1. By SAJID SULTAN
08-162
FINAL YEAR MB,BS

2.  Conservative with bed rest and reassurance till
bleeding stops.
 Sexual intercourse best avoided.
 Follow up with ULTRASOUND-presence of fetal
cardiac activity predicts good outcome in 95%of
cases.
 Hormone therapy -400mg natural progesterone in
2divided doses orally or vaginally on empirical
basis.
 Anti D if mother is Rh negative and pregnancy is
beyond 12 weeks.

3.  Immediate evacuation of pregnancy.
(If duration of pregnancy less than 12 weeks-
suction evacuation and greater than 12 weeks
oxytocin infusion.)
 Shock-resuscitation with i/v fluids and blood
transfusion.
 Prophylactic antibodies and anti-D.

9.  Resuscitation if patient is in shock and evacuation
by suction evacuation.
 If the os is closed PGE1 tablets are kept in vagina
for ripening the cervix.
 Prophylactic antibodies and anti D

10.  Conservative
 Anti D not indicated if pregnancy is less than 12
weeks and there was no operative intervention.

11.  Uterus evacuated as soon as possible. A donor
should be kept ready.
 If uterine size is less than 12 weeks of gestation
PGE1 tablets kept in vagina results in
spontaneous expulsion without the need of
surgical intervention.
 If more than 12 weeks, 6th
or 12th
hourly PGE1
tablets used vaginally results in spontaneous
expulsion or extra amniotic ethacridine acetate.
 Anti D and antibiotics.

12.  Police notification if a criminal abortion is
suspected.
 Mild cases-broad spectrum antibiotics are started
and uterus evacuated.
 Severe cases-maintenance of perfusion and
ventilation.
 I/v infusion and CVP line is inserted
 Blood transfusion
 Oxygen given by nasal catheter.

14.  Antibiotics commenced after taking a high vaginal
swab.
 Ampicillin,Gentamycin and Metronidazole/third
generation cephalosporin like cefotaxime or
cefuroxime with metronidazole or clindamycin.
 Evacuation of uterus after infection is controlled.

15.  Due to cervical incompetence
Management is be cervical cerclage if there is a well
documented history otherwise serial follow up is done with
transvaginal ultrasound for early signs of
incompetence.Cervical cerclage is usually delayed upto 12-14
weeks so that miscarriage due to other causes can be
eliminated.
Sonography is done to confirm live fetus and if there is
infection,it should be treated and sexual intercourse should be
avoided.
Contraindications-Bleeding,contractions/ruptured membranes.

16.  Chromosomal abnormalities-karyotyping of both
parents and prenatal diagnosis in the next
pregnancy.
 Uterine factors-hysteroscopic resection in case of
a septum or division of the adhesion in
Asherman’s syndrome. Myomectomy in case of
fibroid..
 Inherited thrombophilia-Low dose aspirin and
heparin.

18. Patient is in lithotomy position and cervix is exposed with
Sim’s speculum.The cervical lips are held with sponge
holding forceps and a purse string suture with a non
absorbable material like black silk is taken all around the
cervix.
Disadvantage –suture may be below internal os.

20. Small transverse incision is made on anterior lip of
cervix at cervicovaginal junction 2cm above the
external os.Bladder is then pushed up and a suture
of black silk or mersilene tape is passed from anterior
to posterior aspect submucosally using Shirodkar’s or
any curve bodied needle.2 ends of the suture are
pulled and tied posteriorly.Anterior incision is closed
with catgut.

22. Done in cases of repeated failure of vaginal
approach and cervix is inaccessible
Disadvantage-Caesarean section
In case of miscarry cerclage has to be removed at
laparotomy.

23.  Bed rest for 48 hours
 Antibiotic cover
 Avoid sexual intercourse
 Cerclage is removed at 37 weeks or at the onset
of labour ,if not it can result in rupture uterus.

24. THANK YOU