ABORTIONS-Ist TRIMESTER Dr Sathisha Nayak Dept. of OBG MMMC

WE BEGIN..

CASE SCENARIO-1 23YR,PRIMI,8WEEKS,OPD C/O-BLEEDING P/V - 1 DAY PAIN ABDOMEN-6 HOURS O/E- STABLE,NO PALLOR P/A-SOFT,P/S-BLEED+ FROM OS P/V- OS CLOSED,NO TENDERNESS

CASE SCENARIO-1 NORMAL OR ABNORMAL..? GIVE 4 POSSIBILITIES/CAUSES CAN WE SEND HER HOME? WHAT INVESTIGATIONS NEEDED? WHAT IF U DON’T TREAT HER?

CASE SCENARIO-2 30YRS,G3P2,10WEEKS,ER BROUGHT COLLAPSED IN ER H/O –SEVER BLEEDING P/V-1 DAY --PAIN ABDOMEN -12 HRS O/E- NO PULSE,NO BP,RESTLESS PALLOR+++.P/A-SOFT P/V-BLEEDING+++,PRODUCTS+

CASE SCENARIO-2 WHAT IS YOUR FIRST STEP..? WHATS WRONG WITH THIS PATIENT? HOW WOULD YOU EVALUATE HER? WHATS MANAGEMENT AND WHEN WILL U DO IT?

CASE SCENARIO-3 35 YRS,12 WEEKS,OPD ANTENATAL CLINIC NO COMPLAINTS EXAMINATION-P/A SOFT,OS CLOSED P/V-UTERS 8 WEEKS USG SCAN- IRREGULAR GEST.SAC NO FETAL CARDIAC ACT.

CASE SCENARIO-3 DO U THINK THIS IS OK? WHAT IS THE CONDITION? WHAT WILL YOU DO.?

CASE SCENARIO-4 18YRS GIRL,7WEEKS,ER C/ HIGH FEVER -3 DAYS PAIN ABDOMEN - 3 DAYS SHE HAS NOT PASSED URINE 24H O/E-40* C,P/A TENDER P/S-FOUL SMELLING DISCH.

CASE SCENARIO-4 CAN U IDENTIFY THE CONDITION..? WHAT WOULD HAVE CAUSED THIS? HOW CAN WE AVOID & MANAGE?

OBJECTIVES DEFINE ABORTION LIST TYPE OF ABORTIONS IDENTIFY TYPE OS ABORTION LIST 4 COOMON CAUSES KNOW 4 COMMON SYMPTOMS &SIGNS LIST 4 COMPLICATIONS EVALUATION MANAGEMENT OUTLINE

ABORTION COMMON OBG COMPLICATION 15% OF ALL PREGNANCYS ONE OF COMMON AVOIDABLE CAUSE OF MAT MORTALITY

DEFINITION ‘ EXPULTION OF PRODUCT OF CONCEPTION BEFORE PERIOD OF VIABILITY’

ABORTION TYPES -SPONTANEOUS- THREATENED INEVITABLE INCOMPLETE COMPLETE MISSED SEPTIC - INDUCED -MTP

ABORTION-CAUSES CHROMOSOMAL ABNORMALIY-50% GENETIC DEFECTS - 20% UNKNOWN ?-ENDOCRINAL-THYROID,?LFD -IMMUNOLOGICAL- -MATERNAL SYS DISEASE-SLE

ABORTION-CLINICAL FEATURES -SYMPTOMS :-PAIN ABDOMEN BLEEDING P/V PASSING PRODUCTS P/V FOUL DISCHARG/FEVER -SIGNS : BLEEDING P/V NO P/A TENDERNESS CERVIX OPEN +/- PRODUCTS IN CX CANAL

ABORTION-CLINICAL FEATURES -BLEEDING P/V+OS CLOSE = T.A -BLEEDING P/V+OS OPEN =INEVITABLE -BLEED.PV+OS OPEN+PRODUCTS HALF WAY IN CX OR VAGINA= INCOMPLETE -BLEED PV+PRODUCT OUT=COMPLETE -BLEED PV+/-,OS CLOSED,FETUS DEAD == MISSED ABOTION

ABORTION-COMPLICATIONS HAEMORRHAGE HYPOVOLEMIC SHOCK SEPSIS- SEPTIC ABORTION MATERNAL DEATH SEVERE ANAEMIA

ABORTION-EVALUATION DETAILED HISTORY CLINICAL EXAM-GE+P/A+PV INVESTIGATIONS -BL.GROUP,HB% -ULTRASOUND SCAN PELVIS

ABORTION-MANAGMENT STABILISE PATIENT-BLOOD/IVFLUID SPECIFIC MANAGEMENT T.A : REST/OBSERVATION INEVITABLE : EVACUATION OF UT. INCOMPLETE :EVACUATION OF UT. COMPLETE : CHECK FOR RPOC MISSED : D & EVACUATION OF UT. SEPTIC :ANTIBIOTICS,EVACUATION SURGICAL DRAINAGE

THANK YOU