This document defines different types of abortion and provides information about their causes, symptoms, and management. The main types discussed are:
- Spontaneous abortion, which can be threatened, inevitable, complete, incomplete, missed, or septic depending on the progression. Common causes include genetic abnormalities and infections.
- Induced abortion, which is the deliberate termination of a pregnancy. It can be done through medical or surgical means.
- Incomplete abortion occurs when not all pregnancy tissue is expelled, requiring evacuation to prevent complications like bleeding or infection.
- Missed abortion describes a nonviable intrauterine pregnancy where the fetus has died but remains in the uterus. Ultrasound is usually needed to
All mothers and newborns need at least four postpartum check-ups in the first six weeks. This is a
notable change to previous WHO guidance, which recommended only two postpartum check-ups within two to three days and at six weeks after birth.
Oligohydramnios by dr alka mukherjee dr apurva mukherjee nagpur m.s.alka mukherjee
• Oligohydramnios refers to amniotic fluid volume that is less than expected for gestational age. It is typically diagnosed by ultrasound examination and may be described qualitatively (eg, reduced amniotic fluid volume) or quantitatively (eg, amniotic fluid index ≤5 cm, single deepest pocket <2 cm).
• Oligohydramnios may be idiopathic or have a maternal, fetal, or placental cause The fetal prognosis depends on several factors, including the underlying cause, the severity (reduced versus no amniotic fluid), and the gestational age at which oligohydramnios occurs. Because an adequate volume of amniotic fluid is critical to normal fetal movement and lung development and for cushioning the fetus and umbilical cord from uterine compression, pregnancies complicated by oligohydramnios from any cause are at risk for fetal deformation, pulmonary hypoplasia, and umbilical cord compression.
• Oligohydramnios is associated with an increased risk for fetal or neonatal death, which may be related to the underlying cause of the reduced amniotic fluid volume or due to sequelae of the reduced amniotic fluid volume.
• This topic will discuss issues related to oligohydramnios. Methods of amniotic fluid volume assessment are reviewed separately.
• Oligohydramnios occurs when the amniotic fluid is < 5th centile for gestational age.
• The most common causes are premature rupture of membranes (often missed by the mother) and placental insufficiency, however structural abnormalities such as renal agenesis should be considered.
• Prognosis is linked to gestation at diagnosis and likely development of pulmonary hypoplasia and premature delivery.
• Treatment is by optimising gestation of delivery
Causes and management of first and second trimester abortions
anatomical, chromosomal, immunological, hormonal causes and infections. Investigation for detection of cause and possible treatment. Surgical correction of cervical incompetence and medical treatment, progestational drugs
All mothers and newborns need at least four postpartum check-ups in the first six weeks. This is a
notable change to previous WHO guidance, which recommended only two postpartum check-ups within two to three days and at six weeks after birth.
Oligohydramnios by dr alka mukherjee dr apurva mukherjee nagpur m.s.alka mukherjee
• Oligohydramnios refers to amniotic fluid volume that is less than expected for gestational age. It is typically diagnosed by ultrasound examination and may be described qualitatively (eg, reduced amniotic fluid volume) or quantitatively (eg, amniotic fluid index ≤5 cm, single deepest pocket <2 cm).
• Oligohydramnios may be idiopathic or have a maternal, fetal, or placental cause The fetal prognosis depends on several factors, including the underlying cause, the severity (reduced versus no amniotic fluid), and the gestational age at which oligohydramnios occurs. Because an adequate volume of amniotic fluid is critical to normal fetal movement and lung development and for cushioning the fetus and umbilical cord from uterine compression, pregnancies complicated by oligohydramnios from any cause are at risk for fetal deformation, pulmonary hypoplasia, and umbilical cord compression.
• Oligohydramnios is associated with an increased risk for fetal or neonatal death, which may be related to the underlying cause of the reduced amniotic fluid volume or due to sequelae of the reduced amniotic fluid volume.
• This topic will discuss issues related to oligohydramnios. Methods of amniotic fluid volume assessment are reviewed separately.
• Oligohydramnios occurs when the amniotic fluid is < 5th centile for gestational age.
• The most common causes are premature rupture of membranes (often missed by the mother) and placental insufficiency, however structural abnormalities such as renal agenesis should be considered.
• Prognosis is linked to gestation at diagnosis and likely development of pulmonary hypoplasia and premature delivery.
• Treatment is by optimising gestation of delivery
Causes and management of first and second trimester abortions
anatomical, chromosomal, immunological, hormonal causes and infections. Investigation for detection of cause and possible treatment. Surgical correction of cervical incompetence and medical treatment, progestational drugs
Covers the basic information about abortions that you need to know with in depth discussion of the different types of abortions and their characteristics
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
2. • Abortion is the expulsion or extraction of an embryo or fetus
weighing 500 g or less from its mother when it is not capable of
independent survival (i.e. before the period of viability).
• The fetus is generally considered to be viable any time after the fifth to
sixth month of gestation.
• An abortion that occurs without intervention is known as
a miscarriage or "spontaneous abortion" and occurs in
approximately 30% to 40% of pregnancies.
• When deliberate steps are taken to end a pregnancy, it is called
an induced abortion, or less frequently "induced miscarriage". The
unmodified word abortion generally refers to an induced abortion.
3. DEFINITION
“Abortion is the termination of pregnancy before 20
gestational weeks”.
“Abortion is the process of partial or complete
separation of the products of conceptus from the uterine
wall with or without partial or complete expulsion from
the uterine cavity”.
“Interruption of pregnancy or expulsion of the product of
conception before the fetus is viable is called abortion”.
4. INCIDENCE
• 10–20% of all clinical pregnancies
• 75% abortions occur before the 16th week
• Rates vary with maternal age; also high in
women with past miscarriages
7. Fetal Factors
• Genetic
– 50% of early miscarriage is due to chromosomal
abnormalities like Trisomy, Polyploidy,
Monosomy
– Structural defects like translocation, deletion,
inversion
• Multiple Pregnancies
• Degeneration of villi
10. • Environmental Factors
– Cigarette smoking
– Alcohol consumption
– Contraceptive agents
• Maternal medical illness
– Cyanotic heart disease
– Hemoglobinopathies
• Unexplained (40-60%) – In majority, the
exact cause is not known.
11. SPONTANEOUS ABORTION
• Miscarriage, also known as spontaneous abortion, is the
unintentional expulsion of an embryo or fetus before the
24th week of gestation.
• It is estimated that 1 of every 5 to 10 conceptions results in
spontaneous abortion.
• Most of these occur because an abnormality in the fetus
makes survival impossible.
• Other causes may include systemic diseases, hormonal
imbalance, or anatomic abnormalities.
•Spontaneous abortion occurs most commonly in the second or
third month of gestation.
12. There are various kinds of spontaneous abortion,
depending on the nature of the process
• Threatened
• Inevitable
• Complete
• Incomplete
• Missed
• Septic
13. ThreatenedAbortion
• Condition in which miscarriage
has started but has not
progressed to a state from
which recovery is impossible.
• In a threatened abortion, the
cervix does not dilate.
CLINICAL FEATURES:-
1. Bleeding per vaginam
2. Pain - mild backache or dull
pain in lower abdomen.
15. Management & Prognosis
• Rest: Patient should be in bed for few days until
bleeding stops
• Relief of pain: Diazepam 5 mg BD
• 80% of pregnancies with threatened abortions go on
until term.
• If a live fetus is seen on USG, pregnancy is likely
to continue in over 95% cases.
• If pregnancy continues, there is increased frequency
of preterm labor, placenta previa & IUGR
16. InevitableAbortion
• It is the clinical type of abortion where the
changes have progressed to a state from where
continuation of pregnancy is impossible.
• Inevitable abortion is an early pregnancy with
vaginal bleeding and dilatation of the cervix.
• Typically, the vaginal bleeding is worse than with a
threatened abortion, and more cramping is present.
• No tissue has passed yet.
• On ultrasound, the products of conception are
located in the lower uterine segment or the cervical
canal.
17. CLINICAL FEATURES:
• The patient, having the features of threatened
miscarriage, presents with
– vaginal bleeding
– Aggravation of colicky pain in the lower abdomen
• Sometimes, the features may develop quickly
without prior clinical evidence of threatened
miscarriage
• Internal examination reveals dilated internal os
through which the products of conception are felt.
18. Management
• Management is aimed:
– To accelerate the process of expulsion
– To maintain strict asepsis
• If pregnancy < 12 weeks, suction evacuation is done
• If pregnancy > 12 weeks, expulsion by oxytocin
infusion
• General measures:
– Excessive bleeding is controlled by
administering methergin 0.2 mg
– Blood loss is corrected by IV fluid therapy and
blood transfusion
19. Incomplete abortion
• The process of abortion has already taken place, but the
entire products of conception are not expelled & a part of it
is left inside the uterine cavity.
• Incomplete abortion is a pregnancy that is associated with
vaginal bleeding, dilatation of the cervical canal, and
passage of products of conception.
• Usually, the cramps are intense, and the vaginal bleeding is
heavy. Patients may describe passage of tissue, or the
examiner may observe evidence of tissue passage within the
vagina.
• Ultrasound may show that some of the products of
conception are still present in the uterus.
20. Clinical features:
• History of expulsion of a fleshy mass per vaginam;
– Continuation of pain in lower abdomen
– Persistence of vaginal bleeding
• Internal examination reveals
– uterus smaller than the period of amenorrhea
– Open internal os
– varying amount of bleeding
• On examination, the expelled mass is found incomplete
Complications:
• The retained products may cause:
(a) bleeding (b) sepsis or (c) placental polyp.
21. MANAGEMENT:
• Evacuation of the retained products of conception (ERCP)
• Early abortion: Dilatation and evacuation under analgesia or
general anesthesia is to be done.
• Late abortion: Uterus is evacuated under general anesthesia
and the products are removed by ovum forceps or by blunt
curette. In late cases, D&C is to be done to remove the bits of
tissues left behind.
• Prophylactic antibiotics are given; removed materials are
subjected to a histological examination.
• Medical management - Tab. Misoprostol 200 Mg every
4 hours
22. CompleteAbortion
• When the products of conception are
completely expelled from the uterus, it is
called complete miscarriage.
• Complete abortion is a completed
miscarriage. Typically, a history of
vaginal bleeding, abdominal pain, and
passage of tissue exists.
• After the tissue passes, the patient notes
that the pain subsides and the vaginal
bleeding significantly diminishes.
23. Clinical features
• There is history of expulsion of a fleshy mass per
vaginum followed by
– Subsidence of abdominal pain
– Vaginal bleeding becomes trace or absent
• Internal examination reveals:
– Uterus smaller than the period of amenorrhea
– Cervical os is closed
– Bleeding is trace.
24. INVESTIGATION
• Transvaginal sonography confirms that uterus is
empty.
• The examination reveals some blood in the vaginal
vault; a closed cervical os; and no tenderness of the
cervix, uterus, or abdomen.
25. ▪ There is no treatment other than rest is usually needed.
▪ All of the tissues that came out should be saved for
examination by a doctor to make sure that the abortion is
complete.
▪ The laboratory examination of the saved tissue may determine
the cause of abortion.
▪ The effect of blood loss, if any, should be assessed and treated.
▪ If there is doubt about complete expulsion of the products,
uterine curettage should be done.
MANAGEMENT
26. Missed Abortion
• The fetus is dead and retained passively inside the uterus for a
variable period.
• A missed abortion is a nonviable intrauterine pregnancy that
has been retained within the uterus without spontaneous
abortion.
• Typically, no symptoms exist besides amenorrhea, and the
patient finds out that the pregnancy stopped developing
earlier when a fetal heartbeat is not observed or heard at
the appropriate time.
• An ultrasound usually confirms the diagnosis.
• No vaginal bleeding, abdominal pain, passage of tissue, or
cervical changes are present.
27. CLINICAL FEATURES:
The patient usually presents with features of
threatened miscarriage followed by:
–Subsidence of pregnancy symptoms
–Uterus becomes smaller in size
–Cervix feels firm with closed internal os
–Nonaudibility of the fetal heart sound even with
Doppler ultrasound
–Immunological test for pregnancy becomes negative
28. Complications
• Retaining the products for long time can lead
to sepsis
• DIC [Disseminated Intravascular Coagulation]
– (very rare) in gestations exceeding 16 weeks
29. Management
Uterus is less than 12 weeks:
• Prostaglandin E1 (Misoprostol) 800 mg is given
vaginally and repeated after 24 hours if needed.
Expulsion usually occurs within 48 hours
• Suction evacuation is done when the medical method
fails
Uterus more than 12 weeks
• 6th or 12th hourly misoprostol tablets givenvaginally
• If this fails, extra amniotic instillation of
ethacridine lactate is used
• Antibiotics are given
30. SepticAbortion
• Any abortion associated with clinical evidences of
infection of the uterus and its contents
• Most common cause – Attempt at induced abortion by an
untrained person without the use of aseptic precautions.
• A septic abortion is an infection of the placenta and fetus .
• Infection is centred in the placenta and there is risk of
spreading to the uterus, causing pelvic infection or
becoming systemic to cause sepsis and potential damage
of distant vital organs.
31. Clinical Grading:
• Grade–I: The infection is localized in the uterus.
Is the commonest and is usually associated with
spontaneous abortion
• Grade–II: The infection spreads beyond the uterus ,
the tubes and ovaries or pelvic peritoneum.
• Grade–III: Generalized peritonitis and/or
endotoxic shock or jaundice or acute renal
failure.
32. Clinical Features
• Fever, abdominal pain and vomiting or diarrhoea
• A rising pulse rate of 100–120/min or more is a
significant finding than even pyrexia. It indicates
spread of infection beyond the uterus.
• Examination shows abdominal tenderness,
guarding, rigidity
• Internal examination reveals:
– offensive purulent vaginal discharge
– tender uterus
– Soft cervix with open internal os
33. Investigations
• CBC
• Serum urea, creatinine, electrolytes
• vaginal swab
• Blood culture in suspected septicaemia
• Pelvic USG to detect retained products of
conception
• X-ray abdomen in suspected bowel injury
• X-ray chest if there is difficulty in respiration
34. Complications
Immediate:
• Hemorrhage
• Injury may to uterus & adjacent structures
• Spread of infection leads to:
– Generalized peritonitis
– Endotoxic shock—mostly due to E. Coli
– DIC
– Acute renal failure
– Thrombophlebitis.
• All these lead to increased maternal deaths
35. Management
• Mild cases –
– Broad spectrum antibiotics started
– Uterus is evacuated
• Severe Cases
– Vigorous IV infusion with crystalloid
– Oxygen given by nasal catheter
– Broad spectrum antibiotics – combination of
ampicillin, gentamicin, metronidazole is started
– Uterus is evacuated in 4-6 hrs of commencing therapy.
37. •Habitual or recurrent abortion is defined as
successive, repeated, spontaneous abortions
of unknown cause.
•As many as 60% of abortions may result
from chromosomal anomalies.
•After two consecutive abortions, patients are
referred for genetic counselling and testing,
and other possible causes are explored
38. ETIOLOGY
FIRST TRIMESTER ABORTION:
• Genetic factors
• Endocrine and Metabolic
• Infection
• Inherited thrombophilia
• Immunological cause
SECOND TRIMESTER MISCARRIAGE
• Anatomic abnormalities - responsible for
10– 15% of recurrent abortion
• Uterine Causes
• Cervical Insufficiency (Incompetence)
40. Diagnosis
• History - Repeated mid trimester painless
cervical dilatation and escape of liquor amnii
followed by painless expulsion of the products of
conception
• Internal examination:
Interconceptual period:
–Passage of no. 6–8 Hegar dilator beyond the
internal os without any resistance or pain
–Funnelling of internal os seen in
hysterosalpingography
41. During pregnancy
– Clinical digital – Painless cervical shortening and
dilatation
– Sonography: Trans vaginal ultrasound is performed. Short
cervix < 25 mm; Funnelling of the internal Os > 1 cm.
42. MANAGEMENT
• If bleeding occurs in these patients, conservative
measures, such as bed rest and administering
progesterone to support the endometrium, are tried in
an attempt to save the pregnancy.
• Supportive counselling is crucial in this stressful
condition.
• Bed rest, sexual abstinence, a light diet, and no
straining on defecation are recommended in an effort
to prevent spontaneous abortion.
• If infection is suspected, antibiotics may be prescribed.
43. •When an incomplete abortion occurs, oxytocin may
be prescribed to cause uterine contractions before
dilation and evacuation (D & E) or uterine suctioning.
•In the rare case of heavy bleeding, the patient may
require blood component transfusions and fluid
replacement.
•An estimate of the bleeding volume can be
determined by recording the number of perineal pads
44. Management
• Surgical management – Cervical circlage
• Ususally at 12-14 weeks
• The procedure involves placing a purse-string
suture around the cervix at the level of the internal
os.
• !
45. Prognosis of recurrent miscarriage
• The overall risk of recurrent miscarriage is
about 25–30% irrespective of the number of
previous spontaneous miscarriage.
• The overall prognosis is good even without
therapy.
• The chance of successful pregnancy is about
70–80% with an effective therapy.
47. • A voluntary induced termination of pregnancy is called
an elective abortion and is usually performed by skilled
health care providers.
• An elective abortion is the interruption of a pregnancy
before the 20th week of gestation at the woman’s
request for reasons other than maternal health or fetal
disease.
• Most abortions in the United States are performed for
this reason.
48.
49. Vacuum Aspiration
• The cervix is dilated manually with instrumentation or by laminaria (small
suppositories made of seaweed that swells as it absorbs water).
• Laminaria may be used to soften and dilate the cervix prior to the procedure.
• A uterine aspirator is introduced.
• Suction is applied, and tissue is removed from the uterus.
This is the most common type of termination procedure and is used early in
pregnancy, up to 14 weeks.
Dilation and Evacuation
Cervical dilation with laminaria followed by vacuum aspiration
50. Labor Induction
These procedures account for less than 1% of all
terminations and generally take place in an inpatient
setting.
1. Installation of saline or urea results in uterine
contractions.
• Although rare, serious complications can occur, including
cardiovascular collapse, cerebral edema , pulmonary
edema, renal failure, and disseminated intravascular
coagulopathy (DIC).
51. 2. Prostaglandins
• Prostaglandins are introduced into the amniotic fluid or by
vaginal suppository or intramuscular injection in later
pregnancy.
• Strong uterine contractions begin within 4 hours and usually
result in abortion.
• Gastrointestinal side effects (eg, nausea, vomiting, diarrhea,
and abdominal cramping) and fever can occur.
3. Intravenous oxytocin
Used for later abortions for genetic indications. Requires
patient to go through labor.
52. Medical Abortion
Mifepristone
• Mifepristone (formerly known as RU-486) is a
progesterone antagonist that prevents implantation of the
ovum.
• Administered orally within 10 days of an expected
menstrual period, mifepristone produces a medical abortion
in most patients.
• Combined with a prostaglandin suppository, mifepristone
causes abortion in up to 95% of patients.
•
53. Methotrexate
• Methotrexate has also been used to terminate pregnancy
because it is a teratogen that is lethal to the fetus. It has
been found to have minimal risk and few side effects in the
woman. Its a low cost medication.
Misoprostol
• Misoprostol is a synthetic prostaglandin analog that
produces cervical effacement and uterine contractions.
• Inserted vaginally, misoprostol is effective in terminating
a pregnancy in about 75% of cases.
• When combined with methotrexate or mifepristone,
misoprostol’s effectiveness rate is high.
54. MEDICAL MANAGEMENT
• Before the procedure is performed, a nurse or counselor trained in pregnancy
counseling explores with the patient her fears, feelings, and options.
• A pelvic examination is performed to determine uterine size.
• Laboratory studies before an abortion must include a pregnancy test to confirm the
pregnancy, hematocrit to rule out anemia, Rh determination, and an STD screen.
• A patient with anemia may need an iron supplement, and an Rh-negative patient
may require RhoGAM to prevent isoimmunization.
• Before the procedure, all patients should be screened for STDs to prevent
introducing pathogens upward through the cervix during the procedure.
55. NURSING MANAGEMENT
• Recognize the client’s anxiety and encourage to express her feelings.
• Establish a therapeutic relationship, conveying empathy and
unconditional positive regard.
• Provide comfort measures such as breathing and relaxation techniques.
• Explain procedures before they are performed, and stay with the client
to provide concurrent feedback.
• Determine the extent/severity and location of discomfort.
• Provide comfort measures such as relaxation and breathing techniques.
• Administer narcotic/nonnarcotic analgesics, sedatives, and antiemetics,
as prescribed.
57. • An unsafe abortion is the termination of
a pregnancy by people lacking the necessary skills,
or in an environment lacking minimal medical
standards, or both.
• An unsafe abortion is a life-threatening procedure.
• It includes self-induced abortions, abortions in
unhygienic conditions, and abortions performed by
a medical practitioner who does not provide
appropriate post-abortion attention.
• About 25 million unsafe abortions occur a year, of
which most occur in the developing world.
58. • Unsafe abortions result in complications for about 7 million women
a year.
• Unsafe abortions are also one of the leading causes of deaths during
pregnancy and childbirth (about 5-13% of all deaths during this
period).
• Most unsafe abortions occur where abortion is illegal or
in developing countries where affordable and well-trained medical
practitioners are not readily available, or where modern birth
control is unavailable.
• Unsafe abortion was and is a public health crisis.
• More specifically, lack of access to safe abortion was and is a public
health risk.
• The more restrictive the law, the higher the rates of death and other
complications.
59. Methods of unsafe abortion include:
1.Trying to break the amniotic sac inside the womb with a sharp object
or wire . This method can cause infection or injury to internal organs
resulting in death.
2.Pumping toxic mixtures, such as chili peppers and chemicals
like alum, Lysol, permanganate, or plant poison into the body of the
woman. This method can cause the woman to go into toxic shock and
die.
•
60. 3.Inducing an abortion without medical supervision by self-
administering abortifacient over-the-counter drugs or drugs obtained
illegally or by using drugs not indicated for abortion but known to
result in miscarriage or uterine contraction.
• D r u g s t h a t c a u s e u t e r i n e
contractions include oxytocin , prostaglandins, and ergot alkaloids.
• Risks include uterine rupture, irregular heartbeat, a rise in blood
pressure (hypertension), a drop in blood pressure
(hypotension), anemia requiring transfusion, cardiovascular
problems, pulmonary edema, and death.