This document discusses abortion and miscarriage. It defines abortion as the expulsion of an embryo or fetus weighing 500 grams or less that is not capable of survival outside the womb. It notes that 10-20% of clinical pregnancies end in abortion, which can be spontaneous, induced, threatened, inevitable, complete, incomplete, missed or septic. The main causes of first trimester abortion are listed as genetic/chromosomal abnormalities (50%), endocrine factors (10-15%), anatomical factors (10-15%), infections, immunological factors, and other maternal medical illnesses. Signs and symptoms, investigations, management, and complications of different abortion types are described in detail.

1. DR.MAHADEVI SAVANUR

2.  Abortion (miscarriage)
Expulsion or extraction from its mother of
an embryo or fetus weighing 500 gm or
less when it is not capable of independent
survival.

3.  10- 20% of clinical pregnancies

4.  SPONTANEOUS INDUCED
• THREATENED LEGAL
• INEVITABLE ILLEGAL
• COMPLETE
• INCOMPLETE
• MISSED
• SEPTIC

5.  1) GENETIC – CHROMOSOMAL
ABNORMALITIES CONSTITUTE 50% 1ST
TRIMESTER ABORTIONS
 AUTSOMAL TRIPLOIDY
 MONOSOMY(50%)
 POLYPLOIDY
 STRUCTURAL CHROMOSOMAL
REARRANGEMNTS

6.  2) ENDOCRINE (10-15%)
 LUTEAL PHASE DEFECT
 THYROID ABNORMALITIES
 DIABETES MILLETUS
 3) ANATOMICAL (10-15%)
 CERVICAL INCOMPETENCE
 CONGENITAL MALFORMATION OF UTERUS
 FIBROID
 INTRA UTERINE ADHESIONS

7.  4) INFECTIONS
 VIRAL- CMV, RUBELLA, VARIOLA
 PARASITIC- TOXOPLASMA, MALARIA
 BACTERIAL – UREAPLASMA, CHLAMYDIA
o 5)IMMUNOLOGICAL
 ANA , APLA
o 6) MATERNAL MEDICAL ILLNESS
 CHD , HAEMOGLOBINOPATHIES

8.  7) ANTIFETAL Abs
 8)BLOOD GRP INCOMPATIBILITY
 9)INHERITED THROMBOPHILIA
 10)ENVIRONMENTAL FACTORS
cigarette smoking
alcohol
o 11) PREMATURE RUPTURE OF MEMBRANES

9.  AMENORRHOEA
 PAIN ABDOMEN
 PV BLEEDING
 D/D – ABORTION
ECTOPIC PREGNANCY
VESICULAR MOLE

10.  PROCESS OF ABORTION HAS STARTED BUT NT
PROGRSSED TO A STATE FROM WHERE
RECOVERY IS IMPOSSIBLE
 SYMPTOMS
 SLIGHT PV BLEED
 BRIGHT RED IN COLOR
 DULL ABDOMINAL/ BACK PAIN

11.  P/S – BLEEDING + FROM EXTERNAL OS
 P/V – CERVIX CLOSED
UTRUS- SOFT, CORRESPONDS TO GA
 D/D – CERVICAL LESIONS LIKE EROSIONS AND
POLYP

12.  BLOOD – HAEMATOCRIT AND BL GRP &TYPNG
 USG – TO CONFIRM INTRA UTERINE VIABLE
PREGNANCY

13.  REST
 MONITOR VITAL AND VAGINAL BLEEDING
 60-70% CONTINUS FOR >28 WEEKS
HIGH RISK FOR PRETERM LABOR,
IUGR, PLACENTA PREVIA, FETAL ANOMALIES
30% - INEVITABLE/ MISSED ABORTION

14.  PROCESS OF ABORTION HAS REACHED A STAGE
FROM WHERE CONTINUATION OF PREGNANCY
IS NOT PPOSSIBLE
SYMPTOMS- PV BLEED & PAIN ABDOMEN
SIGNS –
 GC DEPENDS ON AMOUNT OF BLOOD LOSS
 DILATED INTERNAL OS- PRODUCTS FELT
THROUGH THE OS
 MEMBRANES MAY BE RUPTURED

15.  IMPROVE GC
IV FLUIDS
BLOOD TRANSFUSION PT IS IN SHOCK
 EVACUATION OF PREGNANCY
<12WKS- DILATATION AND EVACUATION
>12WKS- T.MISOPROST 400MG 4HRLY IN 3
DOSES
OXYTOCIN DRIP 10U IN NS
IF PLACENTA IS RETAINED- EVACUATION UNDER
ANAESTHESIA

16.  PRDUCTS OF CONCEPTION HAVE BEEN
EXPELLED EN MASS
 H/O EXPULSION OF FLESHY MASS F/B
SUBSIDANCE OF PAIN ABDOMEN AND PV BLEED
 UTERUS SIZE SMALLER THAN PERIOD OF
AMENORRHOEA
 UTERUS FIRM
 CERVIX CLOSED

17.  PRODUCTS OF CONCEPTION HAVE BEEN
PARTLY EXPELLED FROM THE UTERINE CAVITY
 H/O EXPULSION OF FLESHY MASS
 PAIN ABDOMEN AND PV BLEED PERSISTS
 UTERUS SIZE SMALLER THAN PERIOD OF
AMENORRHOEA
 CERVIX PATULOUS

18.  COMPLICATIONS
• PROFUSE BLEEDING
 SEPSIS
 PLACENTAL POLYP
 MANAGEMENT
 CORRECTION OF SHOCK – IVF, BLOOD
TRANSFUSION
 IV ANTIBIOTICS
 EVACUATION OF UTERUS

19.  FETUS IS DEAD AND RETAINED INSIDE UTERINE
CAVITY FOR VARIABLE TIME
 PATHOLOGY
 BEFORE 12 WKS- CLOTTED BLOOD WITH
OVUM FORMS CARNEOUS/ FLESHY MLE
 AFTER 12WKS- FETUS BECOME MACERATED
LIQUOR GETS ABSORBED
PLACENTA BECOMES PALE

20. SYMPTOMS
 ABDOMINAL PAIN
 BROWNISH VAGINAL DISCHARGE
 SUBSIDANCE OF PREGNANCY CHANGES
SIGNS
 RETROGRESSION OF BREAST CHANGES
 UTERUS BECOMES SMALLER IN SIZE
 ABSENT FHS
 CERVIX FIRM

21. COMPLICATIONS
 INFECTION
 DIC
INVESTIGATIONS
 HEMOGRAM
 COAGULATION PROFILE
 USG – EMPTY SAC IN EARLY PREGNANCY
ABSENT FHS IN 2ND TRIMESTER

22.  ASSOCIATED WITH CLINICAL EVIDENCE OF
INFECTION OF UTERUS AND ITS CONTENTS

23. MORE ASSOCIATED WITH ILLEGAL ABORTION
 LACK OF ASEPSIS
 INCOMPLETE EVACUATION
 INJURY TO GENITAL TRACT AND GUT
ORGANISMS
 ANAEROBES – BACTEROIDES, STREPTOCOCCI,
Cl.WELCHI
 AEROBIC- E.COLI, STAPH, STRETO,
KLEBSIELLA, PSEUDOMONAS

24. SYMPTOMS
 FEVER >38 C FOR >24 HRS
 PAIN ABDOMEN
 VAGINAL DISCHARGE
SIGNS
 TACHYCARDIA
 TENDERNESS OF ABDOMEN
 PURULENT VAGINAL DISCHARGE
 P/V- UTERINE TENDERNESS,
CERVIX IS OPEN
BOGGY FEEL OF UTERUS

25.  GRADE 1 – LOCALISED TO UTERUS
 GRADE 2 – PARAMETRIUM, TUBES, OVARIES,
PELVIC PERITONEUM INVOLVED
 GRADE 3 – GENERALISED PERITONITIS /
ENDOTOXIC SHOCK / ARF

26.  HAEMOGRAM
 RFT
 COAGULATION PROFILE
 BLOOD CULTURE
 URINE MOCROSCOPY
 HIGH VAGINAL SWAB FOR CS
 USG FOR RETAINED PRODUCTS OF
CONCEPTION AND FLUID IN PERITONEAL
CAVITY

27.  HAEMORRHAGE
 INJURY TO UTERUS,BOWEL
 GENERALISED PERITONITIS
 ENDOTOXIC SHOCK
 ARF
 THROMBOPHLEBITIS

28.  HOSPITALISATION
 ANTIBIOTICS
GRAMPOSITIVE- AMPICILLIN
GRAMNEGATIVE- GENTAMYCIN,CEFTRIOXONE
ANAEROBES- METRONIDAZOLE
 BLOOD TRANSFUSION
 ANTI TETANUS SERUM – 3000 U
 ANTI GANGRENE SERUM 8000 U

29.  DILATATION AND EVACUATION
 POSTERIOR COLPOTOMY FOR PELVIC ABSCESS
 LAPROTOMY IN CASE OF INJURY TO UTERUS
OR BOWEL AND ANY SEPTIC SHOCK

30.  CONSECUTIVE 3 OR MORE ABORTIONS
 1% INCIDENCE
CAUSES
 GENETIC-CHROMOSOMAL ABNORMALITY
 ENDOCRINE
UNCONTROLLED DM
THYROID ANTIBODIES
LPD

31.  INHERETED THROMBOPHILIA
 PROTIEN C RESISTANCE
 HYPERHOMOCYSTINEMIA
 IMMUNOLOGICAL
 INFECTIONS
 UNEXPLAINED
 ANATOMICAL ABNORMALITIES OF GENITAL
TRACT

32. CONGENITAL
 DEFECTIVE MULLERIAN FUSION
 CERVICAL INCOMPETENCE
ACQUIRED
 CERVICAL INCOMPETENCE
 INTRAUTERINE ADHESIONS
 FIBROIDS

33.  BLOOD GROUPING
 BLOOD SUGARS
 VDRL
 TFT
 LA,ACA
 ENDOCERVICAL SWAB
 USG FOR CONGENITAL MALFORMATIONS,
PCOD,FIBROID
 HSG
 KARYOTYPING

34.  SURGICAL TREATMENT OF ANOMOLIES
 METROPLASTY
 HYSTEROSCOPIC RESECTION OF
INTRAUTERINE SEPTUM
SYNECHIE
SUBMUCUOS FIBROID
 TREATMENT OF INFECTIONS
 CONTROL OF DM AND THYROID DISODERS

35.  REASSSURANCE
 NATURAL MICRONISED PROGESTERONE 100MG
BD TILL 10-12 WKS
 APLA +VE PTS
LMWH
ASPIRIN
o ENCIRCLAGE IN CERVICAL INCOMPETENCE
McDONALD METHOD
SHIRODKAR TECHNIQUE

36.  THANK YOU