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ABORTION types methods mtp and management
This document defines abortion and describes the types, etiology, clinical features, investigations, management, and complications of various abortion types including threatened abortion, inevitable abortion, incomplete abortion, missed abortion, septic abortion, and blighted ovum. Abortion is defined as termination of pregnancy before 20 weeks where the fetus weighs less than 500g. Types include spontaneous, induced, medical termination of pregnancy, and criminal abortion. Etiology includes fetal, maternal, environmental, and anatomical factors. Clinical examination, ultrasound, and laboratory investigations are used to diagnose and manage different abortion types.
ABORTION types methods mtp and management
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- 2. DEFINITION Termination ofpregnancy with a fetus born weighing less than or equal to 500gm USUALLY 20-22 WEEKS FETUS REACHES 500GMS Incidence 15 percent of all conceptions 80 percent in first trimester 50 percent of these because of chromosomal anomalies
- 3. Types SPONTANEOUS INDUCED SPONTANEOUS THREATENED ABORTION INCOMPLETE ABORTION INEVITABLE ABORTION MISSED ABORTION SEPTIC ABORTION
- 4. INDUCED MEDICAL TERMINATIONOF PREGNANCY CRIMINAL ABORTION SEPTIC ABORTION
- 5. ETIOLOGY FETAL FACTORS GENETIC FACTORS 54 PERCENT CHROMOSOMAL ANOMALIES EXAMPLE AUTOSOMAL TRISOMY, AUTOSOMAL MONOSOMY,TRIPLOIDY,TETRAPLOIDY
- 6. MATERNAL FACTORS ENDOCRINE ANDMETABOLIC FACTORS LUTEAL PHASE DEFECT PCOS THYROID ABNORMALITIES UNCONTROLLED INSULIN DEPENDENT DIABETES
- 7. AGE TEENAGE ANDAFTER 40 YEARS INFECTIONS MATERNAL CHLAMYDIA, GONORRHEA, GBS, TORCH, HIV, SYPHILIS, MYCOPLASMA ,UREAPLASMA MEDICAL DISORDERS AND IMMUNOLOGICAL HYPERTENSION,CARDIOVASCULAR,RENAL DISORDERS AND THROMBOPHILIAS,CONNECTIVE TISSUE DISEASES LIKE SLE
- 8. ENVIRONMENTAL FACTORS CIGARETTESMOKING ALCOHOL CONSUMPTION EXCESS COFFEE IRRADIATION DRUGS-ANTINEOPLASTIC DRUGS,QUININE,ERGOTS
- 9. ANATOMICAL ABNORMALITIES CERVICALINCOMPETENCE CONGENITAL MALFORMATIONS OF UTERUS ASHERMAN SYNDROME SUBMUCOUS FIBROID
- 10. TRAUMA SURGICAL PHYSICAL PATERNALFACTORS TRANSLOCATION IN THE SPERM UNEXPLAINED 40-60%
- 11. THREATENED ABORTION PROCESSSTARTED YET FURTHER PROGRESSION CAN BE AVERTED AND PREGNANCY CONTINUED CLINICAL FEATURES AMENORRHEA BLEEDING PAIN EXAMINATION: OS CLOSED WITH MILD BLEEDING INVESTIGATIONS: LAB: UPT, HEMOGLOBIN, BLOOD GROUP, SERUM B HCG USG PELVIS
- 12. MANAGEMENT CONSERVATIVE PROGNOSIS80-90 PERCENT SURVIVE WATCH FOR BLEEDING PV PAIN RELIEF PROGESTOGENS: NATURAL MICRONISED PROGESTERONE ORAL 200MG BD OR 100MG BD VAGINALLY TABLET DYDROGESTRONE 5-10MG TDS INJECTION 17 ALPHA HYDROXY PROGESTERONE CAPREOATE 250-500MG IM WEEKLY
- 13. ANTI DPROPHYLAXIS IF RH NEGATIVE FOR ALL AFTER 12 WEEKS OR WITH SIGNIFICANT BLEEDING <12 WEEKS HEMATINICS FOLIC ACID AND CALCIUM DISCHARGE AND FOLLOW UP ADVICE AVOID HEAVY WORK,AVOID COITUS FOLLOW UP SCAN FOR FETAL GROWTH
- 14. DD ECTOPIC PREGNANCY–PAIN,UPT POSITIVE,VAGINAL BLEEDING,NORMAL SIZE UTERUS,TENDER MASS IN ADNEXA-USG OTHER TYPES OF ABORTION-USG OVARIAN TORSION -UPT NEGATIVE, USG FUNCTIONAL MENSTRUAL DISTURBANCE- UPT NEGATIVE, USG
- 15. INEVITABLE ABORTION ABORTIONPROGRESSED TO THE EXTENT THAT EXPULSION IS ENVITABLE WITH NO CHANCE OF CONTINUATION OF PREGNANCY AMENNORHEA AND COLICKY PAIN PATIENT MAY BE PALE,NORMO OR HYPOTENSION, TACHYCARDIA PER SPECULUM : CERVIX OS OPEN PRODUCTS SEEN PELVIC EXAMINATION: SIZE OF UTERUS MAY BE EQUAL TO OR CORRESPONDING TO PERIOD OF GESTATION COMPLICATIONS :HEMORRHAGE AND SHOCK INVESTIGATIONS:UPT, HG ,BLOOD GROUP AND USG
- 16. USG CARDIAC ACTIVITYABSENT POC SEPARATED FROM DECIDUAL ATTACHMENT POC IN LOWER UTERINE AND CERVICAL REGION MANAGEMENT ADMIT CORRECT HYPOVOLEMIA USING FLUIDS/COLLOIDS IF <12 WEEKS TETATNUS TOXOID FOLLOWED BY SUCTION EVACUATION/MANUAL VACUUM ASPIRATION/DILATATION AND EVACUATION/MISOPROSTOL 200/400MCG IV ANTIBIOTIC COVER IF BLEEDING FOR LONGER DURATION
- 17. IF >12 WEEKS OXYTOCIN DRIP 10 UNITS IN 500ML SALINE MISOPROSTOL 400MCG ORALLY OR VAGINALLY METHYLERGOMETRINE ORAL IV /IM TO CONTROL BLEEDING IF PLACENTA IS RETAINED REMOVE USING OVUM FORCEPS UNDER GENERAL ANESTHESIA AFTER FETUS EXPELLED CHECK USG TO BE DONE TISSUE FOR HPE
- 18. FOLLOWUP: ANTIBIOTICS,HEMATINICS,ANTI INFLAMMATORYAGENTS,ANTI D PROPHYLAXIS IF RH NEGATIVE 100MCG IM<12 WEEKS OR 300MCG IF >12 WEEKS CONTRACEPTIVE ADVICE REPORT IF EXCESS BLEEDING OR PAIN
- 19. INCOMPLETE ABORTION PRODUCTSOF CONCEPTION ARE PARTIALLY EXPELLED INEVITABLE BECOMES INCOMPLETE IF NOT TREATED ON TIME CLINICAL FEATURES ANEMIA AND SHOCK AS PER BLOOD LOSS HISTORY OF PASSAGE OF CLOTS AND PRODUCTS PAIN AND BLEEDING SIZE OF UTERUS LESS THAN GESTATIONAL AGE OPEN CERVIX AND POCS FELT COMPLICATIONS AND INVESTIGATIONS AND MANAGEMENT AND FOLLOW UP SAME AS INEVITABLE
- 20. USG FINDINGS POCPRESENT IN UTERINE CAVITY CARDIAC ACTIVITY ABSENT MANAGEMENT ADMIT CORRECT HYPOVOLEMIA USING FLUIDS AFTER TT INJECTION AND ANTIBIOTIC COVER SUCTION EVACUATION/MVA/DILATATION AND EVACUATION/MISOPROSTOL 200/400MCG AFTER FETUS EXPELLED CHECK USG TO BE DONE TISSUE FOR HPE
- 21. MISSED ABORTION(SILENT MISCARRIAGE) DEATH OF FETUS BEFORE 20 WEEKS WITH RETENTION OF ALL PRODUCTS OF CONCEPTION CARNEOUS MOLE/BLOOD MOLE PATHOLOGICAL ENTITY CHORIODECIDUAL SPACE RECURRENT BLEEDS WHICH DONOT RUPTURE CAPSULARIS BUT DISRUPT THE VILLI ATTACHMENTS CLINICAL FEATURES UTERINE SIZE SMALLER THAN EXPECTED CARDIAC ACTIVITY ABSENT BROWN DISCHARGE WITH OS CLOSED COMPLICATIONS INFECTION AND DIC (IF RETAINED NORE THAN A MONTH)
- 22. INVESTIGATIONS UPT MAYBE NEGATIVE OR WEAKLY POSITIVE HEMOGLOBIN PLATELET COUNT BLOOD GROUP AND TYPING BT AND CT COAG PROFILE USG CARDIAC ACTIVITY ABSENT
- 23. MANAGEMENT IF LESS THAN12 WEEKS EXPECTANT-OBSERVATION FOR SPONTANEOUS EXPULSION MEDICAL MISO 800MCG VAGINALLY REPEAT AFTER 24 HOURS IF NEEDED SURGICAL SUCTION EVACUATION,DILATION AND EVACUATION UNDER ANTIBIOTIC COVER
- 24. IF MORE THAN12 WEEKS MISO(PGE1) 200MCG 4 HOURLY MAXIMUM 5 DOSES CARBOBROST(PGF2ALPHA) 250MCG IM 3 HOURLY OXYTOCIN DRIP 2O U IN 500ML NORMAL SALINE STARTING AT 30 DROPS GOING UP TO 60-80 DROPS PER MINUTE FOLLOW UP: ANTIBIOTICS ANTI D PROPHYLAXIS IF RH NEGATIVE CONTRACEPTION
- 25. BLIGHTED OVUM USGREVEALS G SAC WITH DIAMETER 2.5CM OR MORE WITH NO EVIDENCE OF FETAL POLE HPE:FETAL TISSUE IS ABSENT MANAGEMENT: EVACUATION OF UTERUS USING VAGINAL OR ORAL MISOPROSTOL 400MCG REPEATED AFTER 6 HOURS IF PATIENT IS STABLE AND WILLING TO FOLLOW UP
- 26. TYPES OF ABORTION CLINICAL PICTURE SIZE OFUTERUS INTERNAL OS ULTRASOUND SCAN TREATMENT THREATENED SLIGHT BLEEDING CORRESPONDING CLOSED LIVE FETUS SUBCHORIONIC HEMORRHAGE CONSERVATIVE INEVITABLE BLEEDING,PAIN ,SHOCK EQUAL OR LESS OPEN DEAD FETUS EVACUATION INCOMPLETE BLEEDING,PAIN ,SHOCK SMALLER OPEN WITH PRODUCTS FELT HETEROGENOUS TISSUES WITH OR WITHOUT A GESTATIONAL SAC DISTORTING THE ENDOMETRIAL MIDLINE ECHO-(RPOC) RETAINED PRODUCTS OF CONCEPTION EVACUATION MISSED ABSENT OR MINIMAL BLEEDING SMALLER CLOSED DEAD FETUS FETAL POLE CRL >6MM WITH NO HEART BEAT OR PERSISTENCE OF CRL <6MM ON RESCAN AFTER 7-10 DAYS
- 27. SEPTIC ABORTION ANYTYPE OF ABORTION WITH SYMPTOMS AND SIGNS OF INFECTION OF UTERUS CLINICAL CRITERIA FEVER WITH TEMP >=38 DEGREES(100.4) FOR MORE THAN 24 HOURS FOUL SMELLING PUS DISCHARGE LOWER ABDOMINAL PAIN AND PELVIC PAIN AND TENDERNESS 85 PERCENT ENDOGENOUS COMMENSALS OF VAGINA MORE COMMON IN ILLEGAL ABORTIONS CAN OCCUR AFTER SPONATEOUS AND LEGALLY INDUCED ABORTION TOO
- 28. MICROBIOLOGY GRAM NEGATIVEBACILLI E COLI KLEBSIELLA PSEUDOMONAS GRAM POSITIVE STAPH AND STREPTOCOCCUS ANEROBES: BACTEROIDS CLOSTRIDIUM PERFRINGENS AND C.TETANI AND PEPTOSTERPTOCOCCI PATHOLOGY: ENDOMETRITIS 80 PERCENT ENDOMYOMETRITIS 15 PERCENT GENERALISED PERITONITIS SEPTICEMIA AND ENDOTOXIC SHOCK SYSTEMIC DISORDERS LIKE ACUTE RENAL FAILURE,SEPTICEMIA,COAGULATION FAILURE
- 29. CLASSIFICATION GRADE 1:INFECTION LIMITED TO UTERUS GRADE 2: BEYOND UTERUS TO PARAMETRIUM,TUBES,OVARIES OR PELVIC PERITONEUM GRADE 3: BEYOND PELVIS IN TO GENERAL PERITONEUM OR DISTANT ORGANS RESULTING IN GENERALISED PERITONITIS, JAUNDICE, SEPTICEMIA, UREMIA, ENDOTOXIC SHOCK.
- 30. CLINICAL FEATURES FEVERCHILLS AND RIGOR TACHYCARDIA ABDOMINAL AND PELVIC PAIN FOUL SMELLING VAGINAL DISCHARGE CERVIX OS MAY BE OPEN WITH TENDER FORNICES SOFT BOGGY MASS POD-PELVIC ABSCESS EVIDENCE OF UTERINE PERFORATION, BLADDER OR BOWEL INJURY
- 31. INVESTIGATIONS BLOOD GROUPAND TYPE HG, TOTAL AND DIFF COUNT URINE ROUTINE AND CULTURE,KFT,ELECTROLYTES BLOOD CULTURE IF SEPTICEMIA SUSPECTED COAG PROFILE SELECTED CASES HIGH VAGINAL/CERVICAL SWABS FOR GRAM STAIN AND CULTURE PELVIC ULTRASOUND XRAY ABDOMEN IF PERITONITIS OR BOWEL INJURY SUSPECTED XRAY CHEST IF ATELECTASIS IS SUSPECTED
- 32. COMPLICATIONS EARLY COMPLICATIONS: EXCESSBLEEDING PERFORATION OF UTERUS GENERLISED PERITONITIS ENDOTOXIC SHOCK ARDS DIC ACUTE RENAL FAILURE PELVIC THROMBOPHLEBITIS MATERNAL MORTALITY
- 33. LATE COMPLICATIONS CHRONICPELVIC PAIN DYSPAREUNIA INFERTILITY DUE TO TUBAL BLOCKAGE ECTOPIC PREGNANCY
- 34. PREVENTION WIDER FAMILYPLANNING SERVICES AVAILABILITY OF FREE AND SAFE ABORTION IN ALL HOSPITALS ILLEGAL ABORTIONS TO BE CURBED BY LAW MAINTENANCE OF ASEPSIS DURING EXAMINATION PROMPT DIAGNOSIS AND TIMELY MANAGEMENT
- 35. MANAGEMENT IV HYDRATION I/O CHARTING VITALS MONITORING OXYGEN BY MASK IV ANTIBIOTICS: REGIMEN A AQUEOUS PENICILLIN 5 MILLION UNITS IV 6 HRLY AFTER TEST DOSE OR AMPICILLIN 500-1GM IV 6 HOURLY INJECTION GENTAMICIN IV 60-80MG IV 8 HOURLY INJECTION METRONIDAZOLE 500MG IV 8 HOURLY
- 36. REGIMEN B INJECTIONCIPROFLOXACIN 500 MH IV 12 HOURLY INJECTION METRONIDAZOLE 500MG IV 8 HOURLY REGIMEN C FOR SEVERE INFECTIONS INJECTION CEFOTAXIME 1GM IV 12 HOURLY OR INJ CEFTRIAXONE 1GM IV 12 HOURLY INJECTION METRONIDAZOLE 500 MG IV 8 HOURLY INJECTION GENTAMICIN 60-80 MG IV OR IM 12 HOURLY
- 37. SURGICAL EVACUATION OF UTERUS POSTERIORCOLPOTOMY PELVIC ABCSESS DRAINAGE LAPROTOMY IF SUSPECTED UTERINE PERFORATION OR BOWEL OF BLADDER INJURY/ FOREIGN BODY IN THE ABDOMEN SEVERE CASES HYSTERECTOMY
- 38. RECURRENT ABORTION 2OR MORE CONSECUTIVE SPONTANEOUS ABORTION LESS THAN 20 WEEKS CAUSES GENETIC RECURRENT ANEUPLOIDY MGT GENETIC COUNSELLING ENDOCRINE THYROID DIABETES LPD PCOS TREAT THE CAUSE EXAMPLE MICRONISED PROGESTERONE LPD(PROGESTERONE <5NMOL/L ON DAY 21) ANATOMICAL UTERINE ANOMALIES ASHERMAN CERVICAL INCOMPETENCE FIBROID RESECTION OF SEPTUM AND ADHESIONS CERVICAL CERCLAGE IMMUNOLOGICAL ANTIPHOSPHOLIPID ANTIBODY SYNDROME (APLA) LOW DOSE ASPIRIN AND HEPARIN
- 39. MTP MTP ACT1971 REVISED 1975 AMENDMENT 2021 RULES MARRIED OR UNMARRIED WOMEN COVERED 24 WEEKS FOR RAPE SURVIVORS BEYOND 24 WEEKS FOR SUBSTANTIAL FETAL ANOMALIES ONE RMP TILL 20 WEEKS AND TWO RMP 24 WEEKS MEDICAL BOARD APPROVAL AFTER 24 WEEKS
- 40. CONDITIONS THERAPEUTUCAND MEDICAL INDICATION- CARDUAC DISEASE IN MOTHER EUGENIC- ANOMALOUS BABY HUMANITARIAN -RAPE SOCIOECONOMIC- UNPLANNED, FAILURE OF CONTRACEPTION ,MENTAL DISORDER
- 41. PERSON DGOMS MD OBS 6 MONTHS HOUSE SURGEON IN OBS ASSISTED 25MTP PLACE: GOVT HOSP NURSING HOMES AND GOVERNMENT APPROVED CENTERS MEDICAL:MIFEPRISTONE FOLLOWED BY MISOPROSTOL REFER MMA HANDBOOK
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