1. The document discusses different types of abortion including threatened, inevitable, incomplete, complete, missed, and septic abortion.
2. Management strategies are provided for each type and include bed rest, medication to induce contractions, surgical evacuation, and treating any infection or hemorrhage.
3. Causes of miscarriage are also examined including fetal, maternal, immunological factors as well as various maternal illnesses, trauma, toxins, and cervical or uterine abnormalities.
1. Uterine rupture can occur during pregnancy or labor due to a previous cesarean section scar or other procedures that weaken the uterine wall.
2. Uterine ruptures are classified as complete, where the entire scar tears, or incomplete, where only part of the scar tears. They can occur in the upper or lower uterine segment.
3. Symptoms of uterine rupture include abdominal pain, fainting, abnormal fetal heart sounds, and palpation of fetal parts in the abdomen. Diagnosis is confirmed by laparotomy. Early detection is important to prevent maternal and fetal complications.
Uterine inversion is a rare complication where the uterus turns inside out, and can be partial or complete. It occurs in around 1 in 20,000 deliveries and is usually acute and complete. There are three degrees - first involves dimpling of the fundus, second passes through the cervix into the vagina, and third is complete outside the vulva. Treatment involves urgent manual replacement or hydrostatic replacement under anesthesia to prevent shock, hemorrhage, infection and other complications. Proper management of the third stage of labor can prevent induced inversions.
Prolapse of the uterus refers to the downward displacement of the vagina and uterus. It can be congenital or acquired due to factors like childbirth, obesity, chronic coughing, and uterine fibroids. Symptoms include feeling something coming down in the vagina, backache, difficulty urinating, and incomplete bowel movements. Diagnosis involves physical examination in both dorsal and standing positions. Management includes preventative measures, conservative options like pessaries and exercises, and surgery if symptoms become worse.
This presentation discusses prolonged labor, which occurs when labor lasts over 20 hours for first-time mothers or 14 hours for women who have given birth before. Prolonged labor can happen in the latent or active phases of the first stage, or the second stage. Causes include problems with uterine contractions, the birth canal, or the baby. Prolonged labor can endanger the baby through hypoxia or infection and endanger the mother through hemorrhage, trauma, or infection. Management involves identifying the cause, monitoring for effects, and treating any issues through techniques like amniotomy, oxytocin infusion, pain relief, or cesarean delivery if needed to deliver the baby safely.
This document discusses various types of abnormal uterine contractions that can occur during labor. It defines disordered uterine action as any deviation from normal uterine contraction patterns during labor. The types discussed include uterine inertia, precipitate labor, tonic uterine contractions/retraction, spastic lower segment, cervical dystocia, constriction ring, and generalized tonic contraction. For each type, the document describes the definition, causes, clinical features, diagnosis, and management.
1. Uterine rupture can occur during pregnancy or labor due to a previous cesarean section scar or other procedures that weaken the uterine wall.
2. Uterine ruptures are classified as complete, where the entire scar tears, or incomplete, where only part of the scar tears. They can occur in the upper or lower uterine segment.
3. Symptoms of uterine rupture include abdominal pain, fainting, abnormal fetal heart sounds, and palpation of fetal parts in the abdomen. Diagnosis is confirmed by laparotomy. Early detection is important to prevent maternal and fetal complications.
Uterine inversion is a rare complication where the uterus turns inside out, and can be partial or complete. It occurs in around 1 in 20,000 deliveries and is usually acute and complete. There are three degrees - first involves dimpling of the fundus, second passes through the cervix into the vagina, and third is complete outside the vulva. Treatment involves urgent manual replacement or hydrostatic replacement under anesthesia to prevent shock, hemorrhage, infection and other complications. Proper management of the third stage of labor can prevent induced inversions.
Prolapse of the uterus refers to the downward displacement of the vagina and uterus. It can be congenital or acquired due to factors like childbirth, obesity, chronic coughing, and uterine fibroids. Symptoms include feeling something coming down in the vagina, backache, difficulty urinating, and incomplete bowel movements. Diagnosis involves physical examination in both dorsal and standing positions. Management includes preventative measures, conservative options like pessaries and exercises, and surgery if symptoms become worse.
This presentation discusses prolonged labor, which occurs when labor lasts over 20 hours for first-time mothers or 14 hours for women who have given birth before. Prolonged labor can happen in the latent or active phases of the first stage, or the second stage. Causes include problems with uterine contractions, the birth canal, or the baby. Prolonged labor can endanger the baby through hypoxia or infection and endanger the mother through hemorrhage, trauma, or infection. Management involves identifying the cause, monitoring for effects, and treating any issues through techniques like amniotomy, oxytocin infusion, pain relief, or cesarean delivery if needed to deliver the baby safely.
This document discusses various types of abnormal uterine contractions that can occur during labor. It defines disordered uterine action as any deviation from normal uterine contraction patterns during labor. The types discussed include uterine inertia, precipitate labor, tonic uterine contractions/retraction, spastic lower segment, cervical dystocia, constriction ring, and generalized tonic contraction. For each type, the document describes the definition, causes, clinical features, diagnosis, and management.
Premature Rupture of Membranes (PROM) refers to rupture of membranes before the onset of labor. It occurs in 10% of term pregnancies and more commonly in preterm labor. PROM can be diagnosed through various tests including a nitrazine paper test, fern test, sterile speculum exam, or ultrasound. Complications of PROM include preterm labor, infection, and fetal deformities or distress. Management depends on gestational age - expectant management is common above 34 weeks while induction or C-section may be recommended below 36 weeks to prevent complications.
This document discusses postpartum haemorrhage (PPH), defined as blood loss exceeding 500 ml following childbirth. It notes that PPH has various causes including an atonic uterus, trauma during delivery, retained placental tissues, and coagulation disorders. The primary types are those occurring within 24 hours of delivery. Management involves controlling blood loss, administering oxytocics, and may require interventions like uterine packing or hysterectomy in severe cases. Prevention strategies include active management of the third stage of labour and being prepared to treat PPH as a potential complication of childbirth.
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.
This document discusses the management of Rh-negative pregnancies. It begins with an introduction to Rh blood types and the pathophysiology of Rh sensitization. It then discusses epidemiology and outlines the management approach for both unsensitized and sensitized Rh-negative pregnant women. Management involves screening, prophylactic Rh immunoglobulin administration, and monitoring for sensitization and fetal complications. The goals are to prevent sensitization in unsensitized women and detect issues early in sensitized pregnancies through careful history, testing, and consultation.
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.
Cardiotocography (CTG) is a technical method for recording the fetal heartbeat and uterine contractions during pregnancy using ultrasound and tocodynamometry. CTG involves using an electronic fetal monitor, commonly known as a cardiotocograph, to obtain a record of the fetal heart rate and uterine contractions. It was invented in the 1960s and refined to be more accurate. CTG is typically used in late pregnancy or labor to evaluate fetal well-being and identify any signs of hypoxia.
This document discusses abnormal uterine action during labor, including definitions, types, causes, diagnosis, and management. The main types discussed are uterine inertia, ineffective contractions, abnormal polarity, incoordinate contractions including spastic lower segment and constriction ring, cervical dystocia, precipitate labor, tonic contractions, and retraction ring. The importance of assessing uterine tone, frequency and strength of contractions is emphasized for diagnosis. Management depends on the specific abnormality but may include oxytocin augmentation, amniotomy, operative vaginal delivery, or cesarean section.
Complications of the third stage of labourraj kumar
The document discusses complications of the third stage of labour, including postpartum haemorrhage, retained placenta, inversion of the uterus, and obstetric shock. It provides details on the definition, types, causes, diagnosis, and management of primary and secondary postpartum haemorrhage. Prevention focuses on correcting anemia during pregnancy and proper management during labor and delivery. Treatment includes restoring blood volume, arresting bleeding through massage, medications, compression, and ligation, and hysterectomy if needed.
This document provides an overview of shock in obstetrics, including definitions, classifications, pathophysiology, diagnosis, and management. It discusses the main types of shock seen in obstetrics such as hypovolemic (hemorrhagic), septic, cardiogenic, distributive, and anaphylactic shock. For each type, it outlines the causes, clinical features, and specific management approaches. Initial management focuses on maintaining airway, breathing, and circulation while treating the underlying cause.
Cord prolapse occurs when the umbilical cord descends through the cervix ahead of the baby. It is a serious obstetric emergency that requires rapid diagnosis and management to prevent complications of cord compression cutting off blood supply to the baby. Immediate actions upon diagnosis include calling for assistance, preparing for an emergency c-section, and measures to relieve cord compression like elevating the baby. C-section is generally recommended for delivery unless vaginal birth is imminent. Community settings require rapid transfer to a hospital equipped for c-section. Delayed cord clamping can be considered if the baby is healthy after a complicated birth involving cord prolapse.
This document provides information about intrauterine growth restriction (IUGR), including its definition, classification, etiology, diagnosis, treatment and risks. IUGR occurs when a baby's growth is slowed or restricted during pregnancy. It can be symmetric, affecting overall growth, or asymmetric, affecting the growth of some parts more than others. The causes of IUGR are often unknown but can include maternal, fetal, placental or genetic factors. Diagnosis involves assessing growth via ultrasound and monitoring blood flow. Treatment may involve bed rest, aspirin or early delivery depending on gestational age and fetal wellbeing. Both short and long term risks to the infant are increased with IUGR.
Multiple pregnancies can involve more than two fetuses developing simultaneously in the uterus. The most common variety is twins, while triplets, quadruplets, and more are rare. Management of multiple pregnancies aims to monitor fetal well-being and expedite delivery of additional fetuses after the first to prevent strain from placental insufficiency. Cesarean section may be recommended depending on fetal presentation and other complications.
Fetal distress is defined as a state of hypoxia and acidosis during pregnancy caused by depletion of oxygen and accumulation of carbon dioxide in the fetus. It can be caused by maternal factors like preeclampsia, anemia, bleeding, or infection, as well as placental or umbilical cord issues that obstruct blood flow. This leads to respiratory acidosis in the fetus and changes in fetal heart rate. Chronic fetal distress can cause intrauterine growth retardation. Clinical manifestations include meconium staining, abnormal fetal heart rate and movement patterns, and acidosis shown on fetal blood samples. Management involves addressing the cause, correcting acidosis, and potentially terminating the pregnancy through forceps delivery or c-section depending on severity of
The document discusses uterine contractions during labor and delivery. It defines the normal frequency and intensity of contractions. It describes two pacemakers in the uterus that generate contractions and the normal basal tone and peak pressure of contractions. It then discusses different abnormalities that can occur with contractions, including abnormal polarity, hypertonic dysfunction, precipitate labor in the absence of obstruction, tonic contractions and Bandl's ring in the presence of obstruction, hypotonic dysfunction/uterine inertia, contraction rings, and cervical dystocia. It provides details on each abnormality, their causes, and methods of management.
Version is a procedure to change the fetal lie or presentation. There are two main types: external cephalic version and internal podalic version. External cephalic version is done externally without anesthesia to flex the fetus and rotate the head into a vertex presentation. Internal podalic version requires anesthesia and is done when the cervix is dilated to grasp the fetal foot and bring the breech into position for delivery. Potential maternal complications include shock, bleeding, and infection, while fetal risks include asphyxia and complications of breech delivery.
This document discusses various tests used during pregnancy to monitor the health of the mother and fetus. It describes blood tests, ultrasounds, and non-stress tests that can detect issues like hypertension or abnormal fetal growth. For high-risk pregnancies, more invasive prenatal tests are discussed like amniocentesis, which analyzes amniotic fluid for chromosomal issues. The risks and procedures for these various medical tests are outlined to closely monitor pregnancy and fetal development.
This document discusses induction of labor, including definitions, purposes, indications, contraindications, factors for success, and methods. Induction of labor is defined as initiating uterine contractions before spontaneous labor, either through medical, surgical, or combined means, to achieve vaginal delivery. Common indications include post-term pregnancy, hypertension, and fetal growth issues. Methods include cervical ripening with prostaglandins or misoprostol followed by oxytocin infusion once the cervix is ripe. Artificial rupture of membranes is also discussed as a surgical induction method. A combined approach using cervical ripening followed by oxytocin is often most effective at inducing labor.
Fertilization or conception
Union of a sperm and a mature ovum
Takes place in outer third of the fallopian tube
Zygote
Initial name for fertilized ovum
Embryo
Name of product of conception from second through 8th week of pregnancy
Fetus
Name of the product of conception from 9th week through duration of gestational period
This document discusses placental abnormalities including placenta previa and abruption placentae. It provides information on pathophysiology, clinical manifestations, diagnostic evaluation, management, nursing assessment, nursing diagnoses, interventions, patient education, and evaluation for each condition. Placenta previa is when the placenta covers all or part of the cervical os, which can cause painless bleeding late in pregnancy. Abruptio placentae is premature separation of the placenta from the uterus, which causes bleeding and can lead to shock. Ultrasound is used for diagnosis and treatment involves bed rest, monitoring, and delivery by c-section if needed to stabilize the mother and baby.
Premature Rupture of Membranes (PROM) refers to rupture of membranes before the onset of labor. It occurs in 10% of term pregnancies and more commonly in preterm labor. PROM can be diagnosed through various tests including a nitrazine paper test, fern test, sterile speculum exam, or ultrasound. Complications of PROM include preterm labor, infection, and fetal deformities or distress. Management depends on gestational age - expectant management is common above 34 weeks while induction or C-section may be recommended below 36 weeks to prevent complications.
This document discusses postpartum haemorrhage (PPH), defined as blood loss exceeding 500 ml following childbirth. It notes that PPH has various causes including an atonic uterus, trauma during delivery, retained placental tissues, and coagulation disorders. The primary types are those occurring within 24 hours of delivery. Management involves controlling blood loss, administering oxytocics, and may require interventions like uterine packing or hysterectomy in severe cases. Prevention strategies include active management of the third stage of labour and being prepared to treat PPH as a potential complication of childbirth.
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.
This document discusses the management of Rh-negative pregnancies. It begins with an introduction to Rh blood types and the pathophysiology of Rh sensitization. It then discusses epidemiology and outlines the management approach for both unsensitized and sensitized Rh-negative pregnant women. Management involves screening, prophylactic Rh immunoglobulin administration, and monitoring for sensitization and fetal complications. The goals are to prevent sensitization in unsensitized women and detect issues early in sensitized pregnancies through careful history, testing, and consultation.
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.
Cardiotocography (CTG) is a technical method for recording the fetal heartbeat and uterine contractions during pregnancy using ultrasound and tocodynamometry. CTG involves using an electronic fetal monitor, commonly known as a cardiotocograph, to obtain a record of the fetal heart rate and uterine contractions. It was invented in the 1960s and refined to be more accurate. CTG is typically used in late pregnancy or labor to evaluate fetal well-being and identify any signs of hypoxia.
This document discusses abnormal uterine action during labor, including definitions, types, causes, diagnosis, and management. The main types discussed are uterine inertia, ineffective contractions, abnormal polarity, incoordinate contractions including spastic lower segment and constriction ring, cervical dystocia, precipitate labor, tonic contractions, and retraction ring. The importance of assessing uterine tone, frequency and strength of contractions is emphasized for diagnosis. Management depends on the specific abnormality but may include oxytocin augmentation, amniotomy, operative vaginal delivery, or cesarean section.
Complications of the third stage of labourraj kumar
The document discusses complications of the third stage of labour, including postpartum haemorrhage, retained placenta, inversion of the uterus, and obstetric shock. It provides details on the definition, types, causes, diagnosis, and management of primary and secondary postpartum haemorrhage. Prevention focuses on correcting anemia during pregnancy and proper management during labor and delivery. Treatment includes restoring blood volume, arresting bleeding through massage, medications, compression, and ligation, and hysterectomy if needed.
This document provides an overview of shock in obstetrics, including definitions, classifications, pathophysiology, diagnosis, and management. It discusses the main types of shock seen in obstetrics such as hypovolemic (hemorrhagic), septic, cardiogenic, distributive, and anaphylactic shock. For each type, it outlines the causes, clinical features, and specific management approaches. Initial management focuses on maintaining airway, breathing, and circulation while treating the underlying cause.
Cord prolapse occurs when the umbilical cord descends through the cervix ahead of the baby. It is a serious obstetric emergency that requires rapid diagnosis and management to prevent complications of cord compression cutting off blood supply to the baby. Immediate actions upon diagnosis include calling for assistance, preparing for an emergency c-section, and measures to relieve cord compression like elevating the baby. C-section is generally recommended for delivery unless vaginal birth is imminent. Community settings require rapid transfer to a hospital equipped for c-section. Delayed cord clamping can be considered if the baby is healthy after a complicated birth involving cord prolapse.
This document provides information about intrauterine growth restriction (IUGR), including its definition, classification, etiology, diagnosis, treatment and risks. IUGR occurs when a baby's growth is slowed or restricted during pregnancy. It can be symmetric, affecting overall growth, or asymmetric, affecting the growth of some parts more than others. The causes of IUGR are often unknown but can include maternal, fetal, placental or genetic factors. Diagnosis involves assessing growth via ultrasound and monitoring blood flow. Treatment may involve bed rest, aspirin or early delivery depending on gestational age and fetal wellbeing. Both short and long term risks to the infant are increased with IUGR.
Multiple pregnancies can involve more than two fetuses developing simultaneously in the uterus. The most common variety is twins, while triplets, quadruplets, and more are rare. Management of multiple pregnancies aims to monitor fetal well-being and expedite delivery of additional fetuses after the first to prevent strain from placental insufficiency. Cesarean section may be recommended depending on fetal presentation and other complications.
Fetal distress is defined as a state of hypoxia and acidosis during pregnancy caused by depletion of oxygen and accumulation of carbon dioxide in the fetus. It can be caused by maternal factors like preeclampsia, anemia, bleeding, or infection, as well as placental or umbilical cord issues that obstruct blood flow. This leads to respiratory acidosis in the fetus and changes in fetal heart rate. Chronic fetal distress can cause intrauterine growth retardation. Clinical manifestations include meconium staining, abnormal fetal heart rate and movement patterns, and acidosis shown on fetal blood samples. Management involves addressing the cause, correcting acidosis, and potentially terminating the pregnancy through forceps delivery or c-section depending on severity of
The document discusses uterine contractions during labor and delivery. It defines the normal frequency and intensity of contractions. It describes two pacemakers in the uterus that generate contractions and the normal basal tone and peak pressure of contractions. It then discusses different abnormalities that can occur with contractions, including abnormal polarity, hypertonic dysfunction, precipitate labor in the absence of obstruction, tonic contractions and Bandl's ring in the presence of obstruction, hypotonic dysfunction/uterine inertia, contraction rings, and cervical dystocia. It provides details on each abnormality, their causes, and methods of management.
Version is a procedure to change the fetal lie or presentation. There are two main types: external cephalic version and internal podalic version. External cephalic version is done externally without anesthesia to flex the fetus and rotate the head into a vertex presentation. Internal podalic version requires anesthesia and is done when the cervix is dilated to grasp the fetal foot and bring the breech into position for delivery. Potential maternal complications include shock, bleeding, and infection, while fetal risks include asphyxia and complications of breech delivery.
This document discusses various tests used during pregnancy to monitor the health of the mother and fetus. It describes blood tests, ultrasounds, and non-stress tests that can detect issues like hypertension or abnormal fetal growth. For high-risk pregnancies, more invasive prenatal tests are discussed like amniocentesis, which analyzes amniotic fluid for chromosomal issues. The risks and procedures for these various medical tests are outlined to closely monitor pregnancy and fetal development.
This document discusses induction of labor, including definitions, purposes, indications, contraindications, factors for success, and methods. Induction of labor is defined as initiating uterine contractions before spontaneous labor, either through medical, surgical, or combined means, to achieve vaginal delivery. Common indications include post-term pregnancy, hypertension, and fetal growth issues. Methods include cervical ripening with prostaglandins or misoprostol followed by oxytocin infusion once the cervix is ripe. Artificial rupture of membranes is also discussed as a surgical induction method. A combined approach using cervical ripening followed by oxytocin is often most effective at inducing labor.
Fertilization or conception
Union of a sperm and a mature ovum
Takes place in outer third of the fallopian tube
Zygote
Initial name for fertilized ovum
Embryo
Name of product of conception from second through 8th week of pregnancy
Fetus
Name of the product of conception from 9th week through duration of gestational period
This document discusses placental abnormalities including placenta previa and abruption placentae. It provides information on pathophysiology, clinical manifestations, diagnostic evaluation, management, nursing assessment, nursing diagnoses, interventions, patient education, and evaluation for each condition. Placenta previa is when the placenta covers all or part of the cervical os, which can cause painless bleeding late in pregnancy. Abruptio placentae is premature separation of the placenta from the uterus, which causes bleeding and can lead to shock. Ultrasound is used for diagnosis and treatment involves bed rest, monitoring, and delivery by c-section if needed to stabilize the mother and baby.
1) Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. It is a serious condition that can lead to maternal death if left untreated.
2) Risk factors for ectopic pregnancy include previous pelvic infections, IUD use, infertility treatments, and previous ectopic pregnancies or pelvic surgeries.
3) Clinical presentation varies from acute abdominal pain and shock due to tubal rupture to more subtle symptoms like abdominal pain and vaginal bleeding. Diagnosis is confirmed through transvaginal ultrasound and tests of beta-hCG levels and progesterone.
4) Treatment depends on severity but may include medication with methotrexate
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
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.
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
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 most common cause of spontaneous abortion is a significant genetic abnormality in the fetus. Management depends on the type but may include bed rest, ultrasound, suction curettage, controlling bleeding, and emptying the uterus.
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.
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.
The document discusses different types of abortion including complete, incomplete, and missed abortion. It defines each type and describes their causes, symptoms, and management. A complete abortion occurs when all pregnancy contents are expelled. Incomplete abortion happens when some contents remain, and missed abortion is when the fetus has died but remains in the uterus. The teacher leads a discussion on defining each type and reviewing their specific characteristics and treatment.
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.
The document discusses different types of abortion including threatened abortion, inevitable abortion, incomplete abortion, complete abortion, missed abortion, and recurrent abortion. It describes the signs, symptoms, and management for each type. Causes of abortion can include infections, environmental exposures, uterine abnormalities, trauma, and fetal genetic abnormalities. Management depends on the type but may include bed rest, ultrasound, suction curettage, evaluating for underlying medical conditions, and evaluating parents' chromosomes in cases of recurrent abortion.
The key features in the presentation are vaginal bleeding, abdominal pain and partially dilated cervix without expulsion of products of conception. This fits the description of inevitable abortion.
The document discusses abortion and post-abortion care. It defines abortion as the termination of pregnancy before viability and notes definitions vary by country and gestational age cut-offs. It describes spontaneous versus induced abortion and classifications of incomplete versus complete abortion. Post-abortion care aims to reduce morbidity and mortality through treatment of complications, counseling, contraceptive services, and other health services while partnering with communities.
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
1. Hemorrhagic disorders in pregnancy can occur early or late term and include conditions like spontaneous or induced abortion, ectopic pregnancy, molar pregnancy, and placental abnormalities.
2. Spontaneous abortion, also called miscarriage, is the unintentional termination of pregnancy before 20 weeks gestation. Risk factors include chromosomal abnormalities, infections, or lifestyle factors. Ectopic pregnancy occurs when the fertilized egg implants outside the uterus, usually in the fallopian tubes.
3. Molar pregnancy results from abnormal placenta formation causing a cluster of cysts instead of a normal placenta and baby. It carries risks for hemorrhage and later development of gestational troph
Postpartum hemorrhage and other complications are described. Uterine atony is a common cause of early postpartum hemorrhage. Retained placental fragments can also cause hemorrhage. Clinical manifestations of hemorrhage include hypotension and vaginal bleeding. Management involves oxytocics, IV fluids, blood transfusion, and curettage if needed. Nursing focuses on monitoring for shock, administering treatments, and educating on postpartum care and warning signs. Puerperal infections and hematomas are also risks and are managed with antibiotics, analgesics, and hygiene education. Amniotic fluid embolism is a rare but often fatal complication from amniotic debris entering the mother's
Abruptio placentae is the separation of a normally situated placenta from the uterus after 28 weeks of gestation. It can be revealed, with vaginal bleeding, concealed without bleeding, or mixed. Risk factors include hypertension, trauma, high parity, and premature rupture of membranes. It is graded based on symptoms from mild to severe. Treatment involves resuscitation, monitoring, and either expectant management to prolong pregnancy if mild or immediate delivery if moderate to severe due to risks of hemorrhage, DIC, renal failure, and fetal hypoxia.
Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, usually in the fallopian tubes. Common symptoms include abdominal pain and vaginal bleeding. Diagnosis is confirmed through blood tests to detect human chorionic gonadotropin and ultrasound scans to locate the pregnancy. Treatment options include expectant management, medication with methotrexate, or surgery. Without treatment, an ectopic pregnancy can rupture and cause life-threatening bleeding. Prognosis depends on the extent of fallopian tube or other organ damage, with unilateral ectopic pregnancy having a better chance of future fertility.
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DECODING THE RISKS - ALCOHOL, TOBACCO & DRUGS.pdfDr Rachana Gujar
Introduction: Substance use education is crucial due to its prevalence and societal impact.
Alcohol Use: Immediate and long-term risks include impaired judgment, health issues, and social consequences.
Tobacco Use: Immediate effects include increased heart rate, while long-term risks encompass cancer and heart disease.
Drug Use: Risks vary depending on the drug type, including health and psychological implications.
Prevention Strategies: Education, healthy coping mechanisms, community support, and policies are vital in preventing substance use.
Harm Reduction Strategies: Safe use practices, medication-assisted treatment, and naloxone availability aim to reduce harm.
Seeking Help for Addiction: Recognizing signs, available treatments, support systems, and resources are essential for recovery.
Personal Stories: Real stories of recovery emphasize hope and resilience.
Interactive Q&A: Engage the audience and encourage discussion.
Conclusion: Recap key points and emphasize the importance of awareness, prevention, and seeking help.
Resources: Provide contact information and links for further support.
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Exploring the Benefits of Binaural Hearing: Why Two Hearing Aids Are Better T...Ear Solutions (ESPL)
Binaural hearing using two hearing aids instead of one offers numerous advantages, including improved sound localization, enhanced sound quality, better speech understanding in noise, reduced listening effort, and greater overall satisfaction. By leveraging the brain’s natural ability to process sound from both ears, binaural hearing aids provide a more balanced, clear, and comfortable hearing experience. If you or a loved one is considering hearing aids, consult with a hearing care professional at Ear Solutions hearing aid clinic in Mumbai to explore the benefits of binaural hearing and determine the best solution for your hearing needs. Embracing binaural hearing can lead to a richer, more engaging auditory experience and significantly improve your quality of life.
Comprehensive Rainy Season Advisory: Safety and Preparedness Tips.pdfDr Rachana Gujar
The "Comprehensive Rainy Season Advisory: Safety and Preparedness Tips" offers essential guidance for navigating rainy weather conditions. It covers strategies for staying safe during storms, flood prevention measures, and advice on preparing for inclement weather. This advisory aims to ensure individuals are equipped with the knowledge and resources to handle the challenges of the rainy season effectively, emphasizing safety, preparedness, and resilience.
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TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...rightmanforbloodline
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardso...rightmanforbloodline
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
PET CT beginners Guide covers some of the underrepresented topics in PET CTMiadAlsulami
This lecture briefly covers some of the underrepresented topics in Molecular imaging with cases , such as:
- Primary pleural tumors and pleural metastases.
- Distinguishing between MPM and Talc Pleurodesis.
- Urological tumors.
- The role of FDG PET in NET.
Healthy Eating Habits:
Understanding Nutrition Labels: Teaches how to read and interpret food labels, focusing on serving sizes, calorie intake, and nutrients to limit or include.
Tips for Healthy Eating: Offers practical advice such as incorporating a variety of foods, practicing moderation, staying hydrated, and eating mindfully.
Benefits of Regular Exercise:
Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
Maintaining a Balanced Lifestyle:
Integrating Nutrition and Exercise: Suggests meal planning and incorporating physical activity into daily routines.
Monitoring Progress: Recommends tracking food intake and exercise, regular health check-ups, and provides tips for achieving balance, such as getting sufficient sleep, managing stress, and staying socially active.
About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
MBC Support Group for Black Women – Insights in Genetic Testing.pdfbkling
Christina Spears, breast cancer genetic counselor at the Ohio State University Comprehensive Cancer Center, joined us for the MBC Support Group for Black Women to discuss the importance of genetic testing in communities of color and answer pressing questions.
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
2. “Abortion is the termination of pregnancy before the
period of viability which is considered to occur at 28th
week”.
or
“Abortion is the process of partial or complete separation
of the products of conception from the uterine wall or
without partial or complete expulsion from the uterine
cavity before the age of viability(28th weeks)”
Acc. To sanju sira
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.
Acc. To D.C. Dutta
4. It may be defined as involuntary loss of product of
conception prior to 2 weeks of gestation.
1. Majority of abortion or miscarriage occurs in first
trimester or within first 12 weeks of pregnancy and
are called early miscarriage.
2. Miscarriage after 13th weeks are termed as late
miscarriages.
5. 15% of all confirmed pregnancies are said to result
in a miscarriage, the majority of which happen in the 1st
trimester. 1-2% spontaneous miscarriages occur after
the 13th week.
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.
7. 1. Autosomal triosomy having three homologous
chromosomes instead of two autosomes. Any of the
other chromosomes other than sex
chromosomes(commonest).
2. Monosomy condition in without one chromosome of
pair of homologous chromosome is missing.
3. Gross congenital malformation.
4. Blighted ovum(ovum without embryo).
5. Hydropic degeneration of the villi.
6. Interference with the circulation in the umbilical
cord by knots, twists or entanglements may cause
8. cause death of fetus and its expulsion.
7. Faulty placental formation , i.e. circumvallate or low
attachment of placental circulation .
8. Twins of hydroamnios.
9. 1.Maternal illness : it consist of
a.) infection:
Viral infection – rubella, cytomegalovirus, hepatitis
parvovirus, influenza virus etc.
Paracitic –malarias
Protozoal – toxoplasmosis
b.) Maternal hypoxia and shock : due to
Acute respiratory disease
Chronic respiratory disease
Heart failure
Sever anemia
11. 2. Trauma:
a. Direct trauma on abdominal wall by direct blow.
b. Psychic : emotional upset or change in environment
may lead to abortion.
c. In susceptible individual, even a minar trauma, e.g.
Rough road
Internal examination in early month
Sexual intercourse in early months
12. 3. Toxic agents: environmental toxins like:
a. Lead
b. Arsenic
c. Anesthetic gases
d. Tobacco
e. Caffeine
f. Alcohal
g. Radiation in excess amout
14. 6. Blood group incompatibility: it includes Rh
incompatibility.
7. Premature rupture of membranes also leads to
abortion
8. Dietetic factors: in this deficiency of folic acid or
vitamin C is often held possible.
16. 1. FIRST TRIMESTER:
a. Defective germ plasma
b. Hormonal deficiency
c. Trauma
d. Acute infection
2. MID TRIMESTER:
a. Cervical incompetence
b. Uterine malformation
c. Uterine fibroid
d. Low implantation of placenta.
e. Twin and hydramnios
17. 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 :-
a.) The ovum surrounded by the villi with the
decidual coverings is expelled out intact. b.)
sometimes ,the external os fails to dilate so that
the entire mass is accommodated in the dilate
cervical canal is called cervical abortion.
18. 2.) 8-14 weeks :-
a.) here , the expulsion of fetus occurs leaving behind
the placenta and membranes
b.) A part of it may be partially seprated with brisk
hemorrahage or remains totally attached to the
uterine wall.
3.) Beyond 14th weeks :-
a.) The process of expulsion is similar to that of a
“minilabour”
b.) The fetus expelled first followed by expulsion of the
placenta.
20. DEFINITION :- “It is clinical entity where the process of
abortion has started but has not progressed to a state from which
recovery is impossible”.
Or
It is a type of abortion without passage of fleshy tissue but with
possibility of continuation of pregnancy
CLINICAL FEATURES :-
SYMPTOMS:
1.Bleeding per vaginam:
a.) It is slight
b.) The color is bright red
c.) In the late second trimester, bleeding may be brisk and sharp
which suggest low nidation of placenta.
d.) The bleeding usually stops.
21. 2.Pain:
a. Bleeding is usually painless.
b. There may be mild backache.
c. There may be dull pain in lower abdomen. (the pain
resembles dysmenorrhea or menstrual pain.)
d. No history of expulsion of any fresh lump.
SIGNS:
1.Per abdominally: gravid uterus is felt soft, enlarged
corresponding to the period of amenorrhea.
2. Speculum examination or vaginal palpation: the cervical
os is closed. Stained discharge is present.
22. 1. Blood: for Hb, ABO and Rh grouping
2. Urine : for immunological test of pregnancy. It is
done to confirm the fetal death.
3. Bimanual palpation gives the diagnosis.
4. Pelvic ultrasonography.
5. Transvaginal ultrasonography.
23. 1. Assure the mother: as there is no fetal malformation ,
assure the mother that everything would be fine. Clear
all her doubts and queries. Never give false assurance.
2. Complete bed rest:
a. advise the patient to have bed rest until the bleeding
stops.
b. Advise not to do the household work at least 1month
especially heavy strenuous work and exercise
c. Advise her not to engage in sexual activity throughout
the pregnancy
24. 3. Vulval swabbing:
a. Vulval swabbing should be performed at least twice
daily while discharge persists in order to minimize
discomfort. If brownish discharge or bleeding is
present then clean the vulva and perineum every 4 to
12 hourly.
b. Advice the patient to preserve the vulval pads or
anything expelled out per vaginam for inspection
c. Vulval toileting is done using antiseptic lotions, e.g.
hibitane 1:2000
25. 4. Drugs:
a. For poor sleep anxiety give the mother
Tab diazepam
Tab calmpose 5-10mg before night meal
Tab valium
b. For good bowel activity, give her mild laxative, i.e.
milk of magnesia at bed time.
c. Never give enema (as this may stimulate the uterine
contraction) mild purgatives or suppositories may be
used after 48 hours if the client is constipated.
26. 5.Ask to report if :
a. Bleeding becomes more.
b. Pain becomes aggravated
6. Routinely note the:
a. Pulse
b. Blood pressure
c. Temperature
d. Amount of bleeding
7. At the end of 1st week pelvic ultrasound is done:
a. If there is live fetus: continue with the pregnancy but
carefully.
b. If there is blighted ovum: go for suction and evacuation
27. 8. Speculum examination: it is done to exclude local
leisons and to note the state of cerviacal os.
9. Diet: high fiber diet is given to prevent constipation .
Good feeding is encouraged and supplements given i.e.
ferrous sulphate 200mg(b.i.d.)
folic acid 5mg/day(t.i.d.)
the client is provided diet that contains high protein and
vitamine E.
28. DEFINITION :- It is the clinical type of abortion where
the changes have progressed to a state from where
continuation of pregnancy is impossible.
or
It is the type of abortion where process of expulsion of
conceptus is in progress with the dilation of cervical
canal. In this case pregnancy cannot be saved because of
a good portion of the placenta has detached.
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.
29. Symptoms:
1.Increased vaginal bleeding due to the detachment of
considerable part of the placement from the uterus.
2. sever colicky, lower abdominal pain.
3. No tissue is expelled.
4. Faint due to heavy blood loss.
Signs:
1. Maternal vital signs remain normal in majority.
2. Sign of shock due to blood loss.
3. Skin may be cold and clammy.
4.Uterus felt contracted
30. 5. On pelvic examination, the internal cervical os dilates
admitting index finger; conceptus is felt by finger
COMPLICATION:
1. Blood loss: it may cause shock and death.
2. Infection of conceptus and uterus
31. Principles of management:
1. To look after general condition of mother.
2. To accelerate the process of expulsion.
3. To maintain strict asepsis.
MANAGEMENT:
1. The patient is admitted in the hospital.
2. If blood loss is moderate, ringer lactate is started I/V.
3. Blood transfusion are needed in heavy blood loss.
4. In all cases of abortion, blood Hb, ABO Rh group and
random blood glucose are tested.
5. Inj. Morphine 15mg is given I/M
32. 6. Excessive bleeding is controlled by administration of
inj. Methargin 0.2mg, if the cervix is dilated and the
size of uterus is less than 12 weeks.
7. The shock is corrected by I/V fluid therapy and blood
transfusion.
8.If the abortion process is before 12 weeks then under
GA(general anesthesia) the dilatation and evacuation is
done followed by curettage. Alternatively, suction and
evacuation may be employed.
9. If the abortion process is beyond 12weeks then the
uterine contractions are accelerated by oxytocin drip(10
units in 500 ml of 5%dextrose) at 40-60drops/min.
33. 10. If the fetus is expelled and the placenta is retained it
is removed by ovum forceps, if lying separated.
11. If the placenta is not separated, digital separation is
done followed by its evacuation under GA.
12. If bleeding is profuse with the cervix
closed(suggested of low implantation of placenta) then
evacuation of uterus may have to be done by abdominal
hysterectomy.
13. Treat shock in case of excessive blood loss.
34. DEFINITION :- when the products of conception are expelled
in masses ,it is called complete abortion.
CLINICAL FEATURES:-
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.
b. Cervical os is closed.
c. Bleeding is trace.
d. Examination of the expelled fleshy mass is found intact.
5. Transvaginal ultrasonography shows empty uterine cavity
35. 1.Observe the condition of mother meticulously.
2.Note the effect of blood loss, if any should be assessed
and treated.
3.If there is doubt about complete expulsion of the
products then uterin curettage should be done.
4.Trans vaginal sonography is useful to prevent
unnecessary surgical procedure.
5. An RH NEGATIVE WOMEN:- without antibody in
her system should be protected by anti – D gamma
globulin – 100 microgram intramuscularly in cases of
early abortion or respectively within 72 hours.
36. 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 abortion.
CLINICAL FEATURES:
1.History of expulsion of a fleshy mass per vaginam.
2.Continuation of pain lower abdomen(colicky in nature).
3.Persistence of vaginal bleeding .
4.Internal examination reveals :-
a. Uterus smaller than the period of amenorrhea .
b. Patulous cervical os often admitting tip of the finger.
c. Varying amount of bleeding.
d. On examination , the expelled mass is found incomplete.
37. TERMINATION :- The products left behind may lead
to :-
1.Profuse bleeding .
2.Sepsis.
3.Placental polyp.
4.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.
38. DEFINITION :- When the fetus is dead retained
inside the uterus for a variable period more than
4weeks 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.
39. 1.Persistence of brownish vaginal discharge .
2.Subsidence of pregnancy symptoms .
3.Retrogression of breast changes.
4.Cessation of uterine growth.
5.Non audibility of the fetal heart sound .
6.Cervix feels firm.
7.Immunological test for pregnancy becomes negative.
8. Radiology shows collapsed fetal skeleton.
9. Real time ultrasonography reveals an empty sac(in
early pregnancy), absenceof fetal motion or
absence of FHS in later pregnancy.
40. 1. Uterus less than 12 weeks :-
a. Vaginal evacuation can be carried out without delay.
b. suction and evacuation or slow dilatation of cervix by
luminaria tent followed by dilatation and evacuation
(d&c) of the uterus under general anesthesia .
c. Keep in mind the risk of hemorrhage during operation.
Uterus more than 12 weeks:-
a. oxytocin
1. Initially started with 10 -20 units oxytocin in
500ml of 5% normal saline in drip with 30
drops/min.
41. 2. If the above regimen fails then escalate the dose
of oxytocin to 100IU in a pint of 5% dextrose
saline at drip rate of 30drops/min.
b.Prostaglandins :-
1.It is more effective than oxytocin.
2. inj. 15 methyl PGF 2α (carboprostromethamine )
is given 250µg I/M at 3hrly. Interval for a maximum of
10 such.
3.Prostaglandins E1 analogue (Gemiprost pessary)is
inserted in to the posterior vaginal fornix every 3hours for a
maximum of 5 such.
42. DEFINITION :- “Any abortion associated with
clinical evidences of infection of the uterus and its
contents is called septic abortion” .
INCIDENCE :- it is10% of all abortions.
CAUSES:-
1. It is caused by micro-organisms involved in the
sepsis that are usually present in the vagina
(endogenous ).
43. 2. The micro-organisms are:
a.Anaerobic:
i. Bacteroides group(fragilis)
ii. Anaerobic streptococci
iii. Clostridium welchii
iv. Tetanus bacilli
b. Aerobic:
i. E.Coli
ii. Klebsiella
iii. Staphylococcus
iv. Pseudomonas, hemolytic streptococcus
44. 3. The increased association of sepsis in illegal induced
abortion is due to the fact that:
a. Proper antiseptic and asepsis are not taken.
b. Incomplete evacuation.
c. Inadvertent injury to the genital organs and adjacent
structures, particularly the gut.
45. 1.Pyrexia
2.Pain in abdomen
3.A rising pulse rate
4.Variable systemic and abdominal findings.
CLINICAL GRADING
Grade 1 :- The infection is localized in the uterus .
Grade 2 :- The infection spreads beyond the uterus to the
parametrium ,tubes and ovaries or pelvic peritoneum.
Grade 3 :- Generalized peritonitis and /or
endotoxic shock or jaundice or acute renal failure.
46. Routine investigation include
1.Cervical or high vaginal swab is taken prior to
internal examination for
2.Culture in aerobic and anaerobic media to finding out
the dominant micro- organisms.
3.Sensitivity of the micro-organism to antibiotics.
4.Smear for gram stain.
5.Blood for haemoglobin
6.WBC
47. 7.ABO and Rh grouping
8.Urine analysis including culture.
9.Special investigation :-
10.Ultrasonography
11.Blood test
12.Culture
13.Serum electrolytes
14.Coagulation profile
48. It is of two type :-
(1)Immediate (2) remote
IMMEDIATE
a. Hemorrhage.
b. Injury
c. Spread of infection
Generalized peritonitis
Perforation of the uterus.
Injury to the gut
Endotoxic shock
Acute renal failure
Thrombophlebitis.
49. 2. REMOTE COMPLICATIONS:
a. Chronic debility.
b. Chronic pelvic pain and backache.
c. Dyspareunia
d. Ectopic pregnancy
e. Emotional depression
f. Tubal blockage leads to secondary infertility.
50. 1.To boost up family planning acceptance in order to
curb the unwanted pregnancies.
2.To rigid enforcement of legalized abortion in practices
and to curd the pre valences of unsafe abortions.
3.To take antiseptic and aseptic precautions either during
internal examination or during operation in
spontaneous abortion.
51. General management :-
1.Hospitalization is essential for all cases of septic
abortion
2.the patient in isolation.
3.To take high vaginal or cervical swab for culture
,drug sensitivity test and gram stain .
4.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.
52. 4.Over assessment of the case is to be done and
the patient is leveled in accordance with the
clinical grading.
5.Investigation protocols as outlined before are done .
53. 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.
54. 1. The management of patient with septic abortion depend
upon the severity of infection or sepsis.
2. Even a mild case of septic abortion is not to be
hospitalized.
3. Get the mother high vaginal or cervical swab culture, drug
sensitivity test and gram stains.
4. Perform vaginal examination to note the state of abortion.
if the products are found loosely lying in the cervix, they
should be removed by spong holding forcep.
5. Do overall assessment of the case and grading is done for
further treatment.
6. Get all the investigations done.
7. Formulate the line of treatment to control sepsis, remove
source of infection.
55. 8. Give the mother supportive therapy to bring back the
normal homeostatic and cellular metabolism.
9. In grade 1 or mild septic abortion the drug of choice or
abtibiotic used are capsule.
a. Ampicillin/Amoxicillin 500mg TDSx7days
b. cap. Cephadroxil 500mg BDx7days
c. cap. Chloromycetin 500mg 6hrly x 7days.
10. While giving cap. Chloromycetin blood test are done of
Hb,TLC,DLC and placenta.
11.In grade 1 prophylactically anti gas-gangrene serum of
8000units and 3000units of antitetanus serum are given I/M.
56. 12. Analgesics and sedatives are given as per the
prescription of the doctor.
13. To minimize oliguria, anemia or shock, blood
transfusion are done.
14. In grade-1 abortion, an incomplete evacuation should
be done within 24hrs. Following antibiotic therapy.
15. While doing currettage, practise gentelness to avoid
and minimize injury if any and spread of infection in
deeper tissues.
16. In grade-2 the drugs given are according to the type
of organisms, i.e. gram positive and gram negative.
57. FOR GRAM POSITIVE:
inj. Aqueous penicilline G5 million unit every 6hrly
Inj. Ampicillin 0.5-1gm IV every 6hrly
FOR GRAM NEGATIVE:
inj. Gentamicin 1.5mg/kg every 8hrly
Inj. Ceftriaxone 1.5mg,IV 12hrly
FOR ANAEROBES:
inj. Metronidazole 500mg IV/8hrly
Inj clindamycin 600mg IV/6hrly
17. Side by side note the vital signs of the mother
especially pulse, blood pressure and temperature.
58. 18. Evacuation of uterus is done by suction evacuation
within 6hrs of antibiotic therapy.
19. Laparotomy is done if the uterus or intestines are
injured.
20. If there is injured or infected uterus, hysterectomy is
done.
21. When the infection is localized in pouch of douglas,
then posterior colpotomy is done.
22. In grade-3, it is known as sever septic abortion along
with antibiotic therapy . The mother is resusitated and
fluid & electrolyte balance is maintained.
59. Definition :- recurrent miscarriage is defined as a
sequences of three or more consecutive spontaneous
abortions before 20 weeks.
Incidences :- The incidence of recurrent abortion is 0.4% to
2%
ETIOLOGY:
First trimester abortion
1.Genetic factors 6.Inherited thrombophilia
2.Endocrine and metabolic 7.Inherited thrombophilia
3.Infection 8.Immunological causes
4.Autoimmunity. 9.Alloimmunity.
5.Unexplained
60. Second trimester abortion
1.Anatomic abnormalities :- the cause may be
congenital or acquired .
2.Congenital anomalies due to defects in mullerian duct
fusion or resorption.
3.Acquired anomalies are intrauterine adhesions,
uterine fibroid and endometriosis and cervical
incompetence’s.
61. 1.A through medical ,surgical and obstetric history is taken.
2. careful history taking should include:-
a. The nature of previous abortion process .
b. History of the placenta or karyo-typing of the
conceptus, if available .
c. Any chronic illness.
3. Blood glucose level checking
4. VDRL
5. Thyroid function test
6. ABO and Rh grouping
62. 7. Toxoplasma IgG and IgM.
8. Serum LH on D2/D3of cycle
9. Ultrasonography
10. Hysterosalphingography
11. Hysteroscopy or laproscopy
12. Karyotyping of husband & wife
13. Endocervical swab
14. Semen analysis
63. 1. The anxiety of mother is removed or alleviated.
2. If there are anatomic defects they are then corrected
surgically.
3. Hypothyroid state is treated by eltroxin
4. For syphilis, penicillin therapy is given
5. If there is uterine pathology then treat it, eg
a. Metroplasty for double or bicornuate uterus.
b. Removal of septum or myomectomy for submucous
fibroid distorting the uterine cavity.
6. Advice the couple for genetic counselling if there are
chromosomal abnormalities.
64. 7. Advice the mother to take proper rest i.e. for a period of
atleast 2 weeks beyond the expected time of abortion.
8. Advise the mother to avoid strenuous activities of
intercourse and travelling.
9. Ask the mother not to use these drug.
a. inj. Profasi- tab gestin-hCG5000-10000
b. inj. Proluton depot- tab. Duvadilan or yutopar
10. Patient with cervical incompetence is treated by cervical
suture operation, i.e. cerclage operation.
11. The operation is done around 14 weeks to 16weeks of
pregnancy.
12. In this non-absorable encircling suture is placed around
the cervix at level of internal orifice , the suture must be
removed at about 38th week.
65. 13. post-operatively the patient is given bed rest for 5-
7days and sedate by inj. Diazepam 10mg I/M or inj.
Pethidine hydrochloride 75mg 8hrly/for 48 hrs.
14 . The patient is given inj. Proluton depot 500mg I/M
every week for 4 week
15. Tab. Duvadilan 10mg is given TDS for 7days or
earlier if labor pain starts or features of abortion appear
16. Advice the mother to avoid sex, reassure her, clear
her all queries and allay her fear and anxiety.
17. Advice her for regular check-ups and follow up.
66. “It is the deliberate termination of pregnancy before the
viability of the fetus.”
Or
“Therapeutic abortion is evacuation of the uterus done by
qualified medical practitoners in the interest of mother’s life
or her total well being (usually done before 24 weeks of
gestation).”
The induced abortion may be:
1.Legal (MTP)
2. Illegal (criminal)
In India, induction of abortion is legalized by Medical
Termination of pregnancy act of 1971 and has been
enforced in the year April 1972. it was revised in 1975.
67. 1.When the continuation of pregnancy may involve
serious risk of life or grave injury to the physical and
mental health of the pregnant woman.
2.When there is risk of the child being born with
serious physical and mental abnormalities so as
to be handicapped in life.
3.When the pregnancy is caused by rape ,both in
cases of major and minor girl and in mentally
imbalanced women.
4. When the pregnancy is caused as result of
contraceptive failure.
68. 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 10mt .the amount is
to be infused slowly at the rate of 10l/mt.
69. 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.