• Mrs M aged 24 yrs and 11 weeks pregnant
presented to the Emergency Department with
abdominal cramping and heavy vaginal
bleeding and clots. Over the past 2 days, she
has experienced light spotting, which has
increased in severity that morning. Mrs M
reported no fever , chills, burning on urination,
nausea or vomiting.
• Past obstetric H/o : G-4, P-2, A-1
she was receiving prenatal care from her
• Physical Examination:
BP- 125/85 mm Hg
Heart Rate- 83beats/min
RR- 18 breaths/min
O2 saturation- 100% on room air
Lungs - were clear, s1 and s2 normal,
• PELVIC EXAMINATION:
O/E- Moderate active bleeding was noted in
the vaginal vault with cx os open.
Product of conception are felt through OS.
No cervical motion tenderness or adnexal
tenderness was observed.
• WBC – 10,000/uL (normal- 4,500-11,000)
• Hb - 13.7g/dl (normal 12.1-15.1)
• Hematocrit – 39.7% (normal 36%-44%)
• Blood Type- B+ve
• Beta-HCG – 9400.0mlU/mL
• TV USG- Appeared to be an abnormal G.Sac
near to cervical canal
• Cervical Abnormalities- Malignancy, polyps or
• Ectopic Pregnancy
• Idiopathic bleeding in a viable pregnancy
• Infection of the vagina or cervix
• Molar Pregnancy
• Spontaneous Abortion
• Vaginal Trauma
INTRODUCTION / DEFINITION
• TERMINATION OR LOSS OF PREGNANCY
BEFORE THE AGE OF VIABILITY (28,24,22 wks
• WHO- 24wks or 500g
• In our environment- officially still 28 wks
• Significant public health problem, important
cause of maternal mortality in the developing
• Appox. 70,000 women die from complications
of induced Abortions.
• Around 99% of deaths are due to unsafe
DEFINITION & CLINICAL FEATURES
- It a clinical type where the change have
progressed to a state from where continuation
of pregnancy is impossible.
- Pregnancy cannot be redeemed and must be
- vaginal bleeding with severe abdominal pain
and dilatation of the cervix
• To take appropriate measures to look after the
• To accelerate the process of expulsion.
• To maintain strict aseptic measures.
•D&E followed by
• oxytocin drip 10 units in
5oo NS Acceleration of Uterine
• Abdominal Hysterotomy