This document defines abortion and discusses its classification, incidence, etiology, clinical features, investigations, treatment, and complications. It defines abortion as the expulsion of an embryo or fetus weighing less than 500g before 24 weeks of gestation. Abortions can be spontaneous (threatened, inevitable, complete, incomplete, missed, or septic) or induced (legal or illegal). Common causes include genetic factors, endocrine issues, infections, anatomical abnormalities, and immunological or blood disorders. Investigations may include ultrasounds and lab tests. Treatment depends on the type and includes rest, medication, dilation and curettage, or laparotomy in complicated cases. Recurrent abortion is defined as 3 or more consecutive losses and

1. ABORTION
DR. KETAKI JUNNARE
SKN MC & GH

2. DEFINITION

ABORTION (MISCARRIAGE)
EXPULSION OR EXTRACTION FROM ITS
MOTHER OF AN EMBRYO OR FETUS
WEIGHING 500 GM OR LESS WHEN IT IS
NOT CAPABLE OF INDEPENDENT SURVIVAL
(APPROXIMATELY 24 WKS)

ABORTUS – EXPELLED EMBRYO

3. INCIDENCE

10-20 % OF CLINICAL PREGNANCIES

4. CLASSIFICATION

SPONTANEOUS
(SPORADIC/RECURRENT)
 THREATENED
 INEVITABLE
 COMPLETE
 INCOMPLETE
 MISSED
 SEPTIC



INDUCED
LEGAL (MTP)
ILLEGAL

5. ETIOLOGY
1.GENETIC - CHROMOSOMAL ABNORMALITIES
50% -1ST TRIMESTER ABORTIONS
 AUTOSOMAL TRISOMY (50%) – TRISOMY 16
 POLYPLOIDY (22%) -3n, 4n
 MONOSOMY (20%) – 45X
 STRUCTURAL CHROMOSIMAL REARRANGEMENTS
(2-4%) TRASLOCATION DELETION
 OTHERS – MOSAIC , DOUBLE TRISOMY

6. 2. ENDOCRINE (10-15%)



LUTEAL PHASE DEFECT
THYROID ABNORMALIYIES
DIABETES MELLITUS
3. ANATOMICAL (10-15%)




CERVICAL INCOMPETANCE
CONGENITAL MALFORMATIONS OF UTERUS
FIBROID
INTRAUTERINE ADHESIONS

7. 4 . INFECTIONS (5%)



VIRAL – CMV , RUBELLA ,VARIOLA VACCINIA
PARASITIC – TOXOPLASMA , MALARIA
BACTERIAL – UREAPLASMA , CHLAMYDIA , BRUCELLA
5 . IMMUNOLOGICAL DISORDERS (5-10%)


AUTOIMMUNE DISEASES – ANA , APLA (LAC , aCL )
ALLOIMMUNE DISEASE – PATERNAL HLA SHARING WITH
MOTHER
6 . MATERNAL MEDICAL ILLNESS


CYNOTIC HEART DISEASE
HAEMOGLOBINOPATHIES

8. 7 . ANTIFETAL ANTIBODIES
NK CELLS
8 . BLOOD GROUP INCOMPATIBILITY
9 . INHERITED THROMBOPHILIA
10 . ENVIRONMENTAL FACTORS


CIGARETTE SMOKING
ALCOHOL
11 . PREMATURE RUPTURE OF MEMBRANES

9. CLINICAL FEATURES



h/o AMENORRHOEA
PAIN IN ABDOMEN
P/V BLEEDING
D/D –ABORTION
ECTOPIC PREGNANCY
VESICULAR MOLE

10. THREATENED ABORTION

PROCESS OF ABORTION HAS STARTED BUT NOT
PROGRESSED TO A STATE FROM WHERE
RECOVERY IS IMPOSSIBLE
SYMPTOMS



SLIGHT P/V BLEEDING
BRIGHT RED IN COLOUR
DULL ABDOMINAL PAIN / BACKACHE

11. SIGNS
P/SP – BLEEDING +/- FROM EXT OS
P/V – CERVIX CLOSED,
UTERUS –SOFT, CORRESPONDING WITH
GEST AGE
D/D – CERVICAL LESIONS-EROSION
POLYP
VARICOSE VAINS
MALIGNANCY

12. INVESTIGATIONS



BLOOD –HAEMATOCRIT
ABO Rh GROUPING
USG – TO CONFIRM INTRAUTERINE PREGNANCY
VIABILITY
IF ECTOPIC PREGNANCY IS SUSPECTED
Sr. PROGESTERONE LEVELS
Sr.BhCG LEVELS

13. TREATMENT &PROGNOSIS



REST
MONITORING OF VITALS , VAGINAL BLEEDING
PROGESTERONE
ROLE DOUBTFUL
60 -70 %
CONTINUES >28 WEEKS
HIGH RISK OF PRETERM LABOUR , IUGR
PLACENTA
PREVIA , FETAL ANOMALIES
30%
INEVITABLE / MISSED ABORTION

14. INEVITABLE ABORTION
DEFINITION
PROCESS OF ABORTION HAS REACHED A STAGE
FROM WHERE CONTINUATION OF PREGNANCY IS
NOT POSSIBLE
SYMPTOMS- VAGINAL BLEEDING
PAIN IN ABDOMEN
SIGNS – GENERAL CONDITION DEPENDS UPON
AMOUNT OF BLOOD LOSS
DILATED INTERNAL OS – PRODUCTS FELT
THROUGH OS
MEMBRANES MAY BE RUPTURED

15. MANAGEMENT


IMPROVE GENERAL CONDITION
IV FLUIDS
BLOOD TRANSFUSION IF PT IS IN SHOCK / SEVERE
ANAEMIA
EVACUATION OF PREGNANCY
<12 WEEK – DILATATION & EVACUATION
>12 WEEK –T. misoprostol 400 mg 4 hrly 3 doses
- OXYTOCIN DRIP 10 U IN NS
IF PLACENTA IS RETAINED –
EVACUATION UNDER ANAESTHESIA

16. COMPLETE ABORTION

PRODUCTS OF CONCEPTION HAVE BEEN
EXPELLED EN MASS

H/O EXPULSION OF FLESHY MASS FOLLOWED BY
SUBSIDANCE OF ABDOMINAL PAIN AND BLEEDING
P/V
UTERINE SIZE SMALLER THAN PERIOD OF
AMENORRHOEA
UTERUS FIRM
CERVIX CLOSED

17. MANAGEMENT


ASESS & IMPROVE GENERAL CONDITION
ULTRASOUND EXAMINATION TO CONFIRM NO
PRODUCTS HAVE BEEN RETAINED

18. INCOMPLETE ABORTION
PRODUCTS OF CONCEPTION HAVE BEEN PARTLY
EXPELLED FROM UTERINE CAVITY




CLINICAL FEATURES
H/O EXPULSION OF FLESHY MASS
ABDOMINAL PAIN PERSISTS
P/V BLEEDING PERSISTS
P/V EXAMINATION – UTERUS SMALLER THAN
PERIOD OF AMENORRHOEA
- CERVIX PATULOUS

19. COMPLICATIONS



PROFUSE BLEEDING
SEPSIS
PLACENTAL POLYP

20. MANAGEMENT



CORRECTION OF SHOCK – IV FLUIDS , BLOOD
IV ANTIBIOTICS
EVACUATION OF UTERUS

21. MISSED ABORTION
SILENT MISCARRIAGE/EARLY FETAL
DEMISE
FETUS IS DEAD AND RETAINED INSIDE
UTERINE CAVITY FOR VARIABLE TIME
PATHOLOGY


BEFORE 12 WKS – CLOTTED BLOOD WITH OVUM
FORMS CARNEOUS MOLE (FLESHY MOLE)
AFTER 12 WKS – FETUS BECOMES MACERATED
LIQUOR GETS ABSORBED
PLACENTA BECOMES PALE

22. SYMPTOMS



ABDOMINAL PAIN
BROWNISH VAGINAL DISCHARGE
SUBSIDENCE OF PREGNANCY CHANGES
SIGNS
RETROGRESSION OF BREAST CHANGES
UTERUS BECOMES SMALLER IN SIZE
FETAL HEART SOUND NOT AUDIBLE
CERVIX IS FIRM

23. COMPLICATIONS


INFECTION
DIC

24. INVESTIGATIONS
USG –
EARLY PREGNANCY – EMPTY SAC
 2 nd TRIMESTER – ABSENCE OF FETAL HEART /
ABSENCE OF FETAL MOVEMENTS
HEMOGRAM
COAGULATION PROFILE
BT , CT , PT
PLATELET COUNT


25. SEPTIC ABORTION
ASSOCIATED WITH CLINICAL EVIDENCE OF
INFECTION OF UTERUS AND ITS CONTENTS

26. AETIOLOGY
MORE ASSOCIATED WITH ILLEGAL ABORTION



LACK OF ASEPSIS
INCOMPLETE EVACUATION
INJURY TO GENITAL TRACT & OTHER ORGANS LIKE GUT
ORGANISMS


ANAEROBES – BACTEROIDES , STREPTOCOCCI , Cl. WELCHI ,
Cl . TETANI
AEROBIC – E. COLI , STAPH , STREPTOCOCCI , KLEBSIELLA ,
PSEUDOMONAS

27. CLINICAL FEATURES








FEVER 38 C OR MORE - FOR > 24 HRS
ABDOMINAL PAIN
VAGINAL DISCHARGE
FEBRILE
TACHYCARDIA
ABDOMINAL TENDERNESS
PURULENT VAGINAL DISCHARGE
P/V – UTERINE TENDERNESS , CERVIX IS OPEN
BOGGY FEEL OF UTERUS

28. CLINICAL GRADING
– LOCALISED TO UTERUS (80%)

GRADE 1

GRADE 2 – PARAMETRIUM , TUBES , OVARIES ,PELVIC
PERITONEUM INVOLVED (15%)

GRADE 3 –GENERALISED PERITONITIS / ENDOTOXIC SHOCH /
ACUTE RENAL FAILURE (5%)

29. INVESTIGATIONS

BLOOD –
HEMOGLOBIN ,TLC DLC
RENAL FUNCTION TESTS
COAGULATION PROFILE
BLOOD CULTURE

URINE MICROSCOPY

CERVICAL / HIGH VAGINAL SWAB (BEFORE P/SP , P/V)
GM STAIN
CULTURE , SENSITIVITY

30. ULTRASONOGRAPHY
RETAINED PRODUCTS OF CONCEPTION
PYOMETRA
FOREIGN BODY
FLUID IN PERITONEAL CAVITY

31. COMPLICATIONS






HAEMORRHAGE
INJURY TO UTERUS , BOWEL
GENERALISED PERITONITIS
ENDOTOXIC SHOCK
ACUTE RENAL FAILURE
THROMBOPHLEBITIS

32. LATE COMPLICATIONS



TUBAL BLOCK – INFERTILITY , ECTOPTC
PREGNANCY
CHRONIC PELVIC PAIN – DYSPAREUNIA
EMOTIONAL DEPRESSION

33. MANAGEMENT





HOSPITALISATION
ANTIBIOTCS
GM POSITIVE – AMPICILLIN
GM NEGATIVE – GENTAMYCIN , CEFTRIAXONE
ANAEROBES – METRONIDAZOLE
BLOOD TRANSFUSION
ANTITETANUS SERUM – 3000 U
ANTI GANGRENE SERUM – 8000 U

34. 
EVACUATION OF UTERUS
D & E – AFTER 24 HRS OF ANTIBIOTC COVERAGE
EMERGENCY ON ADMISSION IF ACTIVE BLEEDIG
POSTERIOR COLPOTOMY – TO DRAIN PUS
FOR PELVIC ABSCESS . C/F – SPIKY RISE IN FEVER
TENESMUS
BOGGY MASS FELT IN POST FORNIX

35. LAPAROTOMY





INDICATIONS
INJURY TO UTERUS / BOWEL
PRENCE OF FOREIGN BODY IN ABDOMEN
COLLECTION OF PUS IN ABDOMEN NOT
RESPONDING TO ANTIBIOTICS
SEPTIC SHOCK

36. RECURRENT ABORTION


CONSECUTIVE THREE OR MORE ABORTIONS
INCIDENCE – 1%

37. CAUSES

GENETIC – PARENTAL CHROMOSOMAL
ABNORMALITY

ENDOCRINE
UNCONTROLLED DIABETES MELLITUS
THYROID ANTIBODIES
LUTEAL PHASE DEFECT






INHERITED THROMBOPHILIA
PROTEIN C RESISTENCE
HYPERHOMOCYSTINAEMIA

38. 


IMMUNOLOGICAL
AUTOIMMUNITY – ANA , APLA (LA , ACA)
ALLOIMMUNITY
SHARING OF HLA BETWEEN PARTNERS
LACK OF BLOCKING ANTIBODY PRODUCTION
INFECTIONS – SYPHILIS , LISTERIOSIS
UNEXPLAINED

ANATOMIC ABNORMALITIES OF GENITAL TRACT
(10 – 15 %)
SECOND TRIMESTER ABORTIONS
CONGENITAL
ACQUIRED

39. CONGENITAL


DEFECTIVE MULLERIAN FUSION
CERVICAL INCOMPETENCE

40. ACQUIRED



CERVICAL INCOMPETENCE
INTRAUTERINE ADHESIONS
FIBROIDS

41. INVESTIGATIONS









BLOOD GROUPING
BLOOD SUGAR LEVEL
VDRL
THYROID FUNCTION TEST
AUTOIMMUNE SCREENING – LA , ACA
ENDOCERVICAL SWAB
ULTRASOUND –CONGENITAL MALFORMATION,
PCOD , FIBROID
HYSTEROSALPINGOGRAPHY
KARYOTYPING

42. TREATMENT
INTERCONCEPTION PERIOD
SURGICAL TREATMENT OF ANOMALIES

METROPLASTY

HYSTEROSCOPIC RESECTION OF
INTRAUTERINE SEPTUM
SYNECHIE
SUBMUCOUS FIBROID




43. 

TREATMENT OF INFECTIONS
CONTROL OF DIABETES , THYROID DISORDERS

44. DURING PREGNANCY



REASSURANCE
TENDER LOVING CARE
NATURAL MICRONISED PROGESTERONE
100 mg BD –TO BE CONTINUED TILL 10 - 12 WKS OF
GESTATION
APLA POSITIVE PATIENTS
LOW MOLECULAR WEIGHT HEPARIN
ASPIRIN

45. ENCIRCLAGE


OS TIGHTENING IN CERVICAL INCOMPETANCE
METHOD
McDONALD METHOD
SHIRODKAR TECHNIQUE
Wurms technique

TIMING
16 – 18 WKS

46. Mc donald technique

47. Wurms technique