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ABORTIONSABORTIONS
OBJECTIVESOBJECTIVES
At the end of this session you shouldAt the end of this session you should
be able to:be able to:
1.1. Define various types of abortions.Define various types of abortions.
2.2. Outline the causes and managementOutline the causes and management
approach for various types of abortions.approach for various types of abortions.
3.3. Describe the relation between complicationsDescribe the relation between complications
of abortions and maternal mortalityof abortions and maternal mortality
DEFINITIONS OF ABORTIONDEFINITIONS OF ABORTION
1.1. Termination of pregnancyTermination of pregnancy
before 28/40before 28/40
2.2. Delivery of a fetus of weightDelivery of a fetus of weight
less than 500 gramsless than 500 grams
STATISTICS OF ABORTIONSSTATISTICS OF ABORTIONS
• 50 - 60% of all pregnancies end in50 - 60% of all pregnancies end in
spontaneous abortion (SAB) since 2-4 wkspontaneous abortion (SAB) since 2-4 wk
pregnancies will often go unnoticed.pregnancies will often go unnoticed.
• 15% of all recognized pregnancies 4-20 wks15% of all recognized pregnancies 4-20 wks
end in SAB.end in SAB.
• 30% lost between implantation and the 630% lost between implantation and the 6thth
wk.wk.
• 70% of first trimester losses are due to70% of first trimester losses are due to
chromosomal abnormalitieschromosomal abnormalities
TYPESTYPES
1.1. InducedInduced
2.2. ThreatenedThreatened
3.3. InevitableInevitable
4.4. IncompleteIncomplete
5.5. CompleteComplete
6.6. SepticSeptic
7.7. MissedMissed
8.8. RecurrentRecurrent
TYPES OF ABORTIONSTYPES OF ABORTIONS
1. INDUCED ABORTION1. INDUCED ABORTION
• Intentional medical or surgicalIntentional medical or surgical
termination of a pregnancytermination of a pregnancy
• TypesTypes
– Elective:Elective: if performed for aif performed for a
woman’s desireswoman’s desires
– Therapeutic:Therapeutic: if performed forif performed for
reasons of maintaining health ofreasons of maintaining health of
the motherthe mother
INDUCED ABORTION –INDUCED ABORTION – MEDICO-MEDICO-
LEGAL ASPECTS IN TANZANIALEGAL ASPECTS IN TANZANIA
• Only allowed for medical indicationsOnly allowed for medical indications
– If continuation of pregnancy is risk to life ofIf continuation of pregnancy is risk to life of
the womanthe woman
• At least two medical doctors shouldAt least two medical doctors should
reach the decision and signreach the decision and sign
• Elective abortionsElective abortions – are unlawful– are unlawful
INDUCED ABORTIONSINDUCED ABORTIONS --
COMPLICATIONSCOMPLICATIONS
Because most induced abortions are done byBecause most induced abortions are done by
less skilled persons they are usually associatedless skilled persons they are usually associated
with fatal complications including:with fatal complications including:
1. Perforation of uterus, intestines, etc1. Perforation of uterus, intestines, etc
2. Severe haemorrhage,2. Severe haemorrhage,
3. Sepsis and its associated complications,3. Sepsis and its associated complications,
4. Asherman’s syndrome, etc4. Asherman’s syndrome, etc
2. THREATENED ABORTION2. THREATENED ABORTION
Refers to a stage in the abortionRefers to a stage in the abortion
that suggests potentialthat suggests potential
miscarriagemiscarriage may take placemay take place..
SymptomsSymptoms
• Minimal or no lower abdominal pain or
cramps
• Slight abd pain
• Minimal draining of liquor
Threatened abortionThreatened abortion contcont
SignsSigns
• Stable general condition
• Fundal height corresponds to
GA
• Cervix closed
Management of threatened abortionManagement of threatened abortion
1.1. Bed restBed rest
– Avoid strenuous exercisesAvoid strenuous exercises
1.1. If GA > 16/40 give - tocolyticsIf GA > 16/40 give - tocolytics
3. INEVITABLE ABORTION3. INEVITABLE ABORTION
Refers to a stage in theRefers to a stage in the
abortion when it is notabortion when it is not
possible for the pregnancy topossible for the pregnancy to
continue.continue.
INEVITABLE ABORTIONINEVITABLE ABORTION CONTCONT
SymptomsSymptoms
• Moderate to severe vaginal bleedingModerate to severe vaginal bleeding
• Severe abd painSevere abd pain
• Significant draining of liquorSignificant draining of liquor
SignsSigns
• Dilatation of cervix with evidence ofDilatation of cervix with evidence of
imminent expulsion of the PoCimminent expulsion of the PoC
• Fundal height corresponds to GAFundal height corresponds to GA
• Presence of contractionsPresence of contractions
Management of InevitableManagement of Inevitable
abortionabortion
1.1. Resuscitation:Resuscitation: IV fluids: RL, NSIV fluids: RL, NS
2.2. Blood grouping & Cross matchingBlood grouping & Cross matching
3.3. EvacuationEvacuation
• MVA for GA < 12/40MVA for GA < 12/40
• Augment if the GA > 12/40Augment if the GA > 12/40
 OxytocinOxytocin
 If some PoC remain after abortionIf some PoC remain after abortion
manage like incomplete abortion.manage like incomplete abortion.
MANUAL VACUUM ASPIRATORMANUAL VACUUM ASPIRATOR
4. INCOMPLETE ABORTION4. INCOMPLETE ABORTION
• Some POC have been expelled from theSome POC have been expelled from the
uterine cavity and other are retaineduterine cavity and other are retained
inside.inside.
SymptomsSymptoms
– Moderate to severe vaginal bleedingModerate to severe vaginal bleeding
– Cramping/severe abd painCramping/severe abd pain
– Partial expulsion of POCPartial expulsion of POC
SignsSigns
– Uterus smaller than datesUterus smaller than dates
– Cervix is dilated of cervixCervix is dilated of cervix
Management of Incomplete abortionManagement of Incomplete abortion
1.1. Resuscitation:Resuscitation: IV fluids: RL, NSIV fluids: RL, NS
2.2. Blood grouping & Cross matching → BT if indicatedBlood grouping & Cross matching → BT if indicated
3.3. EvacuationEvacuation
– MVA for GA < 12/40MVA for GA < 12/40
– Augment if the GA > 12/40Augment if the GA > 12/40
• OxytocinOxytocin
• If some PoC remain after abortion manage likeIf some PoC remain after abortion manage like
incomplete abortion.incomplete abortion.
4.4. Antibiotics: ampicilin, metronidazoleAntibiotics: ampicilin, metronidazole
5. Analgesics5. Analgesics
5. SEPTIC ABORTION5. SEPTIC ABORTION
An abortion complicated by infectionAn abortion complicated by infection
SymptomsSymptoms
– Abdominal painAbdominal pain
– FeverFever
– Vaginal discharge (foul smelling)Vaginal discharge (foul smelling)
SignsSigns
– Sick looking, febrile or jaundicedSick looking, febrile or jaundiced
– Tender uterusTender uterus
– Offensive vaginal discharge or bleedingOffensive vaginal discharge or bleeding
– Cervix is usu. soft and may be dilatedCervix is usu. soft and may be dilated
Complications of septic abortionsComplications of septic abortions
Immediate cpxImmediate cpx
• HaemorrhageHaemorrhage
• PeritonitisPeritonitis
• Pelvic abscess,Pelvic abscess,
endometritis,endometritis,
• Septicemia,Septicemia,
• Septic/haemorrhagicSeptic/haemorrhagic
shockshock
Late cpxLate cpx
• PIDPID
• Pelvic adhesionsPelvic adhesions
• 2° Infertility2° Infertility
• Chronic LAPChronic LAP
ManagementManagement
1.1. ResuscitationResuscitation
– IV fluids: RL, NSIV fluids: RL, NS
1.1. Insert urethral catheterInsert urethral catheter
– Monitor Input/outputMonitor Input/output
1.1. Blood grouping & Cross matchingBlood grouping & Cross matching
2.2. Antibiotics:Antibiotics:
• Preferably cephalosporins, if not availablePreferably cephalosporins, if not available
ampicilin and metronidazoleampicilin and metronidazole
1.1. EvacuationEvacuation
2.2. HaematenicsHaematenics
6. RECURRENT PREGNANCY LOSSES6. RECURRENT PREGNANCY LOSSES
• Defined as 3 or more consecutiveDefined as 3 or more consecutive
pregnancy lossespregnancy losses
Other names:Other names:
• habitual abortionshabitual abortions
• habitual miscarriagehabitual miscarriage
• recurrent abortionsrecurrent abortions
• recurrent miscarriagesrecurrent miscarriages..
Aetiology of RPLAetiology of RPL
• Genetic FactorsGenetic Factors
• Endocrine FactorsEndocrine Factors
• Anatomic CausesAnatomic Causes
– Congenital anomalies, in competenciesCongenital anomalies, in competencies,,
• Infectious causesInfectious causes
• Immunologic problemsImmunologic problems
Aetiology: Can be established in only 30%

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Abortions

  • 2. OBJECTIVESOBJECTIVES At the end of this session you shouldAt the end of this session you should be able to:be able to: 1.1. Define various types of abortions.Define various types of abortions. 2.2. Outline the causes and managementOutline the causes and management approach for various types of abortions.approach for various types of abortions. 3.3. Describe the relation between complicationsDescribe the relation between complications of abortions and maternal mortalityof abortions and maternal mortality
  • 3. DEFINITIONS OF ABORTIONDEFINITIONS OF ABORTION 1.1. Termination of pregnancyTermination of pregnancy before 28/40before 28/40 2.2. Delivery of a fetus of weightDelivery of a fetus of weight less than 500 gramsless than 500 grams
  • 4. STATISTICS OF ABORTIONSSTATISTICS OF ABORTIONS • 50 - 60% of all pregnancies end in50 - 60% of all pregnancies end in spontaneous abortion (SAB) since 2-4 wkspontaneous abortion (SAB) since 2-4 wk pregnancies will often go unnoticed.pregnancies will often go unnoticed. • 15% of all recognized pregnancies 4-20 wks15% of all recognized pregnancies 4-20 wks end in SAB.end in SAB. • 30% lost between implantation and the 630% lost between implantation and the 6thth wk.wk. • 70% of first trimester losses are due to70% of first trimester losses are due to chromosomal abnormalitieschromosomal abnormalities
  • 5. TYPESTYPES 1.1. InducedInduced 2.2. ThreatenedThreatened 3.3. InevitableInevitable 4.4. IncompleteIncomplete 5.5. CompleteComplete 6.6. SepticSeptic 7.7. MissedMissed 8.8. RecurrentRecurrent TYPES OF ABORTIONSTYPES OF ABORTIONS
  • 6. 1. INDUCED ABORTION1. INDUCED ABORTION • Intentional medical or surgicalIntentional medical or surgical termination of a pregnancytermination of a pregnancy • TypesTypes – Elective:Elective: if performed for aif performed for a woman’s desireswoman’s desires – Therapeutic:Therapeutic: if performed forif performed for reasons of maintaining health ofreasons of maintaining health of the motherthe mother
  • 7. INDUCED ABORTION –INDUCED ABORTION – MEDICO-MEDICO- LEGAL ASPECTS IN TANZANIALEGAL ASPECTS IN TANZANIA • Only allowed for medical indicationsOnly allowed for medical indications – If continuation of pregnancy is risk to life ofIf continuation of pregnancy is risk to life of the womanthe woman • At least two medical doctors shouldAt least two medical doctors should reach the decision and signreach the decision and sign • Elective abortionsElective abortions – are unlawful– are unlawful
  • 8. INDUCED ABORTIONSINDUCED ABORTIONS -- COMPLICATIONSCOMPLICATIONS Because most induced abortions are done byBecause most induced abortions are done by less skilled persons they are usually associatedless skilled persons they are usually associated with fatal complications including:with fatal complications including: 1. Perforation of uterus, intestines, etc1. Perforation of uterus, intestines, etc 2. Severe haemorrhage,2. Severe haemorrhage, 3. Sepsis and its associated complications,3. Sepsis and its associated complications, 4. Asherman’s syndrome, etc4. Asherman’s syndrome, etc
  • 9. 2. THREATENED ABORTION2. THREATENED ABORTION Refers to a stage in the abortionRefers to a stage in the abortion that suggests potentialthat suggests potential miscarriagemiscarriage may take placemay take place.. SymptomsSymptoms • Minimal or no lower abdominal pain or cramps • Slight abd pain • Minimal draining of liquor
  • 10. Threatened abortionThreatened abortion contcont SignsSigns • Stable general condition • Fundal height corresponds to GA • Cervix closed
  • 11. Management of threatened abortionManagement of threatened abortion 1.1. Bed restBed rest – Avoid strenuous exercisesAvoid strenuous exercises 1.1. If GA > 16/40 give - tocolyticsIf GA > 16/40 give - tocolytics
  • 12. 3. INEVITABLE ABORTION3. INEVITABLE ABORTION Refers to a stage in theRefers to a stage in the abortion when it is notabortion when it is not possible for the pregnancy topossible for the pregnancy to continue.continue.
  • 13. INEVITABLE ABORTIONINEVITABLE ABORTION CONTCONT SymptomsSymptoms • Moderate to severe vaginal bleedingModerate to severe vaginal bleeding • Severe abd painSevere abd pain • Significant draining of liquorSignificant draining of liquor SignsSigns • Dilatation of cervix with evidence ofDilatation of cervix with evidence of imminent expulsion of the PoCimminent expulsion of the PoC • Fundal height corresponds to GAFundal height corresponds to GA • Presence of contractionsPresence of contractions
  • 14. Management of InevitableManagement of Inevitable abortionabortion 1.1. Resuscitation:Resuscitation: IV fluids: RL, NSIV fluids: RL, NS 2.2. Blood grouping & Cross matchingBlood grouping & Cross matching 3.3. EvacuationEvacuation • MVA for GA < 12/40MVA for GA < 12/40 • Augment if the GA > 12/40Augment if the GA > 12/40  OxytocinOxytocin  If some PoC remain after abortionIf some PoC remain after abortion manage like incomplete abortion.manage like incomplete abortion.
  • 15. MANUAL VACUUM ASPIRATORMANUAL VACUUM ASPIRATOR
  • 16. 4. INCOMPLETE ABORTION4. INCOMPLETE ABORTION • Some POC have been expelled from theSome POC have been expelled from the uterine cavity and other are retaineduterine cavity and other are retained inside.inside. SymptomsSymptoms – Moderate to severe vaginal bleedingModerate to severe vaginal bleeding – Cramping/severe abd painCramping/severe abd pain – Partial expulsion of POCPartial expulsion of POC SignsSigns – Uterus smaller than datesUterus smaller than dates – Cervix is dilated of cervixCervix is dilated of cervix
  • 17. Management of Incomplete abortionManagement of Incomplete abortion 1.1. Resuscitation:Resuscitation: IV fluids: RL, NSIV fluids: RL, NS 2.2. Blood grouping & Cross matching → BT if indicatedBlood grouping & Cross matching → BT if indicated 3.3. EvacuationEvacuation – MVA for GA < 12/40MVA for GA < 12/40 – Augment if the GA > 12/40Augment if the GA > 12/40 • OxytocinOxytocin • If some PoC remain after abortion manage likeIf some PoC remain after abortion manage like incomplete abortion.incomplete abortion. 4.4. Antibiotics: ampicilin, metronidazoleAntibiotics: ampicilin, metronidazole 5. Analgesics5. Analgesics
  • 18. 5. SEPTIC ABORTION5. SEPTIC ABORTION An abortion complicated by infectionAn abortion complicated by infection SymptomsSymptoms – Abdominal painAbdominal pain – FeverFever – Vaginal discharge (foul smelling)Vaginal discharge (foul smelling) SignsSigns – Sick looking, febrile or jaundicedSick looking, febrile or jaundiced – Tender uterusTender uterus – Offensive vaginal discharge or bleedingOffensive vaginal discharge or bleeding – Cervix is usu. soft and may be dilatedCervix is usu. soft and may be dilated
  • 19. Complications of septic abortionsComplications of septic abortions Immediate cpxImmediate cpx • HaemorrhageHaemorrhage • PeritonitisPeritonitis • Pelvic abscess,Pelvic abscess, endometritis,endometritis, • Septicemia,Septicemia, • Septic/haemorrhagicSeptic/haemorrhagic shockshock Late cpxLate cpx • PIDPID • Pelvic adhesionsPelvic adhesions • 2° Infertility2° Infertility • Chronic LAPChronic LAP
  • 20. ManagementManagement 1.1. ResuscitationResuscitation – IV fluids: RL, NSIV fluids: RL, NS 1.1. Insert urethral catheterInsert urethral catheter – Monitor Input/outputMonitor Input/output 1.1. Blood grouping & Cross matchingBlood grouping & Cross matching 2.2. Antibiotics:Antibiotics: • Preferably cephalosporins, if not availablePreferably cephalosporins, if not available ampicilin and metronidazoleampicilin and metronidazole 1.1. EvacuationEvacuation 2.2. HaematenicsHaematenics
  • 21. 6. RECURRENT PREGNANCY LOSSES6. RECURRENT PREGNANCY LOSSES • Defined as 3 or more consecutiveDefined as 3 or more consecutive pregnancy lossespregnancy losses Other names:Other names: • habitual abortionshabitual abortions • habitual miscarriagehabitual miscarriage • recurrent abortionsrecurrent abortions • recurrent miscarriagesrecurrent miscarriages..
  • 22. Aetiology of RPLAetiology of RPL • Genetic FactorsGenetic Factors • Endocrine FactorsEndocrine Factors • Anatomic CausesAnatomic Causes – Congenital anomalies, in competenciesCongenital anomalies, in competencies,, • Infectious causesInfectious causes • Immunologic problemsImmunologic problems Aetiology: Can be established in only 30%