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

2. WE BEGIN..

3. 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

4. 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?

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

6. 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?

7. 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.

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

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

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

11. 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

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

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

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

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

16. 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

18. 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

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

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

21. 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

26. THANK YOU