1. ABORTIONS

2. Definition Termination of pregnancy before the period of viability

3. Types of abortions Spontaneous Induced

4. Types of spontaneous abortions Threatened Inevitable Recurrent Missed Septic

5. Etiology Fetal Factors Chromosomal anomalies Cord & placental accidents Polyhydramnios Premature rupture of membranes

6. Maternal Factors Infections Immunological Disorders Endocrine Disorders Nutritional Deficiency Chronic Systemic Diseases Psychological problems Drugs& Toxins Uterine Defects

7. Threatened Abortion Bleeding of intrauterine origin with or without uterine contractions,without dilatation of cervix and without expulsion of P.O.C.

8. Inevitable Abortion Bleeding of Intrauterine origin with continuous and progressive dilatation of cervix and without expulsion of POC

9. Complete Abortion Expulsion of all the products of conception

10. Incomplete Abortion Expulsion of some but not all of the products of conception

11. 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.

12. Infected Abortion Abortion associated with the infection the genital organs

13. 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

14. Etiology of RSA In 25 % cases cause is unknown In 75 % causes are: 1.Genetic factors ------ 50- 60 % 2.Anatomical Abnormalities of the genital tract 3.Hormonal abnormalities 4.Infections 5.Immunological Factors 6.Systemic Diseases

15. 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

16. Tests During Pregnancy All tests except HSG, Hysteroscopy & laparoscopy USG,Doppler Studies Reassessment of Serum Folate &B12 levels Assay of HCG,Oestriol &Progesterone

17. Management Threatened Abortion diagnosis history Bimanual Examination Per Speculam Examination USG

18. Treatment Sympathetic attitude Counselling (85%) will reach term Bed rest only if brisk bleeding Avoidence of sex Sedatives Hormones Serial US

19. 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

20. Missed Abortion USG Coagulation profile Evacuation - Suction curettage/D&C Medical - PGs,Misoprostol Blood - FFP if required.