases in which dead fetus or
embryo has been retained in the uterus
for more than 4-8weeks
 After period of normal pregnancy the
fetus dies
 This may or may not be heralded by
vaginal bleeding or abdominal pain

23. CLINICAL TYPE PRESENTATION
contd
MISSED ABORTION contd…
 Vaginal bleeding stops and patient
continues to be ammenorrheic
 In some other cases vaginal bleeding
continues intermittently and usually is
dark brown discharge
 Fetal movements if felt before ceases

24. CLINICAL TYPE PRESENTATION
contd
MISSED ABORTION contd…
 Symptoms of early pregnancy begin to
disappear
 Uterine size remain stationery or even
decreases
 Cervix is closed
 Fetal heart cannot be heard by either
fetoscope or Doppler
 Pregnancy test usually is negative

25. CLINICAL TYPE PRESENTATION
contd
MISSED ABORTION contd
 process of abortion will eventually start
spontaneously 4-5 weeks
 The main complication of missed abortion
is development of Disseminated
Intravascular Coagulation (DIC)
 Patient notices gum or nose bleeding or
bleeding may occur after mild trauma
(cutaneous ecchymoses)

26. CLINICAL TYPE PRESENTATION
contd
7. SEPTIC ABORTION
 Infection can complicate any type of abortion
 If the infection is disseminated into the
maternal systemic circulation it is usually called
septic.
 Illegal (criminal) abortion used to be the cause
of septic abortion
 The risk to the patient was not only from the
sepsis (unsterile instruments or environment)
but also from possible associated injuries to
the birth canal.

27. CLINICAL TYPE PRESENTATION
contd
SEPTIC ABORTION contd..
 Per vaginal bleeding with pain
 Amount of bleeding is variable and pain is
suprapubic constant and severe
 Patient feels weak and complains of
headache, malaise and seem to be
extremely ill

28. CLINICAL TYPE PRESENTATION
contd
SEPTIC ABORTION contd..
 Chills and fever signifies serious infection
 Most serious complications of septic
abortion is septic shock characterized by
hypotension with tachycardia, normal or
subnormal temperature
 Generalized abdominal tenderness with
rebound tenderness, rigidity or distension
are signs of spreading peritonitis

29. CLINICAL TYPE PRESENTATION
contd
SEPTIC ABORTION contd..
 On vaginal examination cervix is open with
foul smelling purulent bloody vaginal
discharge
 Products of conception may be felt in
cervical canal or inside the uterine cavity
 Cervical motion elicits severe tenderness

30. CLINICAL TYPE PRESENTATION
contd
8. HABITUAL ABORTION
 A woman who has had three or more successive
abortions is called a habitual aborter.
 In the majority of patients no obvious causes
can be found.
 However some of the known causes are chronic
illness, such as diabetes mellitus, and abnormalities
such as a septate uterus and cervical incompetence
 These women should always be referred to the
hospital.

31. IMMIDIATE MANAGEMENT OF ABORTION
THREATENED ABORTION
 Obtain history and do physical
examination and vital observations for
diagnosis, assessment, and base line data.
 Bed rest is the most important form of
treatment. The patient should remain in
bed for 5-7days or for as long as blood is
bright red. Bed rest increases blood flow
to the placenta and reduces pain.

32. IMMIDIATE MANAGEMENT OF
ABORTION contd..
THREATENED ABORTION contd..
 Give mild sedatives e.g. phenobarbitone 60mg
8hourly to enable patient rest in bed
 If uterine contractions become stronger,
analgesics such as pethidine100mg
intramuscularly or morphine 15mg may be
needed.
 Pads should be saved in order to help assess the
amount of blood loss. Report any increase in
bleeding or pain.

33. IMMIDIATE MANAGEMENT OF
ABORTION contd..
COMPLETE ABORTION
 Rest in bed, if possible with sedation
 Evacuate uterus as soon as possible to
ensure completeness
 Check Hb after 24hours
 Curettage only needed if bleeding persists

34. IMMIDIATE MANAGEMENT OF
ABORTION contd..
INCOMPLETE ABORTION
 Evacuate uterus under anesthesia or
strong analgesia
 Replace blood if necessary
 Antibiotics only if febrile
 Set up pitocin drip
 If patient is in shock start a plasma
expander drip after taking blood for
grouping and cross-matching

35. IMMIDIATE MANAGEMENT OF
ABORTION contd
INCOMPLETE ABORTION contd..
 Do a sterile vaginal examination and remove any
placental tissue distending the cervix with a
finger or sponge forceps
 Give ergometrine 0.5mg intramuscularly. Once
these steps have been taken the condition
usually improves and the patient can safely be
transferred to hospital.
 N.B Do not transfer a shocked patient to
hospital; Resustate first.

36. IMMIDIATE MANAGEMENT OF
ABORTION contd
SEPTIC ABORTION
 Treatment of these patients with septic
abortion is an emergency as delay may
result in severe complications or death
 Patients should be managed in the
hospital if possible, however treatment
should be instituted as soon the diagnosis
is made

37. IMMIDIATE MANAGEMENT OF
ABORTION contd
SEPTIC ABORTION contd..
 Resustate with intravenous fluids
 Give parenteral broad spectrum antibiotics
 Take a cervical swab for culture and
sensitivity before starting antibiotic
treatment
 Blood transfusion can be given in cases of
low haemoglobin

38. IMMIDIATE MANAGEMENT OF
ABORTION contd
SEPTIC ABORTION contd..
 Most patients will have fluid deficit from
blood loss during abortion or from poor
fluid intake due to ill health
 Evacuation of the uterus should be
instituted immediately resustation is
complete and antibiotics started

39. IMMIDIATE MANAGEMENT OF
ABORTION contd
 MISSED ABORTION
 Wait up to one month for bleeding to
commence
 There is poor response to pitocin
 Refer cases of missed abortion to hospital
for surgical evacuation and checking of
uterus may be necessary

40. COMPLICATIONS OF ABORTION
 Severe vaginal bleeding due to retained
products of conception
 Shock due to bleeding
 Secondary bacterial infections due to use
of unsterile instruments to abort or from
an endogenous infective organism

41. COMPLICATIONS OF ABORTION
contd..
 Peritonitis
 Uterine rupture
 Bacteremia
 Anaemia

42. CONCLUSION
 We have discussed abortion and we said that
abortion is the expulsion of products of
conception before the 28th week of gestation.
 An abortion can either be induced or can start
spontaneously.
 Causes of abortion can either be maternal or
fetal, but there are cases where the cause is not
known.
 We also looked at various clinical types of
abortion such as incomplete, complete and
others.
 All cases of abortion should be considered
incomplete until a thorough investigation is done
 They should be treated as an emergency

43. THE END
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