1. ABORTION Razieh M. Jaafari, MD Dept of ObGyn Ahwaz University of Med. Science

2. Abortion Termination of pregnancy by any means before the fetus is sufficiently developed to survive.

3. Pathology Hemorrhage in to the decidua basalis,necrotic changes in the tissue adjacent to the bleeding accompany abortion.

4. The ovum becomes detached and stimulates uterine contractions that result in expulsion.

5. Resumption of ovulation As early as 2wk after an abortion.

6. Effective contraception should be initiated soon after abortion

8. More than 80% occur in 12wk

9. Risk is increased with : 1 - parity 2 - maternal & paternal. age

10. Pregnancy within 3months of a term birth.

12. Aneuploid abortion 50-60% of early abortions 3/4 before 8wk

13. Chromosomal anomaly due to gametogenesis errors Maternal 25% Paternal 5%

14. Autosomal trisomy The most common 13 16 18 21 22

15. Monosomy x

16. *T*Triploidy *T*Tetraploidy *C*Chromosomal structural. anomaly *A*Autosomal monosomy *S*Sex chromosomalomal. polysomy

17. Euploid abortion Peaked at 13wk maternal age > 35 incidence

18. The reasons are unknown but possibilities: Jisolated mutation Jmaternal factor Jsome paternal factor

19. Maternal factors

20. Infections H IV-1 syphilis Vaginal colonization with B strep. Mycoplasma hominis Ureaplasma urealyticum HSV

21. Chronic Debilitating Diseases

22. Endocrine Abnormalities Hypothyroidism Diabetes melitus Progestrone Deficiency

23. Nutrition

24. Drug use and Environmental factors

25. TOBACCO ALCOHOL CAFFEINE RADIATION CONTRACEPTIVE ENVIROMENTAL TOXIN

26. Immunological Factors

27. Two primary pathophysiological models: 4Autoimmune 4Alloimmune

28. Autoimmune factors 15% of over 1000 recurrent pregnancy loss

29. The most significant antibodies detected by testing for ( LAC) and (ACA).

30. Abortion occurred in 25% of the AB +group 10% of the AB -group

31. LAC is an Ig. (IgG, IgM or both) it is associated with in thromboembolic events.

32. ACA are against a phospholipid (IgG,IgA,IgM)

33. The mechanism of pregnancy loss : *placental thrombosis & infarction *Inhibition of prostacyclin release

34. Treatment 3Low dose aspirin 3Prednisone 3Heparin 3IGs

35. ALLoimmune Factors

36. Diagnosis Maternal and paternal HLA comparison Assessment of maternal serum for cytotoxic AB to paternal leukocyte Maternal serum testing for blocking factor

37. Treatment Paternal leukocyte Pool human IG

38. 4Trauma 4Laparatomy 4Uterine Defects: 4Incompetent cervix 4Aging Gametes Acquired Developmental

39. Paternal factors Chromosomal translocation in sperm Adenovirus, HSV in sperm

40. Categories & Treatment

41. Threatened Abortion

42. Inevitable Abortion

43. Incomplete Abortion

44. Missed Abortion

45. Recurrent Abortion

46. Induced Abortion 4Therapeutic 4Elective

47. Abortion Techniques Surgical Medical

48. Surgical 1- D&C 2- Suction Curettage 3- D&E 4- laparotomy Hysterotomy Hysterectomy

49. Medical 4Oxytocin IV 4Intra-amnionic 41-20% saline 42-30%urea 4PGE2,F2@ 4Ru486

50. Complication of Elective Abortion (Maternal mortality (Future pregnancy (Septic abortion