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. PRESENTATION
ON
ABORTION
PRSENTED BY
MISS.EKTA BAGH
APOLLO COLLEGE OF
NURSING,DURG

2. INTRODUCTION

3.  Abortion is the expulsion or extraction from
its mother of an embryo or fetus weighing
500gm or less when it is not capable of
independent survival (WHO) .This 500gm of
fetal development is attained approximately
at 22 weeks of gestation .the expelled
embryo or fetus is called abortion.The term
miscarriage ,which is mostly used is
synonymous with spontaneous abortion.

4. 10-20% of all clinical pregnancy and 10%
are induced illegally .75% abortion occur
before the 16th week and of these ,about
75% occur before the 8th week of
pregnancy.

5.  Genetic factors.
 Infection
 Endocrine and metabolic factors
 Anatomic factors

6. COMMON CAUSES OFABORTION
FIRST TRIMESTER
 Genetic factors (50%)
 Endocrine disorders (LPD, thyroid
abnormalities ,diabetes)
 Immunological disorders (autoimmune and
alloimmune)
 Infection
 Unexplained

7. CONT.
SECOND TRIMESTER
 Anatomic abnormalities
 Cervical incompetence
 Muller an fusion defects
 Uterine synechiae
 Uterine fibroid
 Maternal medical illness
 Unexplained

8. MECHANISM OF ABORTION
In the early weeks, death of the ovum 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 8weeks :- the ovum ,occurs first ,followed by its
expulsion coverings, is expelled out intact . sometimes ,the
external os fails to dilate so that the entire mass is
accommodated in the dilate cervical canal is called cervical
abortion.
 8-14 weeks :- expulsion of the commonly occurs leaving behind
the placenta and the membranes a part of it may be remains
totally attached to the uterine wall.
 Beyond 14th weeks :- the process of expulsion is similar to that of
a “minilabour” the fetus expelled first followed by expulsion of
the placenta after a varying interval.

9. THERATENDABORTION
DEFINITION :- It is clinical entity where the
process of abortion has started but has not
progressed to a state from which recovered
is impossible.
CLINICAL FEATURES :-
 Bleeding per vaginam
 Pain.
 Pelvic examination should be done as gently as possible
 Speculum examination reveals –bleeding if any escapes
through the external os.
 Digital examination reveals the closed external os.

10. INVESTIGATION
Routine investigation :-
 BLOOD TEST
 URINETEST

11.  REST
 DRUGS
 GENERAL MEASURES
1)The patient advised to preserve the vulval pads and anything expelled out
per vaginam, for inspection.
2)To report if bleeding and or pain becomes aggravated.
3) Routine note of pulse, temperature and vaginal bleeding.
ADVICE ON DISCHARGE
• The patient should limits her activity for at least two weeks and avoid
heavy work.
• Coitus is contraindicated during this period.
• She should be re-examined after one month to assess the growth of the
fetus.

12.  The prognosis is very unpredictable whatever method of
treatment is employed either in the hospital at home.
 In isolated spontaneous threatened abortion ,the following
events may occur.
 In about two, third the pregnancy continues beyond 28
weeks.
 In the rest ,it terminates either in inevitable or missed
abortion .
 If the pregnancy continues ,there is increased frequency of
preterm ,placenta ,intra-uterine growth retardation of the
fetus and fetal anomalies.

13. INEVITABLE ABORTION
 DEFINITION :- It is the clinical type of infection
where the changes have progressed to a state from
where continuation of pregnancy is imposed.
 CLINICAL FEATURES
 Increased vaginal bleeding .
 Aggravation of pain in the lower abdomen.
 The general condition of the patient is proportion to
the visible blood loss.
 Dilated internal os.

14. MANAGEMENT :-
 To take appropriate measures to look after the general
condition.
 To accelerate the process of expulsion.
 To maintain strict asepsis as outlined in condition of labour.
GENERAL MEASURES :- excessive bleeding should be
promptly controlled by administering 0.2g if the cervix is
dilated and the size of the uterus is less than 12 weeks .the
shock is corrected by intravenous fluid therapy fluid
therapy and blood transfusion

15. ACTIVE MANAGMENT
BEFORE 12 WEEKS :-
 dilatation and evacuation followed by curettage of the
uterine cavity by blunt curette under general anesthesia.

 Alternatively ,suction evacuation followed by curettage is
done.
AFTER 12 WEEKS :-
 The uterine contraction is accelerated by oxytocin drip (10
units in 500ml of normal NS) 40-60 drops /mint.
 If bleeding is profuse with the cervix closed –evacuation of
the uterus may have to be done by abdominal
hysterectomy.

16. COMPLETEABORTION
DEFINITION :- when the products of conception are expelled
en masses ,it is called complete abortion.
CLINICAL FEATURES:-
 Subsidence of abdominal pain.
 Vaginal bleeding becomes trace or absent.
 Internal examination reveals
 Uterus is smaller than the period of amenorrhea and a little
firmer.
 Cervical os is closed.
 Bleeding is trace.
 Examination of the expelled fleshy mass is found intact.

17. MANAGMENT
• The effect of blood loss, if any should be assessed and
treated.
• If there is doubt complete expulsion of the products,
uterine curettage should be done.
• Trans vaginal sonography is useful to prevent
unnecessary surgical procedure.
• RH NEGATIVE WOMEN:- A rh – negative patient
without antibody in her system should be protected by
anti – D gamma globulin – 50 microgram
intramuscularly in cases of early abortion or late
abortion respectively within 72 hours.

18. INCOMPLETE ABORTION
DEFINITION :- when the entire products of conception are
not expelled, instead .apart of it is left inside the uterine
cavity ,it is called incomplete abortion.
CLINICAL FEATURES
 Continuation of pain lower abdomen, clocking in nature
although in diminished magnitude .
 Persistence of vaginal bleeding of varying magnitude.
 Internal examination reveals :-
 Uterus smaller than the period of amenorrhea .
 Patulous cervical os often admitting tip of the finger.
 Varying amount of bleeding.
 Rarely choriocarcinoma.

19. TERMINATION
TERMINATION :- The products left behind may lead to :-
 Profuse bleeding .
 Sepsis.
 Placental polyp.
 Rarely choriocarcinoma.
MANAGEMENT :-
 Early abortion :- Dilatation evacuation under
general anaesthesia is to be done.
 Late abortion :- The uterus is evacuated under
general anaesthesia and the product are removed by ovum
forceps or blunt curette.

20. MISSED ABORTION
DEFINITION :- When the fetus is dead retained
inside the uterus for a variable period it is called
.missed abortion or silent miscarriage or early fetal
demise.
 PATHOLOGY :- The cause of prolonged retention
the dead fetus in the uterus is not clear. beyond 12
weeks ,the retained fetus becomes macerated or
mummified .the liquor amine gets absorbed and the
placenta becomes pale ,thin and may be adherent
,before 12 weeks ,the pathological process differs
when the ovum is more or less completely surround
by the chorionic villi.

21. CLINICAL FEATURES
 Persistence of brownish vaginal discharge .
 Subsidence of pregnancy symptoms .
 Retrogression of breast changes.
 Cessation of uterine growth which infect becomes
smaller in size.
 Non audibility of the fetal heart sound even with
doppler cardio scope if it had been audible before.
 Cervix feels firm.
 Immunological test for pregnancy becomes negative .
 Real time ultrasonography reveals an empty sac time in
the pregnancy or the absence of fetal motion or fetal
heart movement later in the pregnancy.

22. COMPLICATION
 Intrauterine fetal death .
 Blood coagulation disorders are less likely to
occur in missed abortion

23. MANAGEMENT
Uterus is less than 12 weeks :-
 Vaginal evacuation can be carried out without
delay.
 This can be effectively done by suction
evacuation or slow dilatation of the cervix by
luminaries tent followed by dilatation and
evacuation (d&c) of the uterus under general
anesthesia .
 The risk of damage to the uterine walls and brisk
hemorrhage during the operation should be kept
in mind.

24.  Uterus ore than 12 weeks:-
 Oxytocin :- to start with 10 -20 units of oxytocin in 500ml of
normal saline at 30 drops per /mint if fails escalating dose of
oxytocin to the maximum of 200IU/min may be used with
monitoring.
 Prostaglandins are more effective than oxytocin in such
case.The method are:-
 Prostaglandins E1 analogue (misoprostol ) 200 µg tablet is
inserted in to the posterior vaginal fornix every 4 hours for a
maximum of 5 such.
 Intramuscular administration of methyl PGE2α
(carboprost tromethamine ) 250µg at three hourly interval
for a maximum of 10 such.

25. SEPTIC ABORION
DEFINITION :- Any abortion associated with clinical
evidences of infection of the uterus and
contents,is called abortion .
INCIDENCE :- It is difficult to work out the overall
incidences of septic abortion .About 10% of
abortion requiring admission to hospital are
septic.
Mode of infection :-The micro-organisms involved
in the sepsis are usually those normally present in
the vagina (endogenous ).

26. CLINICAL FEATURES
 Pyrexia
 Pain in abdomen
 A rising pulse rate
 Variable systemic and abdominal findings.
CLINICAL GRADING
 Grade 1 :-The infection is localized in the uterus .
 Grade 2 :-The infection spreds beyond the uterus to the
parametriu ,tubes and ovaries or pelvic peritoneum.
 Grade 3 :- Generailised peritonitis and /or endotoxic
shock or jaundice or acute renal failure.

27. INVESTIGATION
Routine investigation include
 Cervical or high vaginal swab is taken prior to internal examination for
 Culture in aerobic and anaerobic media to finding out the dominant micro-
organisms.
 Sensitivity of the micro-organism to antibiotics.
 Smear for gram stain.
 Blood for haemoglobin
 WBC
 ABO and Rh grouping
 Urine analysis including culture.
 Special investigation :-
 Ultrasonography
 Blood test
 Culture
 Serum electrolytes
 Coagulation profile.

28. COMPLICATION
 IMMEDIATE
 hemorrhage.
 Injury
 Spread of infection :-
 Generalized peritonitis :-
 The uterine tube.
 Perforation of the uterus.
 Bursting of the icroabsces in the uterine wall and
 Injury to the gut
 Endotoxic shock
 Acute renal failure
 Thrombophlebitis.
 REMOTE
 Chronic debility.
 Chronic pelvic pain and backache.
 Dyspareunia

29.  To boost up family planning acceptance in
order to curb the unwanted pregnancies.
 To rigid enforcement of legalized abortion in
practices and to curd the pre valences of
unsafe abortions.
 To take antiseptic and aseptic precautions
either during internal examination or during
operation in spontaneous abortion.

30. MANAGEMENT
General management :-
 Hospitalization is essential for all cases of septic abortion
.the patient in isolation.
 To take high vaginal or cervical swab for culture ,drug
sensitivity test and gram stain .
 Vaginal examination is done to note the state of the
abortion process and extension of the infection .if the
products are found loosely lying in the cervix ,it is removed
by an ovum forceps.
 Over assessment of the case is to be done and the patient is
leveled in accordance with the clinical grading.
 Investigation protocols as outlined before are done .

31. PRINCIPAL OF MANAGEMENT
 To control sepsis.
 To remove the sources of infection .
 To give supportive therapy to bring
back the normal homeostatic and
cellular metabolism.
 To assess the response of treatment.

32. DRUG
 Antibiotic anti gas gangrene serum of 8000units 3000
units of ant tetanus serum intramuscularly are given if
there is a history of interferences .
 Analgesics and sedatives as required are to be
prescribed.
 Blood transfusion is given to improve anemia and body
resistance.
 Evacuation of the uterus :- as abortion is often
incomplete evacuation should be performed be at a
convenient time within 24 hours following antibiotic
therapy .excessive bleeding is of course an urgent
indication for evacuation .early emptying not also
removes the nidus of infection of infection .the
procedures should be gentle to avoid injury to the uterus.

33.  GRADE -2
 DRUGS :- antibiotics infections including gram positive
,gram negative and anaerobic organisms are common.
 For gram positive aerobes :-
 Aqueous penicillin G5 million units I.U. every 6 hours.
 Ampicillin 0.5-1G I.V every 6 hours .
 Gram negative aerobes :-
 Gentamicin 1.5 mg/kg I.V every 8hours.
 Ceftraiaxone I.G,I.V every 12 hours.
 Anaerobes :- metronidazole 500 mg I.V. every 8hours ,or
clindamycin 600mg I.V every 6 hours .

34. CLINICAL MONITORING :- to note pulse ,respiration
,temperature output and progress of the pain tenderness
and mass in lower abdomen.
SURGERY
 Evacuation of the uterus -> evacuation should be with
held for at least 48 hours who the infection is controlled
and is localized ,the only exception being excessive
bleeding.
 Posterior colpotomy -> . when the infection is
localized in the pouch of Douglas pelvic abscess is
formed it is evidences by spiky rise of temperatures
,rectal tenesmus andboggy mass felt through the
posterior fornix. Posterior colpotomy and improve and
the general outlook of the patient.

35.  GRADE -3 Antibiotic -> mixed infection including
gram negative and anaerobic organisms are common.
 For gram positive aerobes :-
 Aqueous penicillin G 5 million units I.V. every 6 hours
or
 Ampicillin 0.5-1 gm I.V every 6 hours.
 Gram negative aerobes:-
 Gentamicin 1.5 mg/kg I.V every 8 hours
 Ceftriaxone I.G ,I.V every 12 hours.
 Anaerobes :- metronidazole 500mg I.V every 8hours
,or clindaycin 600g I.V every 6hours.

36.  CLINICAL MONITORING :- To note pulse, respiration
,temperature urinary output and progress of the pain
,tenderness and mass in lower abdomen. Supportive therapy
is directed to treat generalized peritonitis by gastric suction
and intravenous saline infusion.
 ACTIVE SURGERY
 Indication are :-
 Injury to the uterus.
 Suspected injury to bowel .
 Presences of foreign body in the abdomen as evidences by
the sonography or X-ray or felt through the fornix on
bimanual examination .
 Unresponsive peritonitis suggestive of collection of pus .
 Septic shock or oliguria not responding to the conservative
treatment.
 Uterus too big to be safely evacuated per vaginam .

37.  Unsafe abortion :- is defined to the
procedures of termination of unwanted
pregnancy either by persons locking the
necessary skills or in an environment lacking
the minimal standards or both.

38. RECURRENT MISCHARRIAGE
 Definition :- recurrent miscarriage is defined as a
sequences of three or more consecutive
spontaneous abortion before 20 weeks.
 Incidences :- this distressing problem is affecting
approximately 1% of all women of reproductive
age .the risk increase with each successive
abortion over 30% after three consecutive losses.

39. ETIOLOGY
 First trimester abortion
 Genetic factors
 Endocrine and metabolic
 Infection
 Inherited thrombophilia
 Immunological causes
 Autoimmunity.
 Alloimmunity.
 Unexplained

40. Cont.
Second trimester abortion
 Anatomic abnormalities :- the cause may be
congenital or acquired .
 Congenital anomalies due to defects in mullerian
duct fusion or resorption.
 Acquired anomalies are intrauterine adhesions,
uterine fibroid and endometriosis and cervical
incompetence’s.

41.  INVESTIGATION :- a through medical ,surgical
and obstetric history with meticulous clinical
examination should be carried out to find out the
possible cause as mentioned previously careful
history taking should include:-
 The nature of previous abortion process .
 History of the placenta or karyo-typing of the
conceptus,if available .
 Any chronic illness.

42. TREATMENT
 Inter conceptual period:-
 To alleviate anxiety and to improve the
psychological .
 Chromosomal anomalies.
 Hysteroscopy resection .
 Hypersecetion of LH.
 Endocrine dysfunction .
 Genital tract infection.

43. During pregnancy
 Reassurances and tender loving care.
 Ultrasound.
 Rest.
 Luteal phase defect.
 Antiphospholipid antibody syndrome.
 Circlage operation.
 Chromosome anomaly.
 Alloimune disorders.
 Inherited thrombophilias.
 Medical complication in pregnancy.
 Unexplained.

44. PROGNOSIS OF RECURRENT
ABORTION :-
 The prognosis of recurrent abortion is not so
gloomy as it was previously thought.
 It has been calculated that after one abortion ,the
risk of other abortion is 20% ,after two abortions
25% and after three abortion abortion 30%.
 Thus no matter what treatment is used the
apparent cure rate after three abortion range
between 70-85%.
 Reassurance and tender loving care every much
helpful.

45. INDUCTION OF ABORTION
 Deliberate termination of pregnancy before the
viability of the fetus is called induction of
abortion .the induced abortion may be legal or
illegal.
 Medical termination of pregnancy (MTP)
since legalization of abortion India ,deliberate
of abortion by a registered medical
practitioner in the interest of mothers health
and life is protected under the MTP act.

46. THE FOLLOWING PROVISIONS
ARE LAID DOWN:-
 The continuation of pregnancy would involve serious risk of
life or grave injury to the physical and mental health of the
pregnant woman.
 There is a substantial risk of the child being both with
serious physical and mental abnormalities so as to be
handicapped in life.
 When the pregnancy is caused by rape ,both in cases of
majour and minor girl and in mentally
 Between 16-20weeks:-
 Intra –uterine of hypertonic solution :-
 Intra –amniotic.
 Extra-amniotic.

47. THE FOLLOWING PROVISIONS
ARE LAID DOWN:-
 The continuation of pregnancy would involve serious risk of life
or grave injury to the physical and mental health of the pregnant
woman.
 There is a substantial risk of the child being both with serious
physical and mental abnormalities so as to be handicapped in life.
 When the pregnancy is caused by rape ,both in cases of majour
and minor girl and in mentally
 Between 16-20weeks:-
 Intra –uterine of hypertonic solution :-
 Intra –amniotic.
 Extra-amniotic.

48.  Intra –amniotic :- intra-amniotic instillation of
hyper amniotic (20%) is less commonly used now .it
is instilled through the abdominal route.
 Procedure :- a fine polythene tube is passed through
the needle in to the amniotic sac followed by
withdrawal of the needle .the polythene tube is
connected with the drip set containing the required
amount of hypertonic saline .the amount of number of
weeks of gestation multiplied by 10 mt .the amount
is to be infused slowly at the rate of 10l/mt.

49. Precautions
 To be sure that the needle is in the amniotic cavity evidenced
by clear liquor coming out .if there is a bloody tap, the needle
should be pushed further or change the direction until ,clear
comes out . if fails ,the procedure is to be abandoned .
 The instillation should be a slow process (10l/min) .
 Vital signs should be checked immediately after the
instillation and she should be kept at bed rest for at least 1
hours.
 To stop the procedure if the untoward symptoms like acute
abdominal pain ,headache ,thirst or tingling in the fingers
appear.
 Strict vigilances is taken during and following instillation till
expulsion occurs.
 Routine antibiotic is given such as ampicillin 500mg thrice
daily for 3-5 days.

50.  Mode of action :- there is liberation of
prostaglandins following necrosis of the amniotic
epithelium and deciduas . this in turn excites
uterine contraction and results in the expulsion of
the fetus.
 Success rate :- the method is effective in 90-95%
case with induction –abortion intercourse of about
32 hours the method failure is considered when
abortion fails to occur within 48 hours .

51. Complication
 Minor complaints like ,headache ,nausea ,
vomiting abdominal pain.
 Cervical tear and laceration .
 Retained products for which exploration has to be
done .
 Infection .
 Hypernatraemia ,cardiovascular collapse –due to
intra vascular injection .
 Pulmonary and cerebral edema.
 Disseminated intravascular coagulopathy.

52.  INTRA-AMNIOTIC INSTILLATION OF
HYPEROSMOTIC UREA :-
 Intra- amniotic instillation of 40% urea solution
(80gm of urea in 200ml distilled water ) along with
syntocinon drip is effective with less complications.
 Combination of intra amniotic hyper osmotic urea
and 15 methyl PGF2 α reduces the indication
abortion internal to 13 hours . compared to
hypertonic saline the combination of 2 mg of methyl
PGF2 α and 80 gm urea in to the amniotic sac is
effective in 80% of cases with induction – abortion
interval of 16 hours.

53. EXTRA –AMNIOTIC
 Extra-amniotic instillation of 0.1% ethacrydin lactate
is done transcervically through a no Foleys catheter.
 The catheter is passed up the cervical canal for
about 10cm above the internal os between the
membranes and the balloon is inflated (10ml ) with
saline.
 It is removed after 4 hours.
 The success rate is similar to saline instillation but is
less hazardous .
 It can be used in cases contraindicated for saline
instillation.

54.  PROSTAGLANDINS :- Prostaglandins and
their analogues are every much effective they
are used extensively ,specially in the second
trimester .they acton the cervix and the uterus.
 ROUTES OF ADMINISTRATION :-
intravenous route is abandoned because of its
high toxicity .the other routes of
administration are :-

55. Vaginal
 PGE1 analogue (misoprostol) 200µg every 12 hours .
 PGE2 (dinoprostone ) suppository 20 mg every 3 hours
are very effective .
Intramuscular :- the following preparations are used
 15 methyl PGF2 ( carboprost tromthamine ) 250µg 3
hourly for a maximum 10 injections.
 Sulprostone (PGE2 analogue ) 500µg administered
intramuscularly at every 8 hours.

56.  Intra- amniotic :- the method of instillation of intra-
amniotic prostaglandins is similar to that of
hypertonic saline .15 methyl PGF2 α 2mg is instilled.
Patients are treated with multiple intra cervical
luminaries tents over night . combination intra-
amniotic hyper osmotic urea and carboprost reduces
the mean induction – abortion interval to 13 hours.
 DRAW BACKS :-
 The method is not suitable with bigger size of more
than 10 weeks as chance of retained products is ore.
 Required electricity to operate and the machine is
costly.

57. DILATATIONAND
EVACUATION
 RAPID METHOD
 SLOW METHOD
 RAPID METHOD :- This can be done as an
outdoor procedure with diazepam sedation and
par cervical block anesthesia .
 Advantages :-
 As it can be done as an outdoor procedure ,the
patient can go home after the sedation effect is
over.
 Chance of sepsis is minimal .

58.  Drawbacks :-
 Chance of cervical injury is more.
 Uterus should not be more than 6-8 weeks of
pregnancy .
 All the drawbacks of D & E
 SLOW METHOD :-Slow dilatation of the cervix is
achieved by inserting laminaria tents in to the
cervical canal .this is followed by evacuation of the
uterus after 12 hours .vaginal misoprostal (PGE1 )
400 µg 3 hours before surgery is equally effective .

59. Advantages :-
 Chance of cervical injury is minimal .
 Suitable in case of therapeutic indications.
Draw backs ;-
 Hospitalization is required at least for one day.
 Chance of introducing sepsis.
 All the complication of D& E.

60. MEDICAL METHOD OF FIRST TRIMESTER
ABORTION
(RU-486) AND MISOPROSTOL
 Mifepristone an analog of progestin
(norethindorne ) acts as an antagonist ,blocking
the effects of natural progesterone . addition of
low dose prostaglandins ( PGE1 ) Improve in the
efficiency of first trimester abortion .it is highly
successful when used within 50 days of gestation.

61.  Protocol :-
 600mg of mifepristone orally is given on day 1 on
day 3 misoprostol (PGE1) 400 for 4 hours during
which patient remains in the clinical (95%) often
occurs .
 patient is reexamined after 10-14 days .if it fails
surgical method of termination should be applied .
 complete abortion is observed in 95% in complete in
about 2% case and about 2% cases and about 1% do
not respond at all oral mifepristone 200mg with
vaginal misoprostol 800µg is equally effective.

62.  METHOTREXETE AND MISOPROSTOL :-
Methotrexate 50g/m2 IM (before 56 days of
gestation ) followed by 7 days later misoprostol
800µg vaginally is effective misoprostol may
have to be repeated 24 hours if is fails .
methotrexate and isoprostol regimen is less
expensive buttakes longer time than mifepristone
and misoprostol . misoprostol has less side
effective and is stable at room temperative unlike
other PGS ,each use be refrigerated.

63.  TAMOXIFEN AND ISOPROSTOL ;- Oral
tamoxifen 20mg daily for 4 days by misoprostol
800µg vaginally results in complete abortion in
92% cases .duration of pregnancy should be less
than 63 days.
 Contraindication :- mifepristone should be used
in women aged over 35 years ,heavy smokes and
those on long term corticosteroid.

64. MID TRIESTER TERINATION
 Between 13-15 weeks.
 16-20 weeks.
 Between 13-15 weeks :- it is difficult to terminate
pregnancy in the second trimester with reasonable
safety as in first trimester .the following principles
may be employed .
 Dilatation and evacuation in the midtrimester is less
commonly done pregnancies at 13 to 14 menstrual
weeks are evacuated .prior cervical dilatation with
laminaria tents or with misoprostol (two stage
procedure ) or rapid dilatation (using metal dilators ) (
one stage procedures ) are performed .

66. DIAGNOSTICTESTS
 Blood –glucose ,VDRL ,thyroid test ,ABO and Rh
grouping ,toxoplasma antibodies IgG & IgM .
 Autoimmune LH ON D2 /D3 of the cycle.
 Hysteroscopy .
 Karyotyping.
 End cervical swab to detect Chaldea
,mycoplasma and bacterial vaginosis.

67. COMPLICATION OF MTP
 IMMEDIATE :-
 Trauma to the cervix and uterus leading to haemorrhage and shock.
 Haemorrhage and shock due to trauma ,incomplete abortion ,atonic uterus
or rarely coagulation failure .
 Thrombosis or embolism.
 Post abortal triad of pain ,bleeding and low grade fever due to retained
clots or products .antibiotics should be continued may repeat evacuation.
 Related to the methods employed.
 Saline :-
 Hypernatraemia,pulmonary edema ,end toxic shock ,DIC ,renal Failure
,cerebral hemorrhage.
 Prostaglandins :- intractable vomiting,diarrhea,fever ,uterine pain and
cervico-uterine injury.
 Oxytocin –water intoxication and convulsions.
 Hysterotomy (vide supra.)

68. cont
 REMOTE :- The complication are grouped in to:-
 Gynecological
 Obstetrical
 Gynecology complication include :-
 Menstrual disturbances.
 Chronic pelvic inflammation .
 Infertility due to corneal block.
 Scar endometriosis (1%) .
 Uterine synechiae leading to secondary amenorrhoea.
 Obstetrical complication include :-
 Recurrent mid trimester due to cervical incompetence .
 Ectopic pregnancy.
 Preterm labour .
 Dysmaturity.
 Increased perinatal loss.
 Rupture uterus.
 Rh isoimmunisation in Rh-negative women ,if not prophylactic ally protected with immunoglobulin.
 Failed and continued pregnancy.