Abortion , it's types and management

The document discusses about what is abortion, definition of abortion by world health organization, causes, Sign and symptoms, classification/types, management for spontaneous and induced abortion.
Abortion is expulsion and extraction of an embryo or fetus weighing 500g or less when it is not capable of independent survival.
10-20% of all pregnancies end in abortion.
80% occur before the 12 th wk of pregnancy.
Abortion is classified as two main types that is spontaneous abortion & second induced abortion

1. ABORTION
AND IT'S TYPES
Miss.Karishma S.Pimpale
Roll no.:-36 (IIIrd Year)
School of nursing K.EM

2. WHAT WE LEARN TODAY ?
1) Defination of Abortion
2)Causes of Abortion
3)Sign & symptoms of Abortion
4) Diagnostic evaluation for Abortion
5)Classification /Types of Abortion
6)Management of Abortion
. -spontaneous
. -induced

3. DEFINATION
“AN EXPULSION OR EXTRACTION OF AN EMBRYO OR
FOETUS BEFORE 20 WEEKS OF GESTATION, WEIGHING
LESS THAN 500GM,WHEN IT IS NOT CAPABLE OF
INDEPENDENT SURVIVAL."
-by World Health Organization

4. CAUSES
1. Genetic/ chromosomal abnormalities
2. Metabolic & endocrine disturbance
Luteal phase defect (deficient progesterone secretion from corpus
luteum, thereby implantation and placentation are not supported
adequately)
Hypothyroidism, hyperthyroidism and uncontrolled diabetes mellitus
Aneuploidy (one extra or one missing chromosome)
Trisomy (3 copies of chromosome instead of 2)
monosomy×45x(missing one chromosome in the pair-Turner
syndrome)

5. 3. Structural Abnormalities
Congenital malformation of uterus (unicornuate, bicornuate
& septate uterus)
Cervical incompetence
Uterine fibroids ( leiomyoma)
Intrauterine adhesions ( synechiae)
Asherman's syndrome
4. Infection
May be viral, bacterial & parasitic
TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes
simplex & HIV
Malaria, chlamydia, brucella

6. Septate uterus
Uterine fibroids ( leiomyoma)

7. 5. Maternal medical disorders
Cyanotic heart disease
Hemoglobinopathy
Hypertension
Chronic renal disease
Inherited thrombophilia
6. Social factors
Alcohol
Cigarette smoking

8. SING & SYMPTOMS
Abortion can occur in two ways – pain and bleeding
1) Abnormal uterine activity – first event pain &
abnormal passage of clot if 18 -20 weeks.
2)Death of the embryo – first event i.e., death of
embryo- expulsion from uterus. bleeding is first
slight but later on increases with passage of clot per
vagina

9. DIAGNOSTIC TESTS
The basic investigations include the following
1) History
2) Examination
3)Hemogram.
4)Routine urine analysis.
5) Kidney and liver function tests.
6)Coagulation profile.
7) High vaginal or cervical swab for culture or
sensitivity.

10. DIAGNOSTIC TESTS
8) Upright x-ray abdomen and pelvis to detect uterine and
gut perforation and peritonitis.
9) Pelvic imaging studies which include:-
. pelvic ultrasound for retained products of
conception, foreign body in uterus
9) CT scan and MRI are also helpful.

11. CLASSIFICATION

12. A) SPONTANEOUS ABORTION
•Defination:-
As the involuntary loss of the products of conception prior to 28
weeks of gestation ,when the fetus weighs approximately 1,000 g or
less.
INCIDENCE :
- In India it has been computed that about 6 million abortions take
place,
-every year of which 2 million are spontaneous and the 4 million are
induced
I) ISOLATED ABORTION

13. II) RECURRENT ABORTION
•Defination:-
- The sequence of two or more spontaneous abortions
as documented by either sonography and
histopathology, before 20 weeks.
INCIDENCE:
-affecting approximately 1% of all women of
reproductive age.

14. TYPES
Threatened
abortion
Incomplete
abortion
Complete
abortion
Missed
abortion
Not progress to a state from
where recovery is not
possible.
Progressed to a state from
where continuation of
pregnancy is not possible.
Some products of conception
are expelled & some part is
left inside the uterine cavity.
Entire product of conception
are expelled as a mass.
Foetus is dead & retained
inside the uterus for a
variable period.
Defination
1.
2.
4.
3.
5.
Inevitable
abortion

15. Threatened
abortion
Incomplete
abortion
Complete
abortion
Missed
abortion
Spotting
mild cramps in lower abdo.
More bleeding
Colicky pain in lower abdo.
Severe bleeding ± shock
severe colicky pain
No bleeding
Pain subsides
No bleeding
No pain
Bleeding/ pain
1.
2.
4.
3.
5.
Inevitable
abortion

16. Threatened
abortion
Incomplete
abortion
Complete
abortion
Missed
abortion
Os Closed
corresponds to weeks of
gestation.
Os Open
equal or may be less
Os Open
smaller fundal height.
Os Closed
smaller fundal height.
P/V & size of uterus
1.
2.
4.
3.
5.
Inevitable
abortion
Os Closed
smaller fundal height.

17. Threatened
abortion
Incomplete
abortion
Complete
abortion
Missed
abortion
Live fetus in gestation sac,
cardiac activities present
(subchorionic hemorrhage)
Irregular gestation sac,
dead fetus
Retained product
Uterine cavity empty
Dead fetus MSD›25mm &
no embryo
CRL›7mm & no cardiac activities
Transvaginal sonography
1.
2.
4.
3.
5.
Inevitable
abortion

18. Threatened
abortion
Incomplete
abortion
Complete
abortion
Missed
abortion
Expectant mng- pelvic rest,
abstaining from sexual intercourse,
avoid strenuous activity
Same as inevitable
No intervention needed
Same as inevitable
Management
1.
2.
4.
3.
5.
Inevitable
abortion
Expectant mng-No intervention,
resolve self.
med mng-misoprostol,surg mng-
suction & evacuation

20. SEPTIC ABORTION
•Defination:-
• Any abortion associated with clinical evidence of infection
of uterus and its contents is called septic abortion.
• It is characterized by
1) Rise of temperature of at least 104°F for 24 hours or
more.
2) Offensive or purulent vaginal discharge.
3) Evidence of pelvic infection such as lower abdominal
pain and tenderness.

21. B) INDUCED ABORTION
•Defination:-
•Deliberate termination of pregnancy either by medical or
by surgical method before the viability of the fetus is called
induction of abortion.
-This may be legal & illegal ( criminal)
-In India, the abortion was legalized by medical
• Termination of pregnancy Act of 1971.

22. MANAGEMENT
1) spontaneous
a.Chromosomal abnormalities:-
-Genetic counseling
-IVF with donar gamets
b.Endocrine distinction
-correct with supplements in preconceptional period
C.structural anomalies
-Hysteroscopic metroplasty (bicornuate/septed uterus)
.-Excision surgery (Asherman's syndrome & leiomyoma)

23. D. Cervical incompetence
-cervical cerclage at the level of internal os
•MC DONALD 'S-
-Most common,less bleeding
-Purse string suture tied anteriorly
•SHIRODKAR 'S-
-Mersilene tape
-Tape is passed subcutaneously bring the suture ends
through the posterior incision.
-

24. •MC DONALD 'S

25. •SHIRODKAR 'S

26. 2) Induced
•Medical method
-Mifepristone -Antiprogestin
1 tab 200mg orally
-Misoprostole-PGE analogue
24-48 hrs after Mifepristone
400-800ug
sublingual/vaginal/oral
•Surgical method
-suction and evacuation
-Dilatation and evacuation

27. THANK
YOU