This document discusses different types of miscarriage including spontaneous abortion, threatened miscarriage, inevitable miscarriage, complete miscarriage, and incomplete miscarriage. It outlines the main causes of miscarriage as genetic factors, infections, anatomical abnormalities, endocrine/metabolic factors, immunological disorders, and thrombophilias. Treatment options are discussed depending on gestational age and include medication, dilation and evacuation, and dilation and curettage.
Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. It accounts for 1-2% of pregnancies and risk factors include previous pelvic inflammatory disease, IUD use, infertility, and smoking. Clinical features range from asymptomatic to acute abdominal pain and vaginal bleeding. Transvaginal ultrasound and quantitative beta-hCG levels are used to confirm the diagnosis. Treatment options include surgical removal by laparoscopy or laparotomy, or medical management with methotrexate depending on the stability of the patient. Expectant management may be considered for some stable cases. Ruptured ectopic pregnancies require emergency surgery and blood transfusions to stabilize the patient.
An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, usually in the fallopian tubes. Risk factors include previous ectopic pregnancy, infections, scarring of the fallopian tubes, and fertility treatments. Ectopic pregnancies can cause life-threatening bleeding if not treated properly. Diagnosis involves beta-hCG levels and ultrasound imaging. Treatment options include medication with methotrexate, expectant management with close monitoring, or surgery depending on the stability of the patient and characteristics of the ectopic pregnancy.
- Palpates fetal back anteriorly.
- Applies counter pressure over fetal back to prevent version.
Obstetrician:
- Applies pressure over fetal presenting part (breech) to flex it.
- Applies pressure over fetal back to extend it.
- Applies pressure over fetal head to flex it.
- Rotates fetal presenting part out of pelvis.
- Rotates fetal head into pelvis.
• Version is complete when head engages.
Osama Warda 34
BREECH PRESENTATION- MANAGEMENT
BREECH
PRESENTATION-
MANAGEMENT
Osama
Ward
This document discusses disorders of amniotic fluid volume, including oligohydramnios and polyhydramnios. It begins by describing the origin, circulation, physical features and components of normal amniotic fluid. It then defines oligohydramnios and polyhydramnios, discusses their causes, clinical presentation, diagnostic evaluation and management. Complications are also outlined. The document provides detailed information on the etiology, investigations and treatment of the two conditions. It emphasizes that oligohydramnios is associated with high rates of pulmonary hypoplasia, growth restriction and adverse pregnancy outcomes.
This document discusses hemorrhage in early pregnancy, miscarriage, ectopic pregnancy, and hydatidiform mole. It provides definitions, risk factors, clinical features, management, and pathogenesis for each condition. Key points include:
- Miscarriage (spontaneous abortion) occurs in 10-20% of pregnancies and is often due to fetal chromosomal abnormalities or maternal factors like age. Management depends on severity from expectant to surgical evacuation.
- Recurrent miscarriage is defined as 2 or more losses and can be caused by genetic, endocrine, immune, or inherited factors.
- Ectopic pregnancies implant outside the uterus, most commonly in the fallopian tubes. Risk factors
This document discusses amniotic fluid disorders including polyhydramnios and oligohydramnios. It defines polyhydramnios as excessive amniotic fluid over 2 liters and oligohydramnios as diminished fluid under 500 ml. Causes, diagnosis, and complications are described for each condition. Polyhydramnios can be caused by fetal abnormalities or diabetes and risks preterm labor and cord problems. Oligohydramnios risks pulmonary hypoplasia and deformities from compression and is often caused by renal issues. Management may include treating underlying issues, monitoring fetal wellbeing, and amnioinfusion.
The document discusses various causes and types of bleeding in early pregnancy. It notes that bleeding can be related to the pregnancy itself, such as spontaneous or induced abortion, ectopic pregnancy, or molar pregnancy. Bleeding can also be associated with pre-existing or pregnancy-aggravated cervical, vascular, or other lesions. Common causes of spontaneous abortion discussed include genetic factors in 50% of early miscarriages, as well as endocrine, anatomic, infectious, immunological, and other medical conditions. Different types of abortion such as threatened, inevitable, incomplete, complete, missed, and septic abortion are also described based on bleeding, pain, cervical dilation, products of conception, and other factors.
Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. It accounts for 1-2% of pregnancies and risk factors include previous pelvic inflammatory disease, IUD use, infertility, and smoking. Clinical features range from asymptomatic to acute abdominal pain and vaginal bleeding. Transvaginal ultrasound and quantitative beta-hCG levels are used to confirm the diagnosis. Treatment options include surgical removal by laparoscopy or laparotomy, or medical management with methotrexate depending on the stability of the patient. Expectant management may be considered for some stable cases. Ruptured ectopic pregnancies require emergency surgery and blood transfusions to stabilize the patient.
An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, usually in the fallopian tubes. Risk factors include previous ectopic pregnancy, infections, scarring of the fallopian tubes, and fertility treatments. Ectopic pregnancies can cause life-threatening bleeding if not treated properly. Diagnosis involves beta-hCG levels and ultrasound imaging. Treatment options include medication with methotrexate, expectant management with close monitoring, or surgery depending on the stability of the patient and characteristics of the ectopic pregnancy.
- Palpates fetal back anteriorly.
- Applies counter pressure over fetal back to prevent version.
Obstetrician:
- Applies pressure over fetal presenting part (breech) to flex it.
- Applies pressure over fetal back to extend it.
- Applies pressure over fetal head to flex it.
- Rotates fetal presenting part out of pelvis.
- Rotates fetal head into pelvis.
• Version is complete when head engages.
Osama Warda 34
BREECH PRESENTATION- MANAGEMENT
BREECH
PRESENTATION-
MANAGEMENT
Osama
Ward
This document discusses disorders of amniotic fluid volume, including oligohydramnios and polyhydramnios. It begins by describing the origin, circulation, physical features and components of normal amniotic fluid. It then defines oligohydramnios and polyhydramnios, discusses their causes, clinical presentation, diagnostic evaluation and management. Complications are also outlined. The document provides detailed information on the etiology, investigations and treatment of the two conditions. It emphasizes that oligohydramnios is associated with high rates of pulmonary hypoplasia, growth restriction and adverse pregnancy outcomes.
This document discusses hemorrhage in early pregnancy, miscarriage, ectopic pregnancy, and hydatidiform mole. It provides definitions, risk factors, clinical features, management, and pathogenesis for each condition. Key points include:
- Miscarriage (spontaneous abortion) occurs in 10-20% of pregnancies and is often due to fetal chromosomal abnormalities or maternal factors like age. Management depends on severity from expectant to surgical evacuation.
- Recurrent miscarriage is defined as 2 or more losses and can be caused by genetic, endocrine, immune, or inherited factors.
- Ectopic pregnancies implant outside the uterus, most commonly in the fallopian tubes. Risk factors
This document discusses amniotic fluid disorders including polyhydramnios and oligohydramnios. It defines polyhydramnios as excessive amniotic fluid over 2 liters and oligohydramnios as diminished fluid under 500 ml. Causes, diagnosis, and complications are described for each condition. Polyhydramnios can be caused by fetal abnormalities or diabetes and risks preterm labor and cord problems. Oligohydramnios risks pulmonary hypoplasia and deformities from compression and is often caused by renal issues. Management may include treating underlying issues, monitoring fetal wellbeing, and amnioinfusion.
The document discusses various causes and types of bleeding in early pregnancy. It notes that bleeding can be related to the pregnancy itself, such as spontaneous or induced abortion, ectopic pregnancy, or molar pregnancy. Bleeding can also be associated with pre-existing or pregnancy-aggravated cervical, vascular, or other lesions. Common causes of spontaneous abortion discussed include genetic factors in 50% of early miscarriages, as well as endocrine, anatomic, infectious, immunological, and other medical conditions. Different types of abortion such as threatened, inevitable, incomplete, complete, missed, and septic abortion are also described based on bleeding, pain, cervical dilation, products of conception, and other factors.
1. Placenta previa and abruptio placenta are the two main causes of antepartum hemorrhage, accounting for about 70% of cases.
2. Risk factors for placenta previa include multiparity, advanced maternal age, previous c-sections, and smoking. Cesarean delivery is usually recommended for major placenta previa.
3. Hypertension is a major risk factor for abruptio placenta, which can lead to concealed bleeding, disseminated intravascular coagulation, and other maternal complications if not recognized and managed promptly.
The document defines prolonged labour as when the first and second stages of labour last more than 18 hours total. It then discusses the phases of labour and outlines causes of prolonged labour including issues with uterine contractions, the cervix, pelvis, or baby. Diagnosis involves assessing cervical dilation and descent rates. Dangers to the mother and baby include hypoxia, infection, and trauma. Treatments include preventing issues with early monitoring, changing positions, hydration, and pain relief or interventions like amniotomy, oxytocin, or c-section depending on the stage and severity.
The document discusses different types of abortion including threatened abortion, inevitable abortion, incomplete abortion, complete abortion, missed abortion, and recurrent abortion. It describes the causes, signs, symptoms, management, and risks associated with each type. The main causes of abortion discussed are infections, environmental exposures, psychological factors, systemic disorders, endocrine factors, uterine abnormalities, trauma, and fetal factors like genetic abnormalities.
Cervical incompetence, or premature cervical dilation, can complicate 0.1-2% of pregnancies and cause 15% of preterm births between 16-28 weeks. While the exact cause is often unknown, it may result from congenital cervical weakness, trauma, or DES exposure. Diagnosis is based on recurrent second trimester miscarriage without other identifiable causes. Treatment options include bed rest or a cervical cerclage procedure to stitch the cervix closed and prolong the pregnancy. Cerclage placement can be elective, urgent based on cervical shortening, or emergency if dilation has already begun. The McDonald and Shirodkar techniques are most common, with choice depending on cervical anatomy and prior trauma. Cer
This document summarizes the physiology of lactation. It discusses the development of the breasts and ductal system during pregnancy due to hormones like estrogens and progesterone. Near the end of pregnancy, progesterone causes growth of breast lobules and alveoli. After birth, prolactin secreted from the pituitary gland initiates milk production. Suckling by the baby causes oxytocin release and milk ejection from the breasts. Mature breast milk provides balanced nutrition and protection for the baby. The process of lactation benefits both mother and baby.
- Induction of labor is recommended for post-term pregnancies (greater than 42 weeks) due to increased risks of complications. Risks increase further as pregnancy progresses beyond 42 weeks.
- For low-risk pregnancies between 41-42 weeks, induction can be considered but is not necessarily recommended since perinatal outcomes do not significantly differ from 40-41 weeks. The risks and benefits should be discussed with the patient.
- Fetal surveillance with non-stress tests and ultrasound amniotic fluid measurements twice weekly is recommended for pregnancies beyond 42 weeks declining induction. Delivery is recommended if any test results cause concern for the fetal environment.
The document provides an overview of forceps delivery. It discusses the history of forceps development from ancient times through modern innovations. It then covers the various types and classifications of forceps, as well as the techniques for low/outlet, mid, and aftercoming head forceps applications. Potential complications of forceps delivery are also mentioned, including disengagement of the head, cord prolapse, and cranial injuries.
This document defines abortion and describes the different types, including spontaneous abortions like threatened, inevitable, incomplete, complete and missed, as well as induced abortions. It discusses the causes of abortion and management approaches for different types, including complications like sepsis. Post-abortion care is also summarized, including counseling, contraception and follow up. Ectopic pregnancy and advanced abdominal pregnancy are briefly covered at the end.
The document discusses the development and types of placentas. It begins by describing the early development of the placenta from the trophoblast cells. It then discusses the stages of placental development including the prelacunar, lacunar, villous, and maturity stages. The document concludes by describing some abnormal placenta shapes including bilobed, circumvallate, succenturiate, membranacea, and ring-shaped placentas. Ultrasound appearance of normal and some abnormal placentas is also presented.
This document discusses miscarriage and related topics in obstetrics and gynecology. It defines different types of miscarriage such as threatened, inevitable, incomplete, and missed/silent miscarriage. It covers etiologies, risk factors, clinical presentations, investigations and management approaches for miscarriage. Key points include that 50% of spontaneous miscarriages are due to chromosomal abnormalities, infection is an unclear cause of recurrent miscarriage, and management involves either conservative expectant monitoring or surgical evacuation of retained products of conception.
Vaginal bleeding in late pregnancy can be caused by placenta previa, placental abruption, ruptured vasa previa, or uterine scar disruption. It is important to determine the diagnosis as treatment depends on the underlying cause. A history, physical exam, ultrasound, and labs can help identify conditions like placenta previa or abruption. Placenta previa is treated expectantly if no active bleeding, while abruption may require delivery depending on grade. Ruptured vasa previa and uterine rupture require emergent delivery.
This document discusses early pregnancy complications including miscarriage, ectopic pregnancy, and molar pregnancy. It defines each condition and describes their causes, clinical features, diagnosis, and management. Miscarriage is defined as expulsion of pregnancy tissue before 22 weeks gestation and can be threatened, inevitable, incomplete, missed, or complete. Ectopic pregnancy occurs when implantation occurs outside the uterus, usually in the fallopian tubes. Molar pregnancy results from abnormal fertilization and can be complete or partial hydatiform moles, or develop into choriocarcinoma. The document provides details on evaluating and treating each complication.
Caesarean section is a surgical procedure to deliver a baby through abdominal and uterine incisions after 28 weeks of pregnancy. The incidence of C-sections has increased due to abandoning difficult procedures and increased use for breech births. Indications include maternal conditions like pelvic abnormalities and previous C-sections, as well as fetal indications like distress. A lower segment transverse incision is most common. Complications can include hemorrhage, injury, infection and rupture of the uterine scar in subsequent pregnancies.
The document discusses the prevention, treatment, and postoperative care of obstructed labor. It outlines measures to resuscitate life-threatening conditions like shock and sepsis, relieve the obstruction through vaginal operative deliveries, destructive procedures, or abdominal deliveries like c-section. Postoperative care involves continued resuscitation and monitoring for complications like infection, along with bladder care, counseling, and follow up for fistula repair if needed.
Incidence of ectopic pregnancy is rising while maternal mortality from it is falling.
ALWAYS suspect ectopic pregnancy in a woman of a child-bearing age c/o pain and/or p.v. bleeding
This document discusses ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It details the risk factors, symptoms, diagnostic process, and management options for ectopic pregnancies. Management may involve expectant monitoring, medical treatment with methotrexate, or surgical intervention depending on the individual case. Proper treatment is important to preserve future fertility and prevent life-threatening complications from tubal rupture.
The document discusses the fetal membranes, which include the chorion and amnion. The chorion is the outer membrane that is attached to the placenta and uterine wall. The amnion lines the chorion and encloses the fetus and amniotic fluid. The amniotic fluid provides protection and nutrition for the fetus, and aids in temperature regulation and movement. It is composed primarily of water, carbohydrates, proteins and minerals. The amniotic fluid circulates continuously, with production from the fetal membranes, fetal urine and transudation from maternal and fetal blood.
The document summarizes the development, functions, and abnormalities of the placenta. It discusses how the placenta develops from implantation through formation of chorionic villi and circulation. It describes the placenta's main functions of transferring nutrients and waste between mother and fetus, as well as endocrine and barrier functions. It also covers placental hormones, mechanisms of substance transfer, and diagnostic uses and immunological role of the placenta.
abortions( hemorrhagic in early pregnancythxz2fdqxw
This document discusses various types of bleeding in early pregnancy. It defines abortion and classifies it as spontaneous or induced, with spontaneous abortion further divided. The main causes of bleeding in early pregnancy are abortion (95%), ectopic pregnancy, molar pregnancy, and implantation bleeding. Genetic factors account for 50% of early miscarriages due to chromosomal abnormalities. Other causes include endocrine, anatomical, infectious, immunological and unexplained factors. Different types of spontaneous abortion are defined including threatened, inevitable, complete, incomplete and missed abortion. Management depends on the type and stage of abortion.
This document defines abortion and discusses its classification, causes, mechanisms, and types. It begins by defining abortion as the expulsion of an embryo or fetus weighing 500g or less that is incapable of survival. Abortions are classified as early (before 12 weeks) or late (12-20 weeks). The main types discussed are threatened, inevitable, complete, incomplete, and missed/silent abortions. Causes include fetal, maternal, environmental, nutritional, and infectious factors. The mechanisms of abortion vary depending on gestational age. Incidence and risk factors are also presented.
1. Placenta previa and abruptio placenta are the two main causes of antepartum hemorrhage, accounting for about 70% of cases.
2. Risk factors for placenta previa include multiparity, advanced maternal age, previous c-sections, and smoking. Cesarean delivery is usually recommended for major placenta previa.
3. Hypertension is a major risk factor for abruptio placenta, which can lead to concealed bleeding, disseminated intravascular coagulation, and other maternal complications if not recognized and managed promptly.
The document defines prolonged labour as when the first and second stages of labour last more than 18 hours total. It then discusses the phases of labour and outlines causes of prolonged labour including issues with uterine contractions, the cervix, pelvis, or baby. Diagnosis involves assessing cervical dilation and descent rates. Dangers to the mother and baby include hypoxia, infection, and trauma. Treatments include preventing issues with early monitoring, changing positions, hydration, and pain relief or interventions like amniotomy, oxytocin, or c-section depending on the stage and severity.
The document discusses different types of abortion including threatened abortion, inevitable abortion, incomplete abortion, complete abortion, missed abortion, and recurrent abortion. It describes the causes, signs, symptoms, management, and risks associated with each type. The main causes of abortion discussed are infections, environmental exposures, psychological factors, systemic disorders, endocrine factors, uterine abnormalities, trauma, and fetal factors like genetic abnormalities.
Cervical incompetence, or premature cervical dilation, can complicate 0.1-2% of pregnancies and cause 15% of preterm births between 16-28 weeks. While the exact cause is often unknown, it may result from congenital cervical weakness, trauma, or DES exposure. Diagnosis is based on recurrent second trimester miscarriage without other identifiable causes. Treatment options include bed rest or a cervical cerclage procedure to stitch the cervix closed and prolong the pregnancy. Cerclage placement can be elective, urgent based on cervical shortening, or emergency if dilation has already begun. The McDonald and Shirodkar techniques are most common, with choice depending on cervical anatomy and prior trauma. Cer
This document summarizes the physiology of lactation. It discusses the development of the breasts and ductal system during pregnancy due to hormones like estrogens and progesterone. Near the end of pregnancy, progesterone causes growth of breast lobules and alveoli. After birth, prolactin secreted from the pituitary gland initiates milk production. Suckling by the baby causes oxytocin release and milk ejection from the breasts. Mature breast milk provides balanced nutrition and protection for the baby. The process of lactation benefits both mother and baby.
- Induction of labor is recommended for post-term pregnancies (greater than 42 weeks) due to increased risks of complications. Risks increase further as pregnancy progresses beyond 42 weeks.
- For low-risk pregnancies between 41-42 weeks, induction can be considered but is not necessarily recommended since perinatal outcomes do not significantly differ from 40-41 weeks. The risks and benefits should be discussed with the patient.
- Fetal surveillance with non-stress tests and ultrasound amniotic fluid measurements twice weekly is recommended for pregnancies beyond 42 weeks declining induction. Delivery is recommended if any test results cause concern for the fetal environment.
The document provides an overview of forceps delivery. It discusses the history of forceps development from ancient times through modern innovations. It then covers the various types and classifications of forceps, as well as the techniques for low/outlet, mid, and aftercoming head forceps applications. Potential complications of forceps delivery are also mentioned, including disengagement of the head, cord prolapse, and cranial injuries.
This document defines abortion and describes the different types, including spontaneous abortions like threatened, inevitable, incomplete, complete and missed, as well as induced abortions. It discusses the causes of abortion and management approaches for different types, including complications like sepsis. Post-abortion care is also summarized, including counseling, contraception and follow up. Ectopic pregnancy and advanced abdominal pregnancy are briefly covered at the end.
The document discusses the development and types of placentas. It begins by describing the early development of the placenta from the trophoblast cells. It then discusses the stages of placental development including the prelacunar, lacunar, villous, and maturity stages. The document concludes by describing some abnormal placenta shapes including bilobed, circumvallate, succenturiate, membranacea, and ring-shaped placentas. Ultrasound appearance of normal and some abnormal placentas is also presented.
This document discusses miscarriage and related topics in obstetrics and gynecology. It defines different types of miscarriage such as threatened, inevitable, incomplete, and missed/silent miscarriage. It covers etiologies, risk factors, clinical presentations, investigations and management approaches for miscarriage. Key points include that 50% of spontaneous miscarriages are due to chromosomal abnormalities, infection is an unclear cause of recurrent miscarriage, and management involves either conservative expectant monitoring or surgical evacuation of retained products of conception.
Vaginal bleeding in late pregnancy can be caused by placenta previa, placental abruption, ruptured vasa previa, or uterine scar disruption. It is important to determine the diagnosis as treatment depends on the underlying cause. A history, physical exam, ultrasound, and labs can help identify conditions like placenta previa or abruption. Placenta previa is treated expectantly if no active bleeding, while abruption may require delivery depending on grade. Ruptured vasa previa and uterine rupture require emergent delivery.
This document discusses early pregnancy complications including miscarriage, ectopic pregnancy, and molar pregnancy. It defines each condition and describes their causes, clinical features, diagnosis, and management. Miscarriage is defined as expulsion of pregnancy tissue before 22 weeks gestation and can be threatened, inevitable, incomplete, missed, or complete. Ectopic pregnancy occurs when implantation occurs outside the uterus, usually in the fallopian tubes. Molar pregnancy results from abnormal fertilization and can be complete or partial hydatiform moles, or develop into choriocarcinoma. The document provides details on evaluating and treating each complication.
Caesarean section is a surgical procedure to deliver a baby through abdominal and uterine incisions after 28 weeks of pregnancy. The incidence of C-sections has increased due to abandoning difficult procedures and increased use for breech births. Indications include maternal conditions like pelvic abnormalities and previous C-sections, as well as fetal indications like distress. A lower segment transverse incision is most common. Complications can include hemorrhage, injury, infection and rupture of the uterine scar in subsequent pregnancies.
The document discusses the prevention, treatment, and postoperative care of obstructed labor. It outlines measures to resuscitate life-threatening conditions like shock and sepsis, relieve the obstruction through vaginal operative deliveries, destructive procedures, or abdominal deliveries like c-section. Postoperative care involves continued resuscitation and monitoring for complications like infection, along with bladder care, counseling, and follow up for fistula repair if needed.
Incidence of ectopic pregnancy is rising while maternal mortality from it is falling.
ALWAYS suspect ectopic pregnancy in a woman of a child-bearing age c/o pain and/or p.v. bleeding
This document discusses ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It details the risk factors, symptoms, diagnostic process, and management options for ectopic pregnancies. Management may involve expectant monitoring, medical treatment with methotrexate, or surgical intervention depending on the individual case. Proper treatment is important to preserve future fertility and prevent life-threatening complications from tubal rupture.
The document discusses the fetal membranes, which include the chorion and amnion. The chorion is the outer membrane that is attached to the placenta and uterine wall. The amnion lines the chorion and encloses the fetus and amniotic fluid. The amniotic fluid provides protection and nutrition for the fetus, and aids in temperature regulation and movement. It is composed primarily of water, carbohydrates, proteins and minerals. The amniotic fluid circulates continuously, with production from the fetal membranes, fetal urine and transudation from maternal and fetal blood.
The document summarizes the development, functions, and abnormalities of the placenta. It discusses how the placenta develops from implantation through formation of chorionic villi and circulation. It describes the placenta's main functions of transferring nutrients and waste between mother and fetus, as well as endocrine and barrier functions. It also covers placental hormones, mechanisms of substance transfer, and diagnostic uses and immunological role of the placenta.
abortions( hemorrhagic in early pregnancythxz2fdqxw
This document discusses various types of bleeding in early pregnancy. It defines abortion and classifies it as spontaneous or induced, with spontaneous abortion further divided. The main causes of bleeding in early pregnancy are abortion (95%), ectopic pregnancy, molar pregnancy, and implantation bleeding. Genetic factors account for 50% of early miscarriages due to chromosomal abnormalities. Other causes include endocrine, anatomical, infectious, immunological and unexplained factors. Different types of spontaneous abortion are defined including threatened, inevitable, complete, incomplete and missed abortion. Management depends on the type and stage of abortion.
This document defines abortion and discusses its classification, causes, mechanisms, and types. It begins by defining abortion as the expulsion of an embryo or fetus weighing 500g or less that is incapable of survival. Abortions are classified as early (before 12 weeks) or late (12-20 weeks). The main types discussed are threatened, inevitable, complete, incomplete, and missed/silent abortions. Causes include fetal, maternal, environmental, nutritional, and infectious factors. The mechanisms of abortion vary depending on gestational age. Incidence and risk factors are also presented.
This document provides an overview of abortion presented by Miss. Ekta Bagh at Apollo College of Nursing, Durg. It defines abortion as the expulsion of an embryo or fetus weighing 500 grams or less that is incapable of survival. The document discusses common causes of abortion in the first and second trimesters such as genetic factors, infections, endocrine disorders, and anatomical abnormalities. It also describes the mechanisms, types (threatened, inevitable, complete, incomplete, missed), signs, investigations, management, and complications of abortion.
1. The document discusses various types of abortion including spontaneous, threatened, inevitable, incomplete, missed, and induced abortions.
2. Spontaneous abortion refers to abortion occurring without medical intervention, while induced abortion is intentionally caused.
3. Causes of abortion include fetal/ovum factors, maternal health issues, trauma, toxic agents, cervical/uterine abnormalities, and unknown causes.
4. Management depends on type and gestational age but may include bed rest, dilation and curettage, medications to expel products of conception, or hysterectomy in some cases.
The document defines abortion and discusses its classification, incidence, etiology, and management. It notes that abortion is the expulsion of an embryo or fetus weighing 500 grams or less before 22 weeks of gestation. Abortions are classified as spontaneous, threatened, inevitable, complete, incomplete, missed, or septic. The incidence of abortion in India is estimated at 10-20% of pregnancies. Complications of abortion include hemorrhage, infection, and future obstetric or gynecological issues. The role of nurses is to assess for complications, provide support and education, and monitor for issues like shock.
It is an abnormal condition of the placenta where there are partly degenerative and partly proliferative changes in the young chorionic villi. These result in the formation of clusters of small cysts of varying sizes. Because of its superficial resemblance to hydatid cyst, it is named as hydatidiform mole.
A miscarriage, or spontaneous abortion, is an event that results in the loss of a fetus before 20 weeks of pregnancy. It typically happens during the first trimester, or first three months, of the pregnancy. Miscarriages can happen for a variety of medical reasons, many of which aren't within a person's control.
This document discusses abortion and miscarriage. It defines abortion as the expulsion of an embryo or fetus weighing 500 grams or less that is incapable of independent survival. Causes of abortion include genetic abnormalities, endocrine issues, infections, anatomical abnormalities, and blood group incompatibility. Threatened abortion refers to bleeding in early pregnancy when recovery is still possible, while inevitable and incomplete abortions involve progression where continuation of pregnancy is impossible. Septic abortion occurs when infection is present. Management depends on severity and aims to evacuate the uterus, treat infection if present, and prevent complications.
It is the expulsion or extraction from its mother of an embryo or fetus weighing 500 gm or less when it is not capable of independent survival (WHO).
The 500gm of fetal development is attained approximately at 22 weeks of gestation.
Expelled fetus- Abortus
This document discusses amniotic fluid disorders including hydramnios (polyhydramnios) and oligohydramnios. It defines each condition and describes their causes, signs and symptoms, diagnosis, and management approaches. Hydramnios is excessive amniotic fluid, typically defined as a maximum vertical pocket >8 cm or AFI >25 cm. It can be caused by fetal anomalies, multiple gestation, diabetes, or other maternal/placental conditions. Oligohydramnios is deficient amniotic fluid (<2 cm pocket or AFI <5 cm) and can result from fetal renal issues, ruptured membranes, or restricted growth. Ultrasound is key to diagnosis
This document discusses abortion, also known as miscarriage. Abortion is defined as the termination of a pregnancy by removing the fetus or embryo before it can survive outside the uterus. The document covers the incidence, classification, etiology, signs and symptoms, investigations, and management of different types of miscarriages such as threatened, inevitable, incomplete, missed, septic, and recurrent miscarriages. Nursing management involves close monitoring of symptoms and vital signs and notifying the healthcare provider immediately if bleeding is noticed.
This document discusses abortion, including its definition, causes, types, diagnosis, and management. It defines abortion as the expulsion of the products of conception from the uterus before 20 weeks of gestation or when the fetus weighs less than 500g. It describes the various causes of abortion including faults in the embryo or maternal environment. It discusses the types of abortion like threatened, incomplete, complete, missed, and recurrent abortion. It covers the diagnosis and management of abortion as well as complications like septic abortion. It also describes methods of induced abortion in the first and second trimester.
This document discusses amniotic fluid disorders, including polyhydramnios (excess amniotic fluid) and oligohydramnios (low amniotic fluid). For polyhydramnios, it defines it as an amniotic fluid index (AFI) over 24cm or deepest vertical pocket over 8cm. Causes include fetal anomalies, placental chorioangiomas, multiple pregnancies, and maternal diabetes. Management includes monitoring, treating the underlying cause if known, and amnioreduction for severe cases. Oligohydramnios is defined as an AFI under 5cm or pocket under 2cm. Causes are fetal issues like anomalies or maternal factors like hypertension. Risks
This document discusses various gynecological disorders that can occur during pregnancy, including vaginal discharge, trichomoniasis, candidiasis, cervical polyps, cervical cancer, fibroids, ovarian cysts, retroverted uterus, uterine prolapse, and incarcerated retroverted gravid uterus. For each condition, it describes the prevalence during pregnancy, potential effects on the pregnancy and delivery, signs and symptoms, diagnosis, and recommended treatment approaches. Conservative management is typically recommended where possible to allow the pregnancy to continue.
This document discusses high risk pregnancies and abnormal pregnancies. It covers various causes of bleeding in early pregnancy like miscarriage, ectopic pregnancy, molar pregnancy and their signs and symptoms. It also discusses disorders caused by or associated with pregnancy like preeclampsia. Other high risk conditions discussed include infections, cardiac/renal problems, fibroids and pelvic abnormalities. Types of miscarriages like threatened, inevitable, incomplete and septic abortions are explained along with their management. Recurrent miscarriages and investigations for their causes are also summarized.
Antepartum bleeding occurs in 2-5% of pregnancies and can be caused by obstetric issues like placental abruption or placenta previa, as well as non-obstetric issues. Placental abruption involves premature separation of the placenta from the uterus and can cause maternal and fetal mortality. It is diagnosed clinically and ultrasonography may show a retroplacental hematoma. Management involves correcting shock, delivering the baby via C-section if necessary, and treating any coagulopathy. Placenta previa involves implantation of the placenta over the cervical os and requires C-section for delivery. Other causes of antepartum bleeding discussed are fetal vessel rupture,
Gestational trophoblastic disease is an abnormal proliferation of trophoblast cells associated with pregnancy. It includes complete and partial hydatidiform moles, invasive moles, and gestational trophoblastic neoplasms like choriocarcinoma and placental site trophoblastic tumors. Risk factors include young or advanced maternal age, previous molar pregnancies, and smoking. Diagnosis involves high hCG levels and ultrasound or biopsy. Treatment ranges from D&C for molar evacuations to chemotherapy for persistent or metastatic disease. Long term follow up is needed to monitor for recurrence or progression to gestational trophoblastic neoplasia.
Gestational trophoblastic disease (GTD) includes a spectrum of abnormal pregnancies associated with trophoblastic proliferation. The most common form is a hydatidiform mole, which occurs when a fertilized egg implants abnormally in the uterus. Complete moles have only paternal chromosomes, while partial moles have both maternal and paternal chromosomes. Symptoms include vaginal bleeding, abdominal pain, and high hCG levels. Treatment involves uterine evacuation followed by chemotherapy for high-risk cases to prevent malignant changes. Long-term monitoring of hCG levels is needed due to the risk of persistent trophoblastic disease.
This document discusses adult basic life support (BLS) and advanced cardiac life support (ACLS). It outlines the steps of BLS, including high-quality chest compressions, airway management, use of an automated external defibrillator (AED), and importance of early CPR. It then describes the ACLS algorithm and management of cardiac arrest, including defibrillation, drug therapy like epinephrine and amiodarone, advanced airways, and treating reversible causes of cardiac arrest. The goal of BLS and ACLS is to restore spontaneous circulation through early recognition, high-quality CPR, defibrillation if needed, and treatment of underlying causes.
This document discusses abortion and miscarriage. It defines different types of abortion including spontaneous, threatened, inevitable, incomplete, complete and missed miscarriage. The main causes of miscarriage are genetic factors, infections, anatomical abnormalities, endocrine/metabolic factors, immunological factors and thrombophilias. Septic abortion is discussed which is any abortion complicated by infection. Grading of septic abortion from localized to generalized infection is described.
This document discusses different types of miscarriage including spontaneous abortion, threatened miscarriage, inevitable miscarriage, complete miscarriage, and incomplete miscarriage. It outlines the main causes of miscarriage as genetic factors, infections, anatomical abnormalities, endocrine/metabolic factors, immunological disorders, and unexplained causes. Treatment options are discussed depending on gestational age and include medication, dilation and evacuation, and dilation and curettage.
This document discusses abortion and miscarriage. It defines different types of abortion including spontaneous, threatened, inevitable, incomplete, complete and missed miscarriage. The main causes of miscarriage are genetic factors, infections, anatomical abnormalities, endocrine/metabolic factors, immunological factors, and thrombophilias. Complications of miscarriage include profuse bleeding and sepsis. Treatment depends on the type and severity but may include expectant management, medical treatment using misoprostol or prostaglandins, or surgical evacuation of the uterus.
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3. INTRODUCTION
Spontaneous abortion (SAB)- Natural termination of pregnancy before the fetus has reached viability.
This term is preferred in talking with patients because the word abortion is frequently associated with
induced abortions.
A fetus of less than 20 weeks of gestation and early and late.
An early abortion occurs before 12 weeks of gestation, and a midtrimester or late abortion occurs
between 12 and 20 weeks of gestation.
4. The causes of bleeding in early pregnancy are broadly divided into two groups:
Those related to the pregnant state:
This group relates to abortion (95%), ectopic pregnancy, hydatidiform mole and
implantation bleeding.
Those associated with the pregnant state:
The lesions are unrelated to pregnancy—either pre-existing or aggravated during
pregnancy. Cervical lesions such as vascular ectopy (erosion), polyp, ruptured
varicose veins and malignancy are important causes.
5.
6. DEFINITION:
Abortion is the expulsion or extraction from its mother of an embryo or fetus weighing
500 g or less when it is not capable of independent survival (WHO).
This 500 g of fetal development is attained approximately at 22 weeks (154 days) of
gestation.
The expelled embryo or fetus is called abortus.
The word abortion is the recommended terminology for spontaneous miscarriage.
7. INCIDENCE:
10–20% of all clinical pregnancies end in miscarriage
10% are induced or deliberate.
About 75% miscarriages occur before the 16th week and of these about 80% occur
before the 12th week of pregnancy.
11. GENETIC FACTORS:
Majority (50%) of early miscarriages
Autosomal trisomy (50%)
Trisomy 16 (30%).
Polyploidy (22% ).Triploidy is more common than tetraploidy
Monosomy X (45, X) (20%).
Structural chromosomal rearrangements 2–4% of abortuses. These include
translocation, deletion, inversion and ring formation.
Other chromosomal abnormalities like mosaic, double trisomy, etc. are found in about
4% of abortuses.
12. ENDOCRINE AND METABOLIC FACTORS (10–15%):
Luteal phase defect (LPD)
Overt hypothyroidism or hyperthyroidism
Diabetes mellitus
14. Causes of fetal loss are:
(i) Reduced intrauterine volume.
(ii)Reduced expansile property of the uterus.
(iii)Reduced placental vascularity when implanted on the septum.
(iv)Increased uterine irritability and contractility.
15. INFECTIONS (5%)
Late as well as early abortions
Transplacental fetal infections
Viral: Rubella, cytomegalovirus, variola, vaccinia or HIV.
Parasitic: Toxoplasma, malaria.
Bacterial: Ureaplasma, chlamydia, brucella. Spirochetes hardly cause abortion before 20th week because of
effective thickness of placental barrier.
16. IMMUNOLOGICAL DISORDERS (5–10%)
Antiphospholipid antibody syndrome (APAS
These are: Lupus anticoagulant (LAC), Anticardiolipin antibodies (ACAs) and-
glycoprotein 1 antibodies (GP1).
IMMUNE FACTORS:
Successful pregnancy is the result of predominantly Th2 cytokine response. Women with
recurrent miscarriage have more Th1 response.
17. MATERNAL MEDICAL ILLNESS
Cyanotic heart disease, hemoglobinopathies are associated with early miscarriage.
PREMATURE RUPTURE OF THE MEMBRANES inevitably leads to abortion.
18. Inherited thrombophilia
Protein C resistance (factor V Leiden mutation)
Other conditions are: Protein C deficiency and hyperhomocysteinemia antithrombin III
or prothrombin gene mutation.
THROMBOPHILIAS:
19. ENVIRONMENTAL FACTORS
Cigarette
Alcohol consumption
X-irradiation and antineoplastic drugs. X-ray exposure up to 10 rad is of little risk.
Contraceptive agents—IUD in situ increases the risk whereas oral pills do not.
Drugs, chemicals, noxious agents—anesthetic gases, arsenic, aniline, lead, formaldehyde.
UNEXPLAINED (40–60%)
20. First trimester:
(1) Genetic factors (50%),
(2)Endocrine disorders
(3) Immunological disorders
(4) Infection, and
(5) Unexplained.
Second trimester:
(1) Anatomic abnormalities—
(a) Cervical incompetence
(b) Müllerian fusion defects
(c) Uterine synechiae, and
(d) Uterine fibroid.
(2) Maternal medical illness.
(3) Unexplained.
COMMON CAUSES OF MISCARRIAGE
21. MECHANISM OF MISCARRIAGE:
In the early weeks, death of the ovum occurs first, followed by its expulsion. In the later weeks, maternal environmental factors
are involved leading to expulsion of the fetus which may have signs of life but is too small to survive.
Before 8 weeks:
Between 8 and 14 weeks:
Beyond 14th week:
22. THREATENED MISCARRIAGE
It is a clinical entity where the process of miscarriage
has started but has not progressed to a state from
which recovery is impossible.
24. Pelvic examination should be done as gently as possible.
(a)Speculum examination reveals—bleeding if any, escapes through
the external os.
(b)Digital examination reveals the closed external os.
The uterine size corresponds to the period of amenorrhea. The uterus
and cervix feel soft.
Pelvic examination is avoided when ultrasonography is available.
25. INVESTIGATIONS
Routine investigations include:
(1)Blood—hemoglobin, hematocrit, ABO and Rh grouping.
(2)Urine - the test remains positive for a variable period even after the fetal death.
Ultrasonography (TVS) findings may be:
(1) A well-formed gestation sac, yolk sac with central echoes from the embryo indicating
healthy fetus.
(2) Observation of fetal cardiac motion.
(3) Anembryonic sac
28. PROGNISIS
The prognosis is very unpredictable. In isolated spontaneous threatened
miscarriage, the following events may occur:
(1) In about two-thirds, the pregnancy continues beyond 28 weeks.
(2) In the rest, it terminates either as inevitable or missed miscarriage.
If the pregnancy continues, there is increased frequency of preterm labor,
placenta previa, intrauterine growth restriction of the fetus and fetal
anomalies.
29. INEVITABLE MISCARRIAGE
It is the clinical type of abortion where the changes have progressed to a state from
where continuation of pregnancy is impossible.
30. CLINICAL FEATURES:
The patient, having the features of threatened miscarriage, develops the following manifestations:
(1) Increased vaginal bleeding.
(2) Aggravation of pain in the lower abdomen which may be colicky in nature.
(3) Internal examination reveals dilated internal os of the cervix through which the products of
conception are felt.
31. MANAGEMENT is aimed:
(a) To accelerate the process of expulsion.
(b) To maintain strict asepsis.
General measures:
Excessive bleeding should be promptly controlled by administering Methergine 0.2 mg
if the cervix is dilated and the size of the uterus is less than 12 weeks. The blood loss
is corrected by intravenous (IV) fluid therapy and blood transfusion.
32. Before 12 weeks:
(1) Dilatation and evacuation followed by curettage of the uterine cavity by
blunt curette using analgesia or under general anesthesia.
(2) Alternatively, suction evacuation followed by curettage is done.
Active treatment
33. After 12 weeks:
(1) The uterine contraction is accelerated by oxytocin drip (10 units in 500 mL of normal
saline) 40–60 drops per minute. If the fetus is expelled and the placenta is retained, it is
removed by dilatation and evacuation under general anesthesia.
35. CLINICAL FEATURES:
There is history of expulsion of a fleshy mass per vaginam followed by:
(1) Subsidence of abdominal pain.
(2) Vaginal bleeding becomes trace or absent.
(3) Internal examination reveals:
(a) Uterus is smaller than the period of amenorrhea and a little firmer,
(b) Cervical os is closed and
(c) Bleeding is trace.
(4) Examination of the expelled fleshy mass is found complete.
(5) Ultrasonography (TVS): reveals empty uterine cavity.
36. MANAGEMENT:
Transvaginal sonography is useful to see that uterine cavity is empty, otherwise
evacuation of uterine curettage should be done.
Rh-NEGATIVE WOMEN:
Protected by antiD gamma globulin 50 μg or 100 μg intramuscularly in cases of
early miscarriage or late miscarriage respectively within 72 hours.
However, anti-D may not be required in a case with complete miscarriage before 12
weeks of gestation where no instrumentation has been done.
37. INCOMPLETE MISCARRIAGE
DEFINITION:
When the entire products of conception are not expelled, instead a part of it is left inside
the uterine cavity, it is called incomplete miscarriage.
38. CLINICAL FEATURES:
History of expulsion of a fleshy mass per vaginam followed by:
(1) Continuation of pain in lower abdomen.
(2) Persistence of vaginal bleeding.
(3) Internal examination reveals—
(a) Uterus smaller than the period of amenorrhea,
(b) Patulous cervical os often admitting tip of the finger and
(c) Varying amount of bleeding.
(4) On examination, the expelled mass is found incomplete.
(5) Ultrasonography—reveals echogenic material (products of conception) within the
cavity.
40. MANAGEMENT:
In recent cases—evacuation of the retained products of conception (ERPC) is done. She
should be resuscitated before any active treatment is undertaken.
Early abortion: Dilatation and evacuation under analgesia or general anesthesia is to be
done. Evacuation of the uterus may be done using MVA also.
41. Late abortion: The uterus is evacuated under general anesthesia and the products are
removed by ovum forceps or by blunt curette. In late cases, dilatation and curettage (D
and C) operation is to be done to remove the bits of tissues left behind. The removed
materials are subjected to a histological examination.
Medical management
Tablet misoprostol 200 mcg is used vaginally every 4 hours. Compared to surgical
method, complications are less with medical method.
42. MISSED MISCARRIAGE
When the fetus is dead and retained inside the uterus for a variable period, it is
called missed miscarriage or early fetal demise.
43. PATHOLOGY:
Beyond 12 weeks, the retained fetus becomes macerated or mummified. The liquor amnii gets
absorbed and the placenta becomes pale, thin and may be adherent. Before 12weeks, the
pathological process differs when the ovum is more or less completely surrounded by the
chorionic villi.
44. CLINICAL FEATURES:
The patient usually presents with features of threatened miscarriage followed by:
(1) Persistence of brownish vaginal discharge.
(2) Subsidence of pregnancy symptoms.
(3) Retrogression of breast changes.
(4) Cessation of uterine growth which in fact becomes smaller in size.
(5) Non-audibility of the fetal heart sound even with Doppler ultrasound.
(6) Cervix feels firm.
(7) Immunological test for pregnancy becomes negative.
(8) Real-time ultrasonography reveals an empty sac early in the pregnancy or the absence of
fetal cardiac motion and fetal movements.
46. Uterus is less than 12 weeks:
(i) Expectant management—many women expel the conceptus spontaneously.
(ii)Medical management: Prostaglandin E1 (misoprostol) 800 µg vaginally in the posterior
fornix is given and repeated after 24 hours if needed. Expulsion usually occurs within 48
hours.
(iii)Suction evacuation or dilatation and evacuation is done either as a definitive treatment or it
can be done when the medical method fails.
47. Uterus more than 12 weeks:
Induction is done by the following methods:
Prostaglandins are more effective than oxytocin
Prostaglandin E1 analog (misoprostol) 200 mcg tablet is inserted into the
posterior vaginal fornix every 4 hours for a maximum of 5 such.
Oxytocin—10–20 units of oxytocin in 500 mL of normal saline at 30
drops/min is started. If fails, escalating dose of oxytocin to the maximum of
200 mlU/min may be used with monitoring.
48. May need surgical evacuation following medical treatment.
ultrasonography should be done to document empty uterine cavity.
Evacuation of the retained products of conception (ERPC) should be
done.
Dilatation and evacuation
49. SEPTIC ABORTION
Any abortion associated with clinical evidences of infection of the uterus and its
contents is called septic abortion.
Abortion is usually considered septic when there are:
(1) Rise of temperature of at least 100.4°F (38°C) for 24 hours or more,
(2) Offensive or purulent vaginal discharge and other evidences of pelvic infection such
as lower abdominal pain and tenderness.
50. INCIDENCE:
About 10% of abortions
The majority is associated with incomplete abortion.
Majority of cases, the infection occurs following illegal induced abortion
But infection can occur even after spontaneous abortion.
51. MODE OF INFECTION:
The microorganisms involved are usually those normally present in the vagina (endogenous). The
microorganisms are:
(a) Anaerobic—Bacteroides group (fragilis), anaerobic Streptococci, Clostridium welchii and
tetanus bacillus.
(b) Aerobic—Escherichia coli (E. coli), Klebsiella, Staphylococcus, Pseudomonas and group A
beta-hemolytic Streptococcus (usually exogenous), methicillin resistant Staphylococcus
aureus (MRSA).
Mixed infection is more common.
52. PATHOLOGY:
In the majority (80%), the organisms are of endogenous
origin and the infection is localized to the conceptus .
In about 15%, the infection either produces localized
endomyometritis surrounded by a protective leukocytic
barrier, or spreads to the parametrium, tubes, ovaries or
pelvic peritoneum.
In about 5%, there is generalized peritonitis and/or
endotoxic shock.
55. CLINICAL GRADING:
Grade I: The infection is localized in the uterus.
Grade II: The infection spreads beyond the uterus to the parametrium, tubes and ovaries
or pelvic peritoneum.
Grade III: Generalized peritonitis and/or endotoxic shock or jaundice or acute renal
failure.
Grade I is the most common and is usually associated with spontaneous abortion. Grade III is
almost always associated with illegal induced abortion.
56. INVESTIGATIONS:
Routine investigations include:
(1) Cervical or high vaginal swab is taken prior to internal examination
(2) Blood for hemoglobin estimation, total and differential count of white cells, ABO and Rh
grouping.
(3) Urine analysis including culture.
57. Special investigations—
(1)Ultrasonography of pelvis and abdomen
(2)(2) Blood—
(a) Culture—if associated with spell of chills and rigors;
(b) Serum electrolytes, C-reactive protein (CRP), serum lactate—as an adjunct to
the management protocol of endotoxic shock. Serum lactate greater than or equal to
4 mmol/L indicates tissue hypoperfusion and
(c) Coagulation profile.
(3) Plain X-ray—
(a) Abdomen— in suspected cases of bowel injury,
(b) Chest—for cases with pulmonary complications (atelectasis).
58. COMPLICATIONS
Immediate: illegally induced abortions of grade III type.
Hemorrhage
Injury
Spread of infection leads to:
(a)Generalized
(b)Endotoxic shock—mostly due to E. coli or Cl. welchii infection.
(c) Acute renal failure
(d)Lungs: atelectasis, ARDS.
(e) Thrombophlebitis.
59. PREVENTION:
(1) To boost up family planning acceptance in order to curb the unwanted
pregnancies.
(2) Rigid enforcement of legalized abortion in practice. Education, motivation and
extension of the facilities to get the real benefit out of it.
(3)To take antiseptic and aseptic precautions either during internal examination or
during operation in spontaneous abortion.
60. MANAGEMENT
GENERAL MANAGEMENT
Hospitalization. The patient is kept in isolation.
To take high vaginal or cervical swab .
Vaginal examination is done to note the state of the abortion process and extension of the
infection.
Overall assessment of the case and the patient is leveled in accordance with the clinical
grading.
Investigation protocols.
61. Principles of management are:
(a) To control sepsis.
(b) To remove the source of infection.
(c) To give supportive therapy to bring back the normal homeostatic
and cellular metabolism.
(d) To assess the response of treatment.
62. GRADE I
DRUGS:
1. Antibiotics
2. Prophylactic antigas gangrene serum of 8,000 units and 3,000 units of antitetanus serum
intramuscularly are given if there is a history of interference.
3. Analgesics and sedatives, as required.
Blood transfusion
Evacuation of the uterus: As abortion is often incomplete, evacuation should be performed
at a convenient time within 24 hours following antibiotic therapy.
Excessive bleeding is, of course, an urgent indication for evacuation.
63. GRADE II
Antibiotics are used as discussed. Clinical monitoring is to be conducted as outlined
in grade
GRADE III
DRUGS: Antibiotics
If Mixed infections, Ideal antibiotic regimens should cover all of them.
Antimicrobial therapy: A combination of either piperacillin-tazobactam or
carbapenem plus clindamycin (IV) gives broadest range of microbial coverage.
Emperical therapy is started first and is changed when culture sensitivity report is
available.
64. Piperacillin-tazobactam and carbapenems: Covers most organisms except MRSA, and are
not nephrotoxic. Piperacillin-tazobactam does not cover extended spectrum –lactamase
(ESBL) producers.
Vancomycin or teicoplanin may be added for MRSA resistant to clindamycin.
Clindamycin: Covers most streptococci, staphylococci including MRSA and is not
nephrotoxic.
Gentamycin (3–5 mg/kg—single dose) can be given when renal function is normal.
Co-amoxiclav—does not cover MRSA, Pseudomonas or ESBL-producing organisms.
Metronidazole—covers anaerobes. Analgesic, and ATS are given as in grade I. Blood
transfusion is more often needed than in grade I cases.
To note pulse, respiration, temperature, urinary output and progress of the pain,
tenderness and mass in lower abdomen, CVP greater than 8 mm Hg.
65. SURGERY:
(1) Evacuation of the uterus—Evacuation should be withheld for at least 48 hours when the
infection is controlled and is localized, the only exception being excessive bleeding.
(2) Posterior colpotomy
Indications for ICU Management (Plaat-2008)
Persistent hypotension, persistently raised
serum lactate (≥ 4
mmol/L)
Pulmonary edema,mechanical ventilation
Renal failure Renal dialysis
Impaired consciousness
Multiorgan failure, hypothermia, acidosis.
66. SUPPORTIVE THERAPY
Gastric suction and intravenous crystalloids infusion. Features of organ dysfunction should be
carefully guarded against.
Active surgery:
The laparotomy should be done by experienced surgeon with a skilled anesthetist
Adnexa is to be removed or preserved according to the pathology found.
Thorough inspection of the gut and omentum for evidence of any injury is mandatory.
Even when nothing is found on laparotomy, simple drainage of the pus is effective.
67. RECURRENT MISCARRIAGE
DEFINITION:
Recurrent miscarriage is defined as the sequence of two or more spontaneous abortions as
documented by either sonography or on histopathology, before 20 weeks (ASRM-2013). However,
earlier definition (RCOG, ESHRE) states prior three or more miscarriages before 24 weeks of
gestation.
68. INCIDENCE:
This distressing problem is affecting approximately 1% of all women of
reproductive age. The risk increases with each successive abortion reaching
over 30% after three consecutive losses.
69. Genetic
factors
(3–5%)
Endocri
ne and
metabol
ic:
Poorly controlled diabetic
(Presence of thyroid
autoantibodies
Luteal phase defect (LPD)
Polycysti
c ovary
syndrom
e
(PCOS)
Infectio
n
Inherite
d
thromb
ophilia
Immune
factors
(10–
15%)
Auto-
immunity
Unexplaine
d
ETIOLOGY
FIRST TRIMESTER ABORTION
70. SECOND TRIMESTER MISCARRIAGE
Anatomic abnormalities are responsible for 10–15% of recurrent abortion. The causes may
be congenital or acquired.
Congenital anomalies - Müllerian duct fusion or resorption (e.g. unicornuate, bicornuate,
septate or double uterus). Congenital cervical incompetence is rare.
Acquired anomalies are: intrauterine adhesions, uterine fibroids and endometriosis and
cervical incompetence. The pathology of abortion has been discussed.
Defective Müllerian fusion—12% cases of recurrent abortion.
71.
72.
73. OTHER CAUSES OF SECOND TRIMESTER MISCARRIAGE
Chronic maternal illness—such as uncontrolled diabetes with arteriosclerotic changes,
hemoglobinopathies, chronic renal disease. Inflammatory bowel disease, systemic lupus
erythematosus (SLE).
Infection—Syphilis, toxoplasmosis and listeriosis may be responsible in some cases.
Unexplained.
74. INVESTIGATIONS FOR RECURRENT MISCARRIAGE
A thorough medical, surgical and obstetric history with meticulous clinical examination
should be carried out to find out the possible cause or causes as mentioned previously.
Careful history-taking should include—
(i) The nature of previous abortion process.
(ii)Histology of the placenta or karyotyping of the conceptus, if available
(iii)Any chronic illness.
75. Diagnostic tests:
(1) Blood-glucose (fasting and postprandial), VDRL, thyroid function test, ABO and Rh
grouping (husband and wife), toxoplasma antibodies IgG and IgM.
(2) Autoimmune screening—lupus anticoagulant and anticardiolipin antibodies.
(3) Serum LH on D2/D3 of the cycle.
(4) Ultrasonography
(5) Hysterosalpingography
(6) This is supported by hysteroscopy and/or laparoscopy.
(7) Karyotyping (husband and wife).
(8) Endocervical swab to detect chlamydia, mycoplasma and bacterial vaginosis.
76. TREATMENT
INTERCONCEPTIONAL PERIOD
To alleviate anxiety and to improve the psychology
Hysteroscopic resection
Chromosomal anomalies
Women with PCOS.Metformin therapy is helpful.
Endocrine dysfunction: Control of diabetes and thyroid disorders is done
Genital tract infections
culture of cervical and vaginal discharge. Empirical treatment with doxycycline or
erythromycin is cost-effective.
77. DURING PREGNANCY
Reassurance and tender loving care (TLC)
Ultrasound
Rest
Progesterone therapy
natural micronized progesterone 100 mg daily as vaginal suppository.
It is started 2 days after ovulation. Once pregnancy is confirmed, progesterone
supplementation is continued until 10–12 weeks of gestation.
Antiphospholipid antibody syndrome (APS):
low-dose aspirin (50 mg/day) and heparin (5,000 units SC twice daily) up to 34
weeks.
78. MANAGEMENT OF CERVICAL INCOMPETENCE
Cerclage operation: Two types of operation are in current use during pregnancy each
claiming an equal success rate of about 80–90%. The operations are named after Shirodkar
(1955) and McDonald (1963).
Principle: The procedure reinforces the weak cervix by a nonabsorbable tape, placed around
the cervix at the level of internal os.
79.
80. SHIRODKAR (Cerclage for
Incompetent OS)
The placement of an encircling
“tape” ligature at the level of the
internal cervical os to maintain
the integrity of the cervical
canal.
81. FIRST TRIMESTER TERMINATION OF PREGNANCY (UP TO 12 WEEKS)
MEDICAL METHODS OF FIRST TRIMESTER ABORTION:
Mifepristone (RU-486) and Misoprostol: It is effective up to 63 days and is highly
successful when used within 49 days of gestation.
Methotrexate and Misoprostol—Methotrexate 50 mg/ m2 IM (before 56 days of gestation)
followed by 7 days later misoprostol 800 mcg vaginally is highly effective. Misoprostol may
have to be repeated after 24 hours if it fails.
82. MIDTRIMESTER TERMINATION OF PREGNANCY
MEDICAL METHODS
PROSTAGLANDINS:
Prostaglandins and their analogs
(i) Misoprostol (PGE1 analog)
(ii) Mifepristone and prostaglandins:
(iii) Gemeprost (PGE1 analog)
(iv) Dinoprostone (PGE2 analog)
(v) Prostaglandin F2 (PGF2 ),
OXYTOCIN: High-dose oxytocin as a single agent can be used for second trimester abortion.
83. SURGICAL METHODS
It is difficult to terminate pregnancy in the second trimester with reasonable safety as in first
trimester. The following surgical methods may be employed.
Between 13 and 15 weeks
Dilatation and evacuation in the midtrimester is less commonly done.
84. SURGICAL METHODS OF FIRST TRIMESTER ABORTION
MENSTRUAL REGULATION
VACUUM ASPIRATION (MVA/EVA)
SUCTION EVACUATION AND/OR CURETTAGE:
DILATATION AND EVACUATION
Rapid method: This can be done as an outdoor procedure with diazepam sedation and
paracervical block anesthesia.
Slow method:
Slow dilatation of the cervix is achieved by inserting laminaria tents (hygroscopic osmotic
dilators) into the cervical canal (synthetic dilators like Dilapan, Lamicel are also used).
This is followed by evacuation of the uterus after 12 hours. Vaginal misoprostol (PGE1) 400
mcg 3 hours before surgery is equally effective for cervical ripening.
85. INTRAUTERINE INSTILLATION OF HYPERTONIC SOLUTION:
Between 16 and 20 weeks:
Extra-amniotic Intra-amniotic
Extra-amniotic: Extra-amniotic instillation of 0.1% ethacridine lactate (estimated amount is
10 mL/week) Isotonic saline is infused extra-amniotically using a transcervical catheter balloon.
Results are similar to that of Foley’s catheter use alone.
Intra-amniotic: Intra-amniotic instillation of hypertonic saline (20%) is less commonly used
now. It is instilled through the abdominal route.
Intra-amniotic instillation of hyperosmotic urea
HYSTEROTOMY: The operation is performed through abdominal route.
86. A Cross-Sectional Study of the Psychosocial Problems Following Abortion
Sameera Kotta, Umashankar Molangur,1 Rajshekhar Bipeta,2 and Radhika Ganesh3
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Abstract
Background:
Twenty percent of pregnant women undergo an abortion. Reviews of previous studies on the effects of abortion on mental health
have been inconclusive. Little research has been carried out in this direction in our country.
Aims:
This study aims to study the psychological effects of abortions and the associated sociodemographic and other parameters.
Setting and Design:
It is a cross-sectional study, conducted in five different government hospitals of Hyderabad.
87. Materials and Methods:
After identifying the participants, an interview was conducted. First, sociodemographic and other parameters were collected by
an interviewer. Then, another interviewer conducted the interview using diagnostic tools (Impact of Events Scale-Revised
[IES-R] and Goldberg Health Questionnaire-12 [GHQ-12]). Analysis was carried out using SPSS software.
Results:
Sixty cases of spontaneous abortion, 31 therapeutic and 9 elective abortions, were collected. Overall, on GHQ-12, 57% women
had no distress, 11% had typical distress, while 14% had more than typical distress, 15% had psychological distress, and 3% of
them had severe distress. On IES-R, 16% women had little or no symptoms of posttraumatic stress disorder PTSD, 57% had
several symptoms, while 27% of them were likely to have PTSD.
Conclusions:
Women who underwent elective abortion showed less distress than the other types. Those that underwent a late abortion were
more likely to suffer from psychological distress than those having an early one. The medical history was a significant factor in
determining the mental health outcome of the women who underwent abortion.
88. BIBILIOGRAPHY
Dutta, D.C. Textbook of Obstetrics. Kolkata, India: New Central Book Agency. 6th
edition.2007.Pg no:345-450
Fraser, D.M., & Cooper, M.A., (Eds.). Myles Textbook for midwives. New York:
Churchill Livingstone.15th edition. 2005. Pg. no: 520-546
Pillitteri, A. Maternal and child health nursing. Philadelphia Lippincott Williams and
Wilkins.6TH edition. 2016. Pg. no: 390-404
Lowdermilk, D.L., &Perry, S.E. Maternity & women’s health care. Missouri: Mosby
Elsevier. 9th Edition. 2007. Pg. no: 245-260.