2. INTRODUCTION
Any bleeding in pregnancy is abnormal.
Vaginal blood loss in early pregnancy should
be through of as threatened miscarriage until
shown otherwise. The term miscarriage and
spontaneous abortion are synonymous.
3. DEFITION
Abortion is process of partial or complete
separation of the products of conception from the
uterine wall with or without partial or complete
expulsion from the uterine cavity before the age of
viability.
Early abortion -1-12week
Late-12-22 week
7. CAUSES
chromosomal abnormalities.
Genetic
Maternal cause such as retroversion of uterus,
bicornuate uterus, fibroids .
Infections like rubella and Chlamydia
Medical conditions- diabetes, renal disease, thyroid
dysfunction.
unknown
8. THREATENED ABORTION
Vaginal bleeding with or without recognizable
uterine contractions. The blood loss may be
scanty with or without accompanying backache
and cramp like pain. Pain resemble to
dysmenorrhea. The cervix remains closed and
soft uterus no tenderness on palpation.
Outcome could be either stop bleeding and
continue pregnancy to term or expel the
products of conception.
9.
10. MANAGEMENT
General and systematic examination
Investigations
Admit and complete bed rest
Treat as per cause found
If pregnancy continues watch for IUGR
Treat as high risk pregnancy because
more chances of preterm labor
11. INEVITABLE ABORTION
Bleeding often heavy, with clots or products
of conception, blood loss may be heavy and
the mother in shocked state. Cervix dilated
on examination, products may seen in the
vagina. Uterus feels smaller than expected.
MANAGEMENT-
* Control bleeding- ergometrine IV/IM
* Analgesics
12. INCOMPLETE ABRTION
In this parts of placenta remains within the
uterine cavity, contributing to heavy and
perfuse bleeding
MANAGEMENT-
Ergometrine IV/IM
vacuum aspiration or curettage of the uterus
under general anesthesia under general
anesthesia
13. COMPLETE ABORTION
The conception products, placenta and
membranes are expelled completely
from the uterus. The pain stops.
No further medical intervention is
required
14.
15. MISSED ABORTION
The embryo dies despite the presence of a
viable placenta and the sac is retained. Death
of the embryo occurs before 8 weeks of
gestation but the mothers body fails to
recognized the demise.
brown discharge is suspected
Failure to weight gain
Uterus is smaller than expected and soft
MANGEMENT- vacuum aspiration or curettage
of the uterus under general anesthesia
16.
17. HABITUAL ABORTION
Spontaneous abortion in three or more
successive pregnancies may occur, usually
abortion occurs at the same gestational age,
mostly after 16 weeks.
Cause may be genetic or immunological
Management- complete bed rest at the time
of occurrence
Special treatment if cause is identified
18. INDUCED ABORTION
MTP (medical termination of pregnancy)
(legal abortion)
Legal abortion is the deliberate induction of
abortion prior to 22 weeks of gestation by a
register medical practitioner in the interest
of mothers health and life
19. PROVISION FOR MTP UNDER THE MTP ACT.
The continuation of pregnancy would involve serious
risk of life or grave injury to the physical or mental
health of the pregnant women.
There is substantial risk of the child being born with
serious physical and mental abnormalities so as to be
handicapped in life
The pregnancy is the result of rape
The pregnancy is the result of failure of contraceptives
Foreseeable environment (social or economical)
20. INDICATIONS FOR MTP
THERAPEUTIC-
Deteriorating health due to pulmonary TB
Cardiac disease
Chronic glomerulonephritis
Malignant hypertension
intractable hyperemesis gravidarum
Cervical or breast malignancy
Diabetes mellitus with retinopathy
Psychiatric illness
21. SOCIAL
Parous women having unplanned pregnancy
with low socioeconomic status
Pregnancy caused by rape
Pregnancy due to failure of contraceptives
22. EUGENIC
Risk of baby born with various physical and mental
abnormalities like-
Chromosomal and gene disorders
Exposure to drugs or radiation
Rubella infection in first trimester
One or both parents are mentally ill
Congenital malformation in siblings
23. CONDITIONS TO BE MET PRIOR TO
THE PROCEDURE
Register medical practitioner is required for MTP to
save the mother
The procedure can only be performed in hospital
Written consent is necessary of pregnant women
If minor is pregnant consent from parents is required
for legal purpose
Procedure has to be reported to the directorate of
Health Services of state
24. METHODS OF MTP
Suction evacuation and curettage
Dilation and evacuation
Pharmacological method
Histerotomy
25. SUCTION EVACUATION AND
CURETTAGE
In this method the product of conception is
sucked out from the uterus with the help of
cannula attached with the suction
apparatus. Cervix dilated with metal dilators
and then cannula introduced into uterine
cavity and with a small flushing curettage
uterine cavity curetted and suction out the
remaining portion of the conception. A dose
of Methergine is administered IV to control
bleeding
26. DILATION AND EVACUATION
There are two methods of D&E that is two stage
method (slow method) and one stage method (rapid
method)
(1) In slow method cervix is dilated by introducing
laminaria tent into the cervical canal and women kept
12 hours in bed during which time tent swell up and
dilate the cervix. (2) After 12 hours with dilators cervix
further dilated and with ovum forceps conception
products are removed, curette can also done,
antibiotics and methergine are administered.
28. SEPTIC ABORTION
This abortion is characterized by infection of he
products of the conception and the uterus. This
condition is most commonly complication of
induced or incomplete abortion. Illegal abortion
carried out in non sterile conditions are often leads
to septic abortion.
Causes-
Criminal abortion- inexpert attempts
Abortion with infection
MTP with infection
