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Abortion (3)
- 1. Abortion Prof.Sasikalavathi Arunachalam MSc(N) OBG Principal Haryana College of Nursing
- 2. Abortion is theexpulsion or extraction from its mother of an embryo or fetus weighing 500gm or less before the viability when its not capable of independent survival Definition
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- 8. Mechanism of Abortion •The ovum surrounded by the villi with the decidual coverings s expelled out intact. Sometimes the external os fails to dilate so that the entire mass is accommodated in the dilated cervical canal and is called cervical abortion. Before 8 weeks • Expulsion of the fetus commonly occurs leaving behind the placenta and membranes. A part of it may be partially separated with brisk haemorrhage or remains totally attached to the uterine wall. 8-14 weeks • The process of expulsion is similar to that of a mini labour. Beyond 14 weeks
- 9. Threatened Abortion The processof abortion has started but has not progressed to a state from which recovery is impossible
- 10. C/F • Bleeding pervagina- slight, bright red, brisk and sharp, stops spontaneously. • Pain-mild back ache or dull pain
- 11. Investigations • Blood • Urine-immunological test of pregnancy • Ultrasonagraphy
- 12. Management • Rest • Drugs-(sedation, relief of pain) Phenobarbitone 30 mg, or diazepam 5 mg. • Preserving the vulval pad • Reporting aggravation of pain & bleeding • Vital signs
- 13. Inevitable abortion The changeshave progressed to a state from where continuation of pregnancy is impossible.
- 14. C/F • Increased vaginalbleeding • Aggravation of pain in the lower abdomen • General condition proportionate to the visible blood loss. • Internal exam- dilated cervix through which products of conception are felt.
- 15. Management • Methargin 0.2mg • IV fluids • Blood transfusion • Before 12 weeks- D/E & C under GA or S/E & C • After 12 wks – oxytocin ( 10units/500ml normal saline at 40- 60 drops/min) • If the fetus is expelled & the placenta is separated but retained- ovum forceps • If not separated- digital separation & evacuation under GA • If the bleeding profuse with the cervix closed- evacuation by abdominal hysterotomy
- 16. Complete abortion When theproducts of conception are expelled en masse it is called complete abortion.
- 17. C/F • Expulsion offleshy mass • Subsidence of abdominal pain • Vaginal bleeding becomes trace or absent • Uterus becomes small • Cervical os closed • Expelled fleshy mass is intact
- 18. Management • If doubt-currettage • Rh-ve – within 72 hrs Anti D
- 19. Incomplete Abortion When theentire products of conception are not expelled instead a part of it is left inside of the uterine cavity.
- 20. C/F • Continuation ofcolicky pain • Persistence of vaginal bleeding • Uterus small • Patulous cervical os • Expelled mass is incomplete
- 21. Complications Profuse bleeding SepsisPlacental polyp Rarely choriocarcinoma
- 22. Management • Early abortion-D/E under GA • Late Abortion – E/C under GA
- 23. Missed abortion • Whenthe fetus is dead & retained inside the uterus for a variable period it is called missed abortion. The cause is unknown. • If it occurs beyond 12 weeks – macerated, mummified, the liquor amni gets absorbed and the placenta becomes pale and may be adherent. • Before 12 wks the pathological process is as follows
- 24. Small repeated hemorrhages' in choriodecid ual space Detachment Bleeding Deadand completely absorbed or remains as a rudimentary structure Gradually the fluid of the blood absorbed Fleshy or carneous mole
- 25. C/F • Features ofthreatened abortion • Persistence of brownish discharge • Subsidence of pregnancy symptoms • Retrogression of breast changes • Cessation of uterine growth and becomes smaller • FHS ( - ) • Firm cervix • Pregnancy test ( - ) • Empty sac Complications Blood coagulation disorders
- 26. Management • Before 12wks- S/E & D – Laminaria tent D/E under GA • Beyond 12 wks – oxytocin 10-20 units/ 500 ml NS at 30 drops/min- fails 200mIU/min Prostaglandins – PGE1, Pessary PGF2 Alpha - IM
- 27. Septic Abortion Evidences ofinfection of the uterus & its contents.
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- 29. C/F C/F varies • Pyrexia •Increased pulse rate • Pain • Offensive purulent vaginal discharge • Tenderness of the uterus Grade I – localized Grade II – beyond the uterus Grade III – generalized peritonitis & endotoxic shock
- 30. Investigations • Cervical orhigher vaginal swab • Blood • Urine • Ultrasonagraphy
- 31. Complications - Immediate Endotoxicshock Thrombophilia ARF Generalized peritonitis Injury Haemorrhage
- 32. Complications - late Chronic debility Chronic pelvicpain & back ache Dyspareunia Ectopic pregnancy Secondary infertility Depression
- 33. Management • Grade I antibiotics prophylacticanti gas gangrene serum of 8000 units 3000 units anti tetanus serum IM Analgesics, sedatives blood transfusion Evacuation • Grade II antibiotics – aerobic gram +ve ampicillin, pencillin, gentamycin, aerobic gram –ve gentamycin, anaerobic- metronidazole, evacuation of the uterus, posterior colpotomy • Grade III antibiotics, laprotomy
- 34. Recurrent Abortion Sequence of3 or more consecutive spontaneous abortion before 20 weeks.
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