Summary of abortions in early pregnancy

1. PROBLEMS IN EARLY
PREGNANCY
ABORTION

2.  Def:expulsion or extraction of poc
before viability –24 vs 28 week
 WHO –expulsion or extraction from its
mother of an embryo or fetus weighing
500g or less
 If shows signs of life register as live
birth
 Incidence:affects 15% of clinically
recognised pregnancies

3. Potential causes
No demonstrable cause –this is the
commonest
Chromosomal abnormalities may
cause up to 25% particularly
trisomy,XO and triploidy—isolated
non recurring in 60%
Anembryonic pregnancies (blighted
ovum), an abnormality of placental
development

4.  Multiple pregnancy
 Uterine anomaly e.g. cervical
incompetence (classically occur in mid-
trimester)
 Corpus luteum failure as seen in PCO
 Infections eg rubella,cmv, bacterial
vaginosis any pyrexial illness or
condition causing peritonitis
 Induced usually criminally

5. Threatened Abortion
The features are:
– Amenorrhoea followed by slight PVB
– No pain
– Uterine size correct for dates
– Cervix is closed
– Bed rest has no role in management

6. Inevitable abortion
Features
– Amenorrhoea followed by heavy
vaginal bleeding
– Pain follows bleeding (cf ectopic
pregnancy)
– Uterus may be small,large or correct
size for dates
– Cervix is dilating and POC may be
passing through the os

7. Incomplete abortion
Features
– As in inevitable
– Some POC have been expelled others
have remained

8. Management of
inevitable/incomplete abortion
Active management is required if
bleeding is heavy
Iv access ,group and save serum
I mg ergometrine and arrange for
evacuation of the uterus
If uterus is larger 12 weeks set up
syntocinon infusion to cause
reduction in uterine size before
undertaking evacuation

9. Complete abortion
The features are:
– Amenorrhoea followed by variable
amount of bleeding which has now
stopped
– Uterus is smaller than expected
– Cervix os is closed
– Conservative management is
indicated but if POC are
suspected,manage as for inevitable
abortion

10. Anembryonic pregnancy(blighted
ovum)
A gestation sac develops in the
absence of an embryo
Diagnosis made on ultrasound
Manage as for missed aborton

11. Missed abortion
Retention of POC after death of the
embryo or fetus
Features:
– Amenorrhoea during which an
episode of slight vaginal bleeding may
or may not have occurred
– Regression of earlier signs and
symptoms of pregnancy
– Uterus small for dates ,cervix os
closed

12. Management
Conservative- if left alone
,resorption or spontaneous
expulsion will occur
– Disadvantages of risk of DIC and
psychological morbidity

13.  Active management options
– If <9 weeks gestation medical treatment–
combine oral mifepristone (competes at
progesterone site) followed by vaginal
prostaglandins
– Uterus at or less than 12 weeks size proceed
to evacuation under GA
– Uterus >12 weeks use vaginal
prostaglandins
to induce abortion. Subsequent evacuation
may be necessary

14. Septic abortion
Def:an incomplete abortion
complicated by infection
Features as for incomplete abortion
accompained by pyrexia and
tachycardia, general malaise,
abdominal pain, marked pelvic
tenderness and purulent vaginal
discharge
Exclude other causes of acute abd
and generalised infection

15. pathogenesis
Common organisms are;E.coli and
other gram
negatives,strep(haemolytic and
anaerobic),other anaerobes (eg
bacteroides) and staphylococcus
Cl.perfringes and cl.tetani rare but
lethal

16. Pathology
Infection usually mild (80%),being
confined to decidual but can spread
to myometrium and beyond (15%)
5% causes more generalised signs
and symptoms
Endotoxic shock and DIC may
develop in severe cases

17. Management
Investigations include:cervical
swabs for m/c/s,coagulation
status,u/e
Broadspectrum antibiotics PO in
mild cases and IV for severe cases
before results of culture
Evacuation of uterus after
reasonable amount of tissues
levels of antibiotics

18. Recurrent miscarriage
Def-three or more consecutive
pregancies lost
May primary recurrent or
secondary
Incidence is 1% of women of
reproductive age

19. Causes
Polycystic ovarian syndrome with
LH hypersecretion
Autoimmune eg SLE and
antiphospolipid syndrome
Anatomical factors such as
fibroids,congenital defects,cervical
incompetence
Chromosomal defects-4%

20. Induced abortion
 Criminal
 Medical
 Methods
– Suction curretage up to 12 completed weeks
– Prostaglandins induction after 12 weeks+/-
oxytocin
– Antiprogesterone-up to 9 weeks gestation
mifepristone can be used and may be
combined with prostaglandins

21. The law and therapeutic abortion in
Zambia
 Abortion is legal in Zambia
 2 doctors must agree to patient’s
request
 When compared with abortion,
continuation of pregnancy must:
– 1.endager the life of woman
– 2.endager the physical or mental health of
woman
– 3.endager mental or physical health of
siblings
– 4. involve a risk that the fetus would be
handicapped