ABORTION AND MANAGEMENT OF INCOMPLETE ABORTION.pptx

Abortion and its management.

1. ABORTION AND MANAGEMENT OF INCOMPLETE ABORTION MODIBBO ADAMA UNIVERSITY TEACHING HOSPITAL, YOLA HOUSE OFFICER’S PRESENTATION BY DR NELSON MOGBI MODERATOR: DR PROMISE OKEKE 8/27/2025 1

2. OUTLINE DEFINITION OVERVIEW RISK FACTORS AETIOLOGY TYPES MANAGEMENT OF INCOMPLETE ABORTION CONCLUSION REFERENCES 8/27/2025 2

3. DEFINITION Abortion is the expulsion or removal of the products of conception before the age of viability - 28th week of pregnancy in Nigeria May be spontaneous (miscarriage) or induced [by termination] 8/28/2025 3

4. OVERVIEW About 80% of miscarriages occur within the first trimester. The frequency of spontaneous abortion increases with age. The frequency of miscarriage decreases with increasing gestational age. 8/28/2025 4

5. OVERVIEW Each year almost half of all pregnancies are unintended. 6 out of 10 unintended pregnancies and 3 out of 10 out of all pregnancies end in induced abortion 8/28/2025 5

6. RISK FACTORS Advanced age Extremes of age Stress Advanced paternal age Previous miscarriage Smoking Alcohol use 8/28/2025 6

7. AETIOLOGY Maternal factors: endocrine, anatomical, infection, immunologic, environmental Fetal factors: genetic, multiple pregnancy, degeneration 8/28/2025 7

8. AETIOLOGY First trimester abortion Genetic factors Endocrine and metabolic Infection Immunologic Second trimester abortion Uterine causes Cervical insufficiency Congenital Acquired (iatrogenic) 8/28/2025 8

9. TYPES OF ABORTION 1. Threatened 2. Incomplete 3. Complete 4. Missed 5. Inevitable 5. Septic 6. Recurrent 8/28/2025 9

10. THREATENED ABORTION It is a condition in which miscarriage has started but has not progressed to a state from which recovery is impossible. Clinical features Slight bleeding per vaginum The uterus and cervix feel soft Mild cramps 8/28/2025 10

11. INCOMPLETE ABORTION The process of abortion has already taken place, but the entire products of conception are not expelled and a part of it is left inside the uterine cavity. F eatures History of expulsion of fleshy mass per vaginum Pain in the lower abdomen Uterus is smaller than the period of amenorrhea Open internal os Varying amount of bleeding 8/28/2025 11

12. COMPLETE ABORTION When the product of conception are completely expelled from the uterus F eatures History of expulsion of fleshy mass per vaginum Subsidence of abdominal pain Vaginal bleeding becomes trace or absent Uterus is smaller than the period of amenorrhea Cervical os is closed 8/28/2025 12

13. MISSED ABORTION The fetus is dead and retained passively inside the uterus for a variable period. It is diagnosed when there is a fetus with a crown rump length of 5mm without fetal heart sound F eatures Subsidence of pregnancy symptoms Uterus becomes smaller in size Cervix feels firm with closed internal os No audible fetal heart sound even with doppler ultrasound 8/28/2025 13

14. INEVITABLE ABORTION Changes have progressed to a state from where continuation of pregnancy is impossible Clinical features Vaginal bleeding Aggravation of colicky pain in the lower abdomen Internal os is dilated through which the products of conception is felt 8/28/2025 14

15. SEPTIC ABORTION Any abortion associated with clinical evidences of infection of the uterus and its contents. Mostly from abortion attempt by an untrained person without the use of aseptic precautions Clinical features Fever Abdominal pain Vomiting/ Diarrhoea Offensive purulent vaginal discharge Tender uterus usually with patulous os or a boggy feel 8/28/2025 15

16. RECURRENT ABORTION A sequence of 3 or more consecutive spontaneous abortion 8/28/2025 16

17. MANAGEMENT OF INCOMPLETE ABORTION An incomplete miscarriage is typically diagnosed with a history, physical exam, and pelvic ultrasound Management options include expectant, medical, and surgical treatments 8/28/2025 17

18. MANAGEMENT OF INCOMPLETE ABORTION A thorough history should be obtained that includes medical conditions obstetric and gynecologic history to identify risk factors and patient-specific issues that may affect management: the first day of the last menstrual period previous miscarriages known uterine anomalie 8/28/2025 18

19. inquire about presenting symptoms such as cramping and pelvic pain the quality and quantity of vaginal bleeding noted, including onset, number of saturated pads or tampons per hour the number and size of clots present 8/28/2025 19

20. An initial assessment of the patient's hemodynamic stability should include vital signs and a focused physical examination. T achycardia and hypotension are suggestive of hemorrhage secondary to heavy uterine bleeding A fever is suggestive of infection and possible septic miscarriage 8/28/2025 20

21. On pelvic examination, typical findings of an incomplete pregnancy loss include an open cervical os with POC visible within the vaginal vault or protruding from the cervix the presence of purulent vaginal discharge and uterine tenderness strongly suggests infection 8/28/2025 21

22. An incomplete pregnancy loss can be confirmed by a transvaginal ultrasound demonstrating the partial expulsion of POC and heterogeneous or echogenic contents within the endometrial cavity or endocervical canal in patients with an open cervical os Additional findings on transvaginal ultrasound consistent with retained POC include a mass or focal thickening within the endometrium; occasionally, blood flow can be visualized within this area using Doppler imaging. 8/28/2025 22

23. The following laboratory studies should be performed to assist in patient management decisions β- HCG Hematocrit Blood type with Rh-D status Histological examination to confirm pregnancy loss and assess for a molar pregnancy Sepsis laboratory studies - complete blood count with a differential, comprehensive metabolic panel, serum lactate, blood and urine cultures, and endocervical cultures 8/28/2025 23

24. Expectant management consists of the watchful monitoring of patients without contraindications to this approach, allowing the natural process of miscarriage to progress spontaneously if the patient remains stable and shows no evidence of infection 8/28/2025 24

25. If medical management is selected, ACOG recommends vaginal misoprostol 800mcg once initially, with a potential second dose between 3 hours and 7 days later. The World Health Organization prefers misoprostol regimens of 400 mcg sublingually once or 600 mcg orally only once for pregnancies <14 weeks of gestation. Appropriate analgesics should also be offered Patients should also have a follow-up plan to ensure the safe completion of the miscarriage 8/28/2025 25

26. Surgical management for incomplete pregnancy loss is indicated in patients with hemodynamic instability, those at high risk for hemorrhage or with septic miscarriages, and people who failed expectant or medical management 8/28/2025 26

27. Rh(D)-immune globulin can be given to Rh-negative patients to prevent alloimmunization . Its use is consistently recommended after surgical management but is more controversial with expectant or medical management of pregnancy loss in the first trimester 8/28/2025 27

28. D ifferential diagnosis for vaginal bleeding in pregnancy includes: Ectopic pregnancy Complete miscarriage Threatened miscarriage Molar pregnancy Nonobstetric bleeding eg , vaginal or cervical trauma, malignancy, Infection of the vagina or cervix eg , candidiasis, bacterial vaginosis, and Chlamydia trachomatis Septic abortion Hemorrhagic shock Cervical shock Uterine rupture 8/28/2025 28

29. CONCLSION Incomplete miscarriage presents with moderate to severe vaginal bleeding, sometimes with the noticeable passage of tissue, that is typically associated with lower abdominal and pelvic pain. Diagnosis is made primarily through visualizing pregnancy tissue in the cervical os during a speculum examination. 8/28/2025 29

30. CONCLSION An ultrasound finding of heterogeneous or echogenic tissue within the endometrial canal in a patient with the characteristic clinical features of a miscarriage or the expulsion of products of conception that is less than generally expected for a given gestational age also supports a diagnosis of incomplete pregnancy loss. 8/28/2025 30

31. CONCLSION Management options include expectant, medical, and surgical treatments, although expectant management alone is often highly successful. Proper diagnosis and treatment with close obstetric follow-up and patient education are essential to prevent serious complications. 8/28/2025 31

32. REFERENCES American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No. 200: Early Pregnancy Loss. Obstet Gynecol. 2018 Nov;132(5):e197-e207. Management of Stillbirth: Obstetric Care Consensus No, 10. Obstet Gynecol. 2020 Mar;135(3):e110-e132. Hendriks E, MacNaughton H, MacKenzie MC. First Trimester Bleeding: Evaluation and Management. Am Fam Physician. 2019 Feb 01;99(3):166-174. 8/28/2025 32