Incomplete Abortion
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1) Incomplete abortion occurs when the products of conception are partially expelled and partially retained, especially in the first 20 weeks of pregnancy. 2) Symptoms include amenorrhea, abdominal pain, heavy vaginal bleeding, and a history of expulsion of conception products. On examination, the uterus may be smaller than expected and the cervical os dilated with products in the uterine cavity or cervical canal. 3) Management involves evacuation of the uterus by MVA or D&C if the cervix is dilated, or D&C if not. Post-evacuation care includes antibiotics, analgesics, counseling to delay future pregnancy for 6-7 months, and anti-D immunoglobulin as needed.
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- Abnormal uterine contractions can cause prolonged labor and fetal distress due to inadequate relaxation between contractions.
- Types include reduced contraction intensity (uterine inertia), asynchronous contractions of different parts of the uterus (incoordinated), and sustained contraction of the entire uterus (generalized tonic).
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VULVA
PERINEUM
RISK FACTORS FOR THIRD DEGREE PERINEL TEAR
REPAIR OF COMPLETE PERINEAL TEAR
VAGINA
CERVIX
PELVIC HEMATOMA
DIAGNOSIS OF RUPTURE UTERUS
Post partum hemorrhage obs and gyne
Introduction
Definition
Incidence
Types of PPH
Causes of Primary PPH
Clinical manifestations
Prevention
Management of 3rd stage bleeding
Management of true PPH
Secondary PPH
Clinical manifestations
Diagnosis
Management of sec PPH
Active management
Evaluation
Bibliography
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Incomplete Abortion
- 2. When the ovum is separated from the uterine wall, it is bound to be expelled. When the products of conception are partially expelled and partially retained, esp. in 1st 20 weeks, it is called Incomplete Abortion. Definition
- 3. Symptoms- Amenorrhea Moderate to severe Lower Abdominal Pain Heavy bleeding from vagina History of expulsion of products of conception. Clinical features
- 4. Signs- Tachycardia and hypotension due to bleeding Uterine size might be lesser than for the period of amenorrhea on palpation Cervical os is dilated and products of conception may be felt in the uterine cavity or cervical canal The products may be protruding through cervical canal. The cervical os is the opening in the cervix at each end of the endocervical canal. The external os is near the vagina, and the internal os is near the uterus. During your menstrual cycle, the cervical os opens more readily during ovulation to allow sperm to enter.
- 6. Is done with USG. Most of the time patient expels it by herself. When the bleeding is severe and persistent, interference is needed. Very often CHECK CURETTAGE is done to remove any retained bits. Investigation Dilation and curettage (D&C) Procedure to remove tissue from inside your uterus. To diagnose and treat certain uterine conditions such as heavy bleeding or to clear the uterine lining after a miscarriage or abortion.
- 9. GENERAL IV with Non Steroids. Blood arrangement if bleeding severe. IV antibiotic single dose (1g Inj. Ampicillin) for infection prophylasis IV sedation. (Inj. Pentazocine ans Prmethazine) If excessive bleeding, she is in shock Inj. TT if not immunized. Management
- 10. 1. Evacuation of uterus when cervix is dilated If it is protruding out of external os, it can be removed gently by sponge holding forceps and twist it. Manual Vacuum Aspiration(MVA) If not available, D&C or suction is done. These 2 can cause perforation. 2. When its not dilated MVA If not D&C or Suction. MVA Procedure that uses a vacuum source to remove an embryo or fetus through the cervix. The procedure is performed to induce abortion, as a treatment for incomplete spontaneous abortion or retained fetal and placental tissue, or to obtain a sample of uterine lining. LOW PERFORATION CHANCE. Complete evacuation
- 11. POST EVACUATION CARE Continue oral antibiotics with analgesics, like Paracetamol Food from fluids to solids Counseling and plan pregnancy after 6-7 months only. Give Anti-D whenever indicated. The anti-D immunoglobulin neutralises any RhD positive antigens that may have entered the mother's blood during pregnancy. If the antigens have been neutralised, the mother's blood won't produce antibodies.
- 12. THANK YOU