The document provides a comprehensive overview of abortion, including its definitions, types, causes, clinical presentations, and treatments. It discusses various forms of abortion, such as threatened, inevitable, and missed abortions, along with their respective symptoms and treatment options. The document also addresses complications arising from abortions, such as infections and habitual abortion, while referencing a medical text for further information.

1. Abortion

2. Definition
The interruption or termination of
pregnancy before viability of the
fetus, that is before 20 weeks or if
the fetus weighs less than 500 gm.
Viability starts after the twentieth
week and means that when the
fetus is expelled from the uterus
it can survive under favourable
conditions.
About 20% of all pregnancies end
in abortion.
Most cases (80%) occur in the
third month (8-12 weeks).
Incidence

3. Aetiology
Abortion may be accidental or habitual (recurrent).
Causes of Accidental Abortion:
1. Chromosomal abnormalities of the fetus
2. Trauma, as blow on the abdomen or operative trauma
3. Fevers
4. Maternal hypoxia, as in badly given anaesthesia
5. Overdistension of the uterus by multiple pregnancies or acute polyhydramnios
6. Psychological disturbances
7. Abortifacient drugs, as quinine

4. Clinical Types of Abortion
Abortion may be:
1. Threatened
2. Inevitable
3. Incomplete
4. Complete
5. Missed
6. Septic
7. Cervical
8. Therapeutic
9. Criminal
10.Habitual

5. Threatened
Abortion
Vagin
al
Bleedi
Clinical Picture:
1. Symptoms and signs of pregnancy.
2. Bleeding, which is usually slight or
moderate. It is due to the separation
of the ovum from the uterine wall.
3. Pain is absent or heaviness may be
felt in the suprapubic region.
4. On examination the uterus is found
enlarged and the internal Os of the
cervix is closed.
5. Pregnancy test is positive.
6. Sonography will show a viable fetus
and differentiates threatened
abortion from missed abortion and
hydatidiform mole.

6. Threatened
Abortion
Vagin
al
Bleedi
End Result
1. Bleeding stops, the ovum is still
alive and pregnancy continues
(50%); or:
2. Bleeding stops, the ovum dies but
is retained in the uterus leading to
missed abortion; or:
3. Bleeding increases, uterine
contractions occur, and cervix
dilates leading to inevitable
abortion.

7. Threatened
Abortion
Vagin
al
Bleedi
Treatment
1. Rest in bed until the bleeding stops (red
loss) and fo some days afterwards.
2. Travelling and sexual intercourse are
avoided.
3. Sedatives to relieve pain and anxiety of
the patient, e.g. diazepam (Valium) 5 mg
orally tds.
4. Treatment of the cause, e.g. hypertension
5. Hormones: Thyroxine is given in case of
hypothyroidism. Progesterone is of no
value in the treatment of threatened
abortion even if there is evidence of
hormone deficiency.
6. Evacuation of the uterus is indicated if
severe bleeding occurs at any time.

8. Inevitable Abortion
Severe
Vaginal
Bleeding
& Cervix
Clinical Picture
1. Symptoms and signs of pregnancy.
2. Bleeding, which is usually severe.
3. Pain: It is colicky intermittent felt in
the suprapubic region (uterine
contractions) and accompanied with
low backache (cervical dilatation).
4. On examination, the uterus is
enlarged and the internal Os of the
cervix is dilated. The products of
conception may be felt through the
dilated cervix. In this case, abortion
will occur despite of any treatment.

9. Inevitable Abortion
Severe
Vaginal
Bleeding
& Cervix
Treatment
Vaginal evacuation and curettage or
suction evacuation if duration of
pregnancy is less than 12 weeks.
After 12 weeks oxytocin is given by
intravenous drip to help the uterus
expel its contents.
If the placenta is retained it has to be
removed under general anaesthesia
followed by curettage of the uterine
cavity.

10. Incomplete Abortion
Some POC is
expelled &
some
remains
Part of the product of conception is
expelled from the uterus and part is
retained inside the uterus.
The clinical picture is like inevitable
abortion, so there is bleeding, colicky
pain, the internal Os is dilated and
retained product may be felt through
it.
Treatment is like inevitable abortion.

11. Complete Abortion
All the product of conception is expelled from uterus. The bleeding is
slight and gradually diminishes, pain is absent, the uterus is smaller
than the period of a amenorrhoea and the cervix is closed or closing.
Complete abortion is better treated by curettage of the uterus
because the decidua remaining in the uterus may lead to postabortive
bleeding or infection.
However, curettage can be avoided if ultrasound scan shows empty
uterine cavity.
N.B.: In all cases of abortion the proucts of conception must be
examined macroscopically and microscopically.

12. Missed Abortion
Close
d
Cervi
Definition
The ovum dies but is retained inside
the uterus.
Carneous mole is a special type of
missed abortion which is due to
repeated attacks of haemorrhage
occuring choriodecidual space around
the ovum before the twelfth week of
pregnancy.
The ovum becomes surrounded by
blood coagulated in layers forming a
bloody or fleshy mole.

13. Missed Abortion
Close
d
Cervi
Clinical Picture
A. Symptoms:
1. Symptoms of threatened abortion may or
may not develop.
2. Pregnancy symptoms gradually disappear
as nausea, vomiting and breast symptoms.
3. Failure of the abdomen to increase in size.
4. Failure to feel fetal movements or cessation
of fetal movements if previously present
5. Milk secretion may start spontaneously
from the breast (La Monte du Lait), frequent
in the second trimester abortion and due to
drop in secretion of estrogen which
normally blocks the action of prolactin on
the breast.
6. A dark brown vaginal discharge may occur
(prune juice discharge).

14. Missed Abortion
Close
d
Cervi
Clinical Picture
B. Signs:
1. The uterus is smaller than the period of
amenorrhoea and fails to enlarge. It is firm
in consistency.
2. Fetal heart sounds (FHS) cannot be heard
by Sonicaid.
C. Investigations:
3. Sonography is diagnostic. It shows a
collapsed pregnancy sac or absent fetal
heart movements.
4. Pregnancy test becomes negative within
two weeks after death of the ovum,
sometimes remains positive for a longer
period if there is still living chorionic tissue.

15. Missed Abortion
Close
d
Cervi
Complications
1. Infection
2. Disseminated intravascular
coagulation (DIC) and
hypofibrinogenaemia.

16. Missed Abortion
Close
d
Cervi
Treatment
If the size of the uterus is less than 12 weeks
vaginal or suction evacuation is done. If the
size of the uterus is more than 12 weeks we
wait 4 weeks so that the uterus may expel its
contents spontaneously (it does so in 90%), if
this fails we induce abortion by:
1. Oxytocin infusion (up to 50 units or more
in 500 ml 5% glucose in normal saline) or:
2. Prostaglandins (E2, F2a) and prostaglandin
analogues (the compounds can be given
orally, intramuscularly, intravenously,
intra-amniotic, extra-amniotic or in the
form of vaginal suppositories or gel)
If these methods fail we can try intra-amniotic
injection of hypertonic saline solution 20% or
urea solution 40% in 5% glucose or do
abdominal hysterotomy.

17. Missed Abortion
Close
d
Cervi
N.B.:
1. Immediate interference in
missed abortion is indicated if
there is infection, bleeding, or
if the patient is anxious.
2. Blood is tested for its
fibrinogen content before the
induction of abortion.

18. Septic Abortion
It is any type of abortion complicated by infection. It is usually
the result of criminal interference.
Causative Organisms:
Any pathogenic organism can cause the infection. Organisms
include staphylococci, streptococci, E. coli, clostridium welchii
as well as other organisms.
The commonest organisms are the anaerobic streptococci.

19. Septic Abortion
Clinical Picture
1. General manifestations of infection in the form of fever, rapid pulse,
headache and vomiting. If the pulse rate is more 110 per minute it usually
indicates spread of infection beyond the uterus. In case of septicaemia
the pulse rate is out of proportion to the rise of temperature. Infection
with clostridium welchii leads to haemolysis of red cells, severe anaemia
and jaundice. Bacteraemic or septic shock leads to hypotension.
2. Abdominally; there is suprapubic pain, tenderness and may be rigidity.
3. Vaginally; there is an offensive discharge.

20. Septic Abortion
Investigations
1. Swab from upper vagina or cervical canal for culture (aerobic and anaerobic)
and sensitivity test
2. Blood for culture (aerobic and anaerobic) and sensitivity test (if pyrexia is 39° C
or more).
3. Complete blood count (cdc).
4. Urine analysis.
5. Kidney function tests: Blood urea, serum creatinine and serum electrolytes.
The most serious complication of septic shock or cl. welchii infection is renal
failure.
6. Coagulation profile if DIC develops.
7. X-ray of the abdomen in the upright position. It can show air under the
diaphragm indicating perforation of uterus or vaginal vault, it diagnoses
physometra and presence of a foreign body as a catheter in the peritoneal
cavity.

21. Septic Abortion
Treatment
1. Isolation in a separate room.
2. Observation for vital signs (pulse, temperature and blood pressure), fluid intake and
urine output.
3. Fluid therapy in the form of 5% glucose and normal saline or lactated Ringer solution
to maintain a urinary flow of at least 30 ml per hour.
4. Antibiotics, given according to sensitivity tests. We can start by giving intravenously a
derivative of penicillin and an aminoglycoside as gentamycin and in severe cases
triple therapy by adding clindamycin.
5. Anti-gas gangrene or antitetanic serum only given in infection with cl. welchii or
tetani.
6. Oxytocin infusion to control bleeding and help passage of retained products.
7. Packed red cells may be given to correct anaemia.
8. Symptomatic treatment in the form of antipyretics and analgesics.
9. Evacuation of the uterus is indicated if it contains products of the conception.
Removal of the contents is followed by sharp uterine curettage.
10. Hysterectomy is indicated in case of gangrene of the uterus or septic shock not

22. Cervical
Abortion
The ovum is separated from the
uterus but retained inside the
cervical canal because of stenosed
external Os due to previous
cauterization or operation on the
cervix.
The cervix becomes ballooned but
bleeding is usually slight.
Under anaesthesia the cervix is
dilated, ovum removed and uterus
curetted to remove the decidua.

23. Theraputic Abortion
It is the termination of
pregnancy for a medical
reason.
Criminal Abortion
It is the termination of
pregnancy for a non
medical reason.

24. Habitual Abortion
Definition
It means three or more
successive spontaneous
abortions.
Incidence
Less than 1% of pregnancies
(0.3 - 0.9%).

25. Habitual Abortion
Aetiology
The causes may by fetal, maternal, paternal,
immunological, or idiopathic.
I) Fetal Factor:
About 50% of fetuses aborted in the first trimester show
chromosomal abnormalities (commonest cause). The
commonest anomaly is trisomy.

26. Habitual Abortion
Aetiology
The causes may by fetal, maternal, paternal, immunological, or
idiopathic.
II) Maternal Factors:
General causes
1. Chronic hypertension
2. Endocrine disturbances
3. Severe malnutrition
4. Chronic anaemia (fetal hypoxia)
5. Psychological disturbances
6. Chronic maternal infection
7. Smoking and alcohol
Local causes
1. Uterine hypoplasia
2. Congenital malformation of
the uterus as bicornuate,
septate and subseptate
uterus.
3. Incompetent cervix
4. Intrauterine adhesions
(Asherman syndrome) due to
lack of space for the growing
ovum

27. Thank
You
Presented by: Dr. Asmaa Abdellah
Reference: “Basic Obstetrics” by Farouk Haseeb - 5th Edition