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Abortion prof druw-pe
This document discusses early pregnancy bleeding and disorders. It covers causes of early pregnancy bleeding including spontaneous miscarriage, ectopic pregnancy, and gestational trophoblastic disease. It then discusses management of different types of abortions including threatened abortion, inevitable abortion, incomplete abortion, missed abortion, septic abortion, and habitual abortion. Specific treatments covered include antibiotics, evacuation and curettage, peritoneal drainage, and laparotomy depending on the situation.
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Abortion prof druw-pe
- 1. Dr Win Pe Clinical Professor / Consultant Department of Obstetrics & Gynaecology University of Medicine, Mandalay
- 2. • Accounts for¾ of gynaecological admissions • Important cause of maternal morbidity and mortality
- 3. Causes of earlypregnancy bleeding • Spontaneous miscarriage • Ectopic pregnancy • Gestational trophoblastic disease • Implantation bleeding
- 4. Gynaecological complications • Cervical cancer • Infections • Cervical polyp
- 5. The normal pregnancy Symptomatology • Classical trial • Amenorrhoea • Pelvic or low abdominal pain • Vaginal bleeding
- 6. First test isto demonstrate the presence of HCG - HCG • Glycoprotein • 2 subunits • Half life 6 to 24 hours • Peak level at 9 to 13 weeks
- 7. Urine test • Sensitivityis around 25 IU/Ltr • Positive results around 14 days after ovulation Plasma HCG • 0.1 to 0.3 iu/L is able to detect a pregnancy 6 to 7 days after ovulation
- 8. Definition • The expulsionof the concepts before 24 weeks of pregnancy
- 9. Aetiological factors ofearly pregnancy disorders Miscarriage Chromosomal Trisomies (Down’s syndrome) abnormalities (Material Triploidies and tetraploides age >35 yrs) Monosomy X (Turner’s syndrome) Transiocation (hereditary) Endocrine disorders Diabetes, hypothyroidsm, luteal phase deficiency, polycytic ovarian syndrome Abnormalities of the Uterine septa (bicornute utetus) uterus Endometrial adhesions (post-curettage or Asherman’s syndrome)
- 10. Miscarriage Infections Salmonella typhi, malaria, cytomegalvirus, Brucella, toxoplasmnosis, Mycoplasma hominis, Chlamydia trachomatis, and Ureaplasma urealyticum Chemical agents Tobacco, anaesthetic gases, arsenic, benene, solvents, ethlene oxide, formaldehyde, pesticides, lead, mercury, and cadmium Pshychological disorders Antiphospholipid syndrome Immunological disorders Thrombophilia (hereditary)
- 11. Different types ofabortion 1.Threaten abortion is characterised by • Bleeding aft amenorrhoea • No uterine contraction and pain • The cervix is closed • Uterus size is similar to date
- 12. 2.Inevitable abortion • There will be – more bleeding • Uterine contraction and pain • The cervix is dilated
- 13. 3. Complete abortion • The whole conceptus is expelled • Uterus contracts to normal size • Bleeding stops • The cervix is closed
- 14. 4. Incomplete abortion • There will be products of conception • Bleeding continue and severe accompanied by shock • There will be pain • Infection may supervene
- 15. 5. Missed abortion • Dead fetus retained in the uterus • Size of uterus is smaller than dates • Signs + symptoms of pregnancy reduced • Brownish discharges per vaginum • The os is closed • In ultrasound there is no fetal heart movement
- 16. 6. Septic abortion • Caused by incomplete abortion complicated by infection • There will be pyrexia • Abdominal pain + pelvic tenderness • Foul smelling purulent discharge per vagina
- 17. 7. Habitual abortion • Three or more consecutive abortion (spontaneous)
- 18. Management of differenttypes of abortion • Threatened abortion • Reassurance • Bed rest • Sedation • Uterine relaxants • Hormone (progestogen) • USS to check viability • All pads + everything passed may be saved for examination • Modern approach – no treatment has proved the value
- 19. Management of differenttypes of abortion • Inevitable abortion • Incomplete abortion • Missed abortion • Complete abortion – No treatment required – Habitual abortion • Treat the cause if cause is found • Treat general disease if present
- 20. Management of septicabortion • General • Nursing care • Nutrition • Fluid and electrolytes balance • Correct anaemia • To note urine out put
- 21. Specific • Cervical swab • High vaginal swab for C & S • Blood culture • IV Antibiotics • C Pen & ampicillin – gm(+) • Gentamycin – gm (-) • Metronidazole – anaerobes • Antitetanus toxoid • Remove the septic focus
- 22. • Management of septic abortion • Evacuation and curettage for RPOC • POD puncture and drainage • Laparotomy and drainage • TAH if perforation detected
- 23. Septicaemic shock •Keep is ICU • O2 • Correct acidosis • Blood transfusion if require • Antibiotics intravenously • Blood and heparin for DIC
- 24. Renal failure (Urineoutput < 30 ml/hr) increased urea and electrolytes • Restrict fluid • High carbohydrate, low protein • Restriction of sodium and potassium • Dialysis if blood urea more than 25 mmol/l • Manitol • frusemide