The document discusses various types of abortion including spontaneous, induced, threatened, inevitable, complete, incomplete, missed, and septic abortion. It defines each type, describes their signs and symptoms, causes, investigations, and management. Spontaneous abortions occur in approximately 20% of pregnancies while 80% are terminated by induction within 2-5 months of gestation. Threatened abortion involves bleeding with no cervical changes, inevitable abortion has progressed bleeding with cervical changes, and missed abortion is a silent miscarriage with fetal demise but retained placenta. Management involves evacuation/dilatation and curettage, antibiotics, and controlling hemorrhage depending on the abortion type and gestational age.

1. Abortion
Prepared By : Syed Hassnain Shah
Group # 02
Semester # 07
Submitted to : Dr. Kahkashan

2. Any bleeding in pregnancy is
abnormal. It is also known as
haemorrhage in early
pregnancy.
The term miscarriage and
abortion are synonymous.

3.  The expulsion or extraction of the fetus or
embryo from the uterus weighing less than
1000gm is called abortion.
OR
 Termination of pregnancy before 28wks. Of
gestation or before the period of viability
either spontaneously or by induction is called
abortion

4. ABORTION
SPONTANEOUS INDUCED
THREATENED
INEVITABLE
COMPLETE
INCOMPLETE
MISSED
SEPTIC
LEGAL
(MTP)
ILLEGAL
HABITUAL

5. Approximately 20% of all
pregnancies are terminated
spontaneously and 80% are
terminated by induction with in
2- 5 months of gestation.

6. Spontaneous abortion is defined
as the involuntary loss of the
products of conception prior to
28 weeks of gestation, when the
fetus weighs approximately 1,000
gm or less.

7.  Maternal cause.
 Structural abnormalities of the genital organ
such as retroversion of uterus, bicornuate
uterus and fibroids.
 Maternal Infections such as rubella, UTI,
hyperpyrexia, hepatitis.
 Medical condition such as diabetes, renal
disease and thyroid dysfunction, when not
well controlled.
 Genetic factor.

8.  Immunological factor- placental infarction,
placental thrombosis.
 Blood group incompatibility
 Drugs- antimalarial, antipsychotic,
anticonvulsant drugs.
 Environmental factors- excessive consumption
of alcohol & smoking
 Lack of iron & vitamin in diet.
 Exposure to radiation

9. Fetal cause-
Chromosomal abnormalities
Blighted ovum (structural
abnormality of ovum)
Multiple congenital defects
Multiple pregnancy

10. 1.Threatened abortion-
 It is a clinical entity where the process of abortion has
started but has not progressed to a state from which
the recovery is impossible.
 Signs & symptoms-
 Amenorrhea more than 6 wks.
 it is an abortion characterized by vaginal bleeding
with or without uterine contraction.
 The blood loss may be scanty with or without
accompanying backache and cramp like
pain(resembling dysmenorrhoea).

12.  The cervix and uterus feels soft
 Os may be closed, and blood seen in the
external os.
 The outcome of a threatened abortion
could be either stoppage of bleeding by
management and continuation of
pregnancy to term.
 continuation of bleeding and uterine
contraction to expel the products of
conception if not treated.

13. Blood- HB estimation, ABO & RH
factor, cross match, VDRL, HIV, torch
test, thyroid function test.
USG- sometimes a blood clot may be
seen around the gestational sac.
Urine test- UPT is always +ve. Culture
test, sugar & albumin .

14.  1. complete bed rest
 2. drugs- hormonal supportive therapy-
HCG 5000 IU ( inj. Proluton 500mg(2ml)
deep I/M twice a week)
 Sedative- T. phenobarb- 30mg HS
T. diazepam 5 mg bd
Laxative- milk of mag or cremaffin 2tsf- HS
enema should be avoided.

15.  Advice the woman to Preserve all the vulval pads to
observe amount of bleeding.
 Anything is expelled out from the vagina should be
reported immediately.
 Note the vital signs.
 If bleeding & abdominal pains is aggravated should
be reported immediately.
 Advice patient should limit her activities at least 2
wks.
 Avoid heavy weight lifting
 Avoid unnecessary journey
 Coitus should be avoided in this period

16. 2. Inevitable abortion-
 It is a clinical type of abortion where the changes
have progressed to a state from where
continuation of pregnancy is impossible.
 Signs & symptoms-
 In this type of abortion the women present with
bleeding, often heavy, with clots or products of
conception.
 The vaginal examination cervix feels soft, os is
open & blood clot may be seen in the vagina or
protruding through the os.

17. ↑ pain in the lower abdomen which may
be colicky or like labour pains
Cervical dilatation & uterine contraction
are present
Patient may look pallor due to blood loss
Tachycardia, hypotension, cold &
clammy extrimities, patient may go in
shock.
Investigations- HB%, bloodgroup, RH
factor, USG.

18.  If pregnancy is less than 12 wks. S/E is done
 Intravenous fluids & blood transfusion to treat
shock.
 If pregnancy is more than 12 wks. Tab.
Misoprost 400 µg p/v or Inj. Oxytocin 20 unit
with 5% dext. Should be given for spontaneous
expulsion.
 If fetus is expelled out & placenta is retained
should be removed by D&C.
 Inj. T.T should be given

19. If mother is RH-ve than Anti-D 50-
150 µmg. I/M given.
If bleeding is excessive should be
controlled by administering inj.
Methargin (0.2mg) or
inj. Prostadin 250 mg I/M.

20. 3 . Complete abortion –
when the products of conception is expelled
Completely from the uterus & the uterine
cavity is empty it is called complete abotion.
S/S- decreased amount of vaginal bleeding &
lower abdominal pain.
- Uterus is smaller than the period of
amenorrhea.
- Cervical os is closed .

21. Management-
Antibiotic, T.T, anti-D( if Rh-ve),
methergin
If bleeding is continous than
D&C should be done.

22. 4. Incomplete abortion-
 When the entire products of conception are
partialy expelled and some products are left
inside the uterine cavity is called incomplete
abotion.
 S/S- continous and profuse vaginal bleeding
 Lower abdominal pain
 Pallor and signs of shock
 Internal os is open
 Uterus feels soft, smaller than the period of
amenorrhea.

23.  If pregnancy is less than 12 wks. S/E done.
 If pregnancy is more than 12 wks. I/V oxytocin 20
unit may be given for spontaneous expulsion
 If fetus is expelled & placenta is retained should be
removed by D&C. if placenta is not separated than
S/E is done under G.A
 Inj. Morphine 15 mg should be given before S/E.
inj.T.T, antibiotic should be given before D&C
 Excessive bleeding may be controlled by
administering inj. Methergin/ prostadin or tab.
Misoprost 200µg P/R

24. 5. Missed abortion-
This is also known as silent miscarriage
The embryo dies despite the presence
of viable placenta and retained inside
of the uterus
Death of the embryo occurs but the
mothers body fails to recognize the
demise.

25.  H/O brownish vaginal discharge or spotting
 Retrogression of breast changes
 Ceasation of uterine growth
 FHS may not be audible (after 20 wks.) in late
pregnancy
 Cervix feels firm, internal os closed
 ↓fetal movement in late pregnancy
 Uterus size is smaller than period of gestation

26. UPT- becomes –ve
USG- reveals absence of FHS
X-ray- shows patchy skeletal
shadows
Blood- B.T,C.T, platelet count, HB
should be done

27.  If pregnancy is less than 12 wks.- D&C/ S&E
of uterine cavity under G.A
 Antibiotic should be given without delay
 If more than 12 wks.- induction is done by
oxytocin (10-20 unit with 5%D) at the rate of
30 drops/min
 Prostaglandin ( tab. misoprost/carboprost)
should be given for cervical dilatation

28.  Occurrence of spontaneous abortion in 3 or more
successive pregnancy is called recurrent of
habitual abortion, it may be occur in first or
second trimester
 Causes-
maternal diseases- syphilis, diabetes, chronic
nephritis, hypertension, RH incompatibility,
metritis, TORCH test is +ve
Progestrone defficiency- luteal phase defect

29.  Blood group & Rh factor.
 HB, complete blood count.
 Urine- routine, microscopic & culture.
 Glucose tolerance test.
 Liver, thyroid, renal function test.
 TORCH test.
 Cervical swab culture.
 USG, hysterosalpingogram- to visualize the uterus &
fallopian tube for any infection.

30.  Systemic illness should be treated promptly
 Hormonal therapy is useful in case of luteal defects.
 The patient should be advice for adequate rest &
appropriate diet
 In case of cervical incompetence cervical encircling
should be done between 3- 4 month of pregnancy (
this operation is called shirodkar suture/ macdonald
suture)
 At the time of delivery(37- 38wks.)this suture is cut
to allow the vaginal delivery.

31. 7. Septic abortion- characterized by infection
of the products of conception in uterus, this
condition is mostly common in induced or
incomplete abortion, some illegal abortion
carried out in non- sterile conditions often lead to
septic abortion.
C/M- pyrexia 100.4 & above chills with rigor
 c/o vomiting & diarrohea
 Abdominal pain
 Foul smelling vaginal discharge which is often
purulent
 Vaginal bleeding with products of conception

32.  Pallor & sweating
 Tachycardia and ↓ B.P
 Abdominal distension and tenderness
 Signs of toxemia
 Clinical grading of infection-
 Grade-I- localized in the uterus- involves
endometrium & myometrium
 Grade-II- infection spread beyond the uterus,
tubes, ovaries & pelvic structure also.
 Grade-III- generalized peritonitis or endotoxic
shock, jaundice & acute renal failure.

33. Complete blood count & urinalysis
BUN & serum electrolytes
High vaginal swab
Blood culture if septicemia suspected
Pelvic USG
Blood coagulation profile
X-ray of pelvis & abdomen.

34. Hemorrhage
Injury may occur to uterus & other
organs
Peritonitis
Perforation of the uterus
Endotoxic shock
Acute renal failure
thrombophlebitis

35.  Hospitalized the patient- start I/V fluids
 Broad spectrum antibiotics I/V should be started
 Take high vaginal swab & blood culture for
investigations
 If pelvic abscess is present should be drain out
 Vital signs should be monitored- if pyrexia
should be treated with antipyretic
 Strict I/O charting
 Uterus should be evacuated to remove the source
of infection