Pathology 7 We Care• Haemorrhage into the decidua basalis.• Necrotic changes in the tissue adjacent to the bleeding.• Detachment of the conceptus.• The above will stimulate uterine contractions resulting in expulsion.
7 We Care ABORTION-DEFINITIONTermination of pregnancy before the fetusis capable of extra-uterine survival i.e. 20wks or 500gm birth wt
• Types of abortion Threatened abortion. 7 We Care• Incomplete abortion.• Complete abortion.• Missed abortion Septic abortion: Any type of abortion, which is complicated by infection
• History CLINICAL APPROACH 7 We Care• Examination• Special Investigations
History• VAGINAL BLEEDING 7 We Care • Slight and bright red • Associated with fleshy mass • Associated with fowl smell and discharge • Associated with grape like vesicle • Sanguinous or dark coloured and continuous • ‘White currant in red currant juice’
Pain abdomen • Minimal 7 We Care • Acute , agonising or colicky • Shoulder pain • Fever
Symptoms of early pregnancy • Amenorrhoea 7 We Care • Morning sickness • Frequency of micturition • Breast discomfort • Fatigue
• Trauma 7 We Care• Cervical pathology• Open cervical os- incomplete abortion
• Bimanual examination 7 We Care • Extreme tenderness on fornix palpation or rocking of cervix • Palpation of bilateral or unilateral enlargement of ovary - molar pregnancy • Palpation of adnexal mass- Ectopic pregnancy
7 We Care HYDATIFORM MOLE(Snow storm appearance)
DIAGNOSIS• Threatened abortion 7 We Care – Positive UPT – Intrauterine pregnancy – Viable fetus• Incomplete abortion • Positive UPT • Product of conception in-situ • Non viable fetus
• Complete abortion 7 We Care – Positive UPT – Absent product of conception• Ectopic pregnancy – Positive UPT – USG confirmation – Product of conception absent in uterus• Molar pregnancy – Positive UPT – Typical USG findings
Management of Threatened Abortion 7 We Care• Advise woman to avoid strenuous activity and sexual intercourse; bed rest not necessary• If bleeding stops, follow up in antenatal clinic. Reassess if bleeding recurs• If bleeding persists, assess for fetal viability.
Incomplete Abortion 7 We Care• If bleeding light to moderate, use fingers or ring (or sponge) forceps to remove products of conception protruding through cervix• If bleeding heavy, evacuate uterus: – Manual vacuum aspiration (MVA) is preferred method – If evacuation not immediately possible, give ergometrine OR misoprostol47
Incomplete Abortion 7 We Care• Infuse oxytocin 40 units in 1 L IV fluids at 40 drops/min. until expulsion of products of conception occurs• Evacuate any remaining products of conception from uterus by dilatation and curettage• If necessary, give misoprostol 200 µg vaginally every 4 hours until expulsion48
Management of Complete Abortion 7 We Care • Evacuation of the uterus usually not necessary • Observe for heavy bleeding • Ensure followup of woman after treatment49
Follow up After Abortion• Tell woman that spontaneous abortion is common 7 We Care• Reassure woman that chances for subsequent successful pregnancy are good• Encourage her to delay next pregnancy until completely recovered• Advise on contraception
Immediate Management of Molar Pregnancy• If diagnosis is certain, evacuate uterus: 7 We Care – If cervical dilatation is needed, use a paracervical block – Use vacuum aspiration (MVA preferred)• Infuse oxytocin 20 units in I L IV fluids at 60 drops per min.
ECTOPIC PREGNANCY• Expectant 7 We Care• Medical• Surgical