Abortion prof druw-pe

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Abortion prof druw-pe

  1. 1. Dr Win Pe Clinical Professor / ConsultantDepartment of Obstetrics & Gynaecology University of Medicine, Mandalay
  2. 2. • Accounts for ¾ of gynaecological admissions• Important cause of maternal morbidity and mortality
  3. 3. Causes of early pregnancy bleeding• Spontaneous miscarriage• Ectopic pregnancy• Gestational trophoblastic disease• Implantation bleeding
  4. 4. Gynaecological complications • Cervical cancer • Infections • Cervical polyp
  5. 5. The normal pregnancySymptomatology• Classical trial• Amenorrhoea• Pelvic or low abdominal pain• Vaginal bleeding
  6. 6. First test is to demonstrate the presence of HCG - HCG • Glycoprotein • 2 subunits • Half life 6 to 24 hours • Peak level at 9 to 13 weeks
  7. 7. Urine test• Sensitivity is around 25 IU/Ltr• Positive results around 14 days after ovulationPlasma HCG• 0.1 to 0.3 iu/L is able to detect a pregnancy 6 to 7 days after ovulation
  8. 8. Definition• The expulsion of the concepts before 24 weeks of pregnancy
  9. 9. Aetiological factors of early pregnancy disordersMiscarriageChromosomal Trisomies (Down’s syndrome)abnormalities (Material Triploidies and tetraploidesage >35 yrs) Monosomy X (Turner’s syndrome) Transiocation (hereditary)Endocrine disorders Diabetes, hypothyroidsm, luteal phase deficiency, polycytic ovarian syndromeAbnormalities of the Uterine septa (bicornute utetus)uterus Endometrial adhesions (post-curettage or Asherman’s syndrome)
  10. 10. MiscarriageInfections Salmonella typhi, malaria, cytomegalvirus, Brucella, toxoplasmnosis, Mycoplasma hominis, Chlamydia trachomatis, and Ureaplasma urealyticumChemical agents Tobacco, anaesthetic gases, arsenic, benene, solvents, ethlene oxide, formaldehyde, pesticides, lead, mercury, and cadmiumPshychological disorders Antiphospholipid syndromeImmunological disorders Thrombophilia (hereditary)
  11. 11. Different types of abortion1.Threaten abortion is characterised by • Bleeding aft amenorrhoea • No uterine contraction and pain • The cervix is closed • Uterus size is similar to date
  12. 12. 2.Inevitable abortion • There will be – more bleeding • Uterine contraction and pain • The cervix is dilated
  13. 13. 3. Complete abortion • The whole conceptus is expelled • Uterus contracts to normal size • Bleeding stops • The cervix is closed
  14. 14. 4. Incomplete abortion • There will be products of conception • Bleeding continue and severe accompanied by shock • There will be pain • Infection may supervene
  15. 15. 5. Missed abortion • Dead fetus retained in the uterus • Size of uterus is smaller than dates • Signs + symptoms of pregnancy reduced • Brownish discharges per vaginum • The os is closed • In ultrasound there is no fetal heart movement
  16. 16. 6. Septic abortion • Caused by incomplete abortion complicated by infection • There will be pyrexia • Abdominal pain + pelvic tenderness • Foul smelling purulent discharge per vagina
  17. 17. 7. Habitual abortion • Three or more consecutive abortion (spontaneous)
  18. 18. Management of different types of abortion• Threatened abortion • Reassurance • Bed rest • Sedation • Uterine relaxants • Hormone (progestogen) • USS to check viability • All pads + everything passed may be saved for examination • Modern approach – no treatment has proved the value
  19. 19. Management of different types of abortion• Inevitable abortion• Incomplete abortion• Missed abortion• Complete abortion – No treatment required – Habitual abortion • Treat the cause if cause is found • Treat general disease if present
  20. 20. Management of septic abortion• General • Nursing care • Nutrition • Fluid and electrolytes balance • Correct anaemia • To note urine out put
  21. 21. Specific • Cervical swab • High vaginal swab for C & S • Blood culture • IV Antibiotics • C Pen & ampicillin – gm(+) • Gentamycin – gm (-) • Metronidazole – anaerobes • Antitetanus toxoid • Remove the septic focus
  22. 22. • Management of septic abortion• Evacuation and curettage for RPOC• POD puncture and drainage• Laparotomy and drainage• TAH if perforation detected
  23. 23. Septicaemic shock • Keep is ICU • O2 • Correct acidosis • Blood transfusion if require • Antibiotics intravenously • Blood and heparin for DIC
  24. 24. Renal failure (Urine output < 30 ml/hr) increased urea and electrolytes• Restrict fluid• High carbohydrate, low protein• Restriction of sodium and potassium• Dialysis if blood urea more than 25 mmol/l• Manitol• frusemide

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