ABORTIONS
Definition Termination of pregnancy before the period of viability
Types of abortions Spontaneous Induced
Types of spontaneous abortions Threatened Inevitable Recurrent Missed Septic
Etiology Fetal Factors Chromosomal anomalies Cord & placental accidents Polyhydramnios Premature rupture of membranes
Maternal Factors Infections Immunological Disorders Endocrine Disorders Nutritional Deficiency Chronic Systemic Diseases Psychological problems Drugs& Toxins Uterine Defects
Threatened Abortion Bleeding of intrauterine origin with or without uterine contractions,without dilatation of cervix and without expulsion of P.O.C.
Inevitable Abortion Bleeding of Intrauterine origin with continuous and progressive dilatation of cervix and without expulsion of POC
Complete Abortion Expulsion of all the products of conception
Incomplete Abortion Expulsion of some but not all of the products of conception
Missed Abortion The Embryo or Fetus dies in utero before the 20 th weeks of pregnancy but is retained in utero for 08 weeks or more.
Infected Abortion Abortion associated with the infection the genital organs
Recurrent Spontaneous Abortion Loss of three or more consecutive pregnancies before the period of viability. Primary - Without a term pregnancy. Secondary - Following a term pregnancy
Etiology of RSA In 25 % cases cause is unknown In 75 % causes are: 1.Genetic factors % 2.Anatomical Abnormalities of the genital tract 3.Hormonal abnormalities 4.Infections 5.Immunological Factors 6.Systemic Diseases
Investigations for RSA Between Pregnancies Blood count &Urine Analysis Grouping &Rh factor Karyotyping of the couple Serological tests for syphilis Lupus Anticoagulant Antinuclear &Antiphospholipid antibodies Glucose Tolerance Test Renal Function Tests Thyroid Function Tests Serum Zinc &Folate Levels USG of the Pelvis HSG,Hysteroscopy,Laparoscopy
Tests During Pregnancy All tests except HSG, Hysteroscopy & laparoscopy USG,Doppler Studies Reassessment of Serum Folate &B12 levels Assay of HCG,Oestriol &Progesterone
Management Threatened Abortion diagnosis history Bimanual Examination Per Speculam Examination USG
Treatment Sympathetic attitude Counselling (85%) will reach term Bed rest only if brisk bleeding Avoidence of sex Sedatives Hormones Serial US
Inevitable Abortion Confine to bed till process is complete Inj.Pethidine/Pentagesic If process is prolonged or incomplete; Accelerate by Oxytocin Evacuation under GA Save and examine expelled POC Inj. Anti-D to Rh-negative women
Missed Abortion USG Coagulation profile Evacuation - Suction curettage/D&C Medical - PGs,Misoprostol Blood - FFP if required.