abortionppt пдф.pdf international university of Kyrgyzstan

Abortion

1. ABORTION

2. INTRODUCTION
Anybleedinginpregnancyisabnormal.
Vaginalbloodlossinearlypregnancyshould
bethroughofasthreatenedmiscarriageuntil
shownotherwise.Thetermmiscarriageand
spontaneousabortionaresynonymous.

3. DEFITION
Abortionisprocessofpartialorcomplete
separationoftheproductsofconceptionfromthe
uterinewallwithorwithoutpartialorcomplete
expulsionfromtheuterinecavitybeforetheageof
viability.
Earlyabortion-1-12week
Late-12-22week

4. CLASSIFICTION
ABORTION
SPONTANEOUS INDUCED

5. CLASSIFICATION
SPONTANEOUS ABORTION
* THREATENED ABORTION
* INEVITABLE ABORTION
* COMPLETE ABORTION
* INCOMPLETE ABORTION
* MISSED ABORTION
* SEPTIC ABORTION (LESS COMMON)

6. CLASSIFICATION
INDUCED
* LEGAL ABORTION (MTP)
* ILLEGAL ABORTION (CRIMINAL)
SEPTIC (COMMON)

7. CAUSES
chromosomal abnormalities.
Genetic
Maternal cause such as retroversion of uterus,
bicornuateuterus, fibroids .
Infections like rubella and Chlamydia
Medical conditions-diabetes, renal disease, thyroid
dysfunction.
unknown

8. THREATENED ABORTION
Vaginalbleedingwithorwithoutrecognizable
uterinecontractions.Thebloodlossmaybe
scantywithorwithoutaccompanyingbackache
andcramplikepain.Painresembleto
dysmenorrhea.Thecervixremainsclosedand
softuterusnotendernessonpalpation.
Outcomecouldbeeitherstopbleedingand
continuepregnancytotermorexpelthe
productsofconception.

10. MANAGEMENT
General and systematic examination
Investigations
Admit and complete bed rest
Treat as per cause found
If pregnancy continues watch for IUGR
Treat as high risk pregnancy because
more chances of preterm labor

11. INEVITABLE ABORTION
Bleeding often heavy, with clots or products
of conception, blood loss may be heavy and
the mother in shocked state. Cervix dilated
on examination, products may seen in the
vagina. Uterus feels smaller than expected.
MANAGEMENT -
* Control bleeding-ergometrineIV/IM
* Analgesics

12. INCOMPLETE ABRTION
In this parts of placenta remains within the
uterine cavity, contributing to heavy and
perfuse bleeding
MANAGEMENT -
ErgometrineIV/IM
vacuum aspiration or curettage of the uterus
under general anesthesia under general
anesthesia

13. COMPLETE ABORTION
The conception products, placenta and
membranes are expelled completely
from the uterus. The pain stops.
No further medical intervention is
required

15. MISSED ABORTION
The embryo dies despite the presence of a
viable placenta and the sac is retained. Death
of the embryo occurs before 8 weeks of
gestation but the mothers body fails to
recognized the demise.
brown discharge is suspected
Failure to weight gain
Uterus is smaller than expected and soft
MANGEMENT-vacuum aspiration or curettage
of the uterus under general anesthesia

17. HABITUAL ABORTION
Spontaneous abortion in three or more
successive pregnancies may occur, usually
abortion occurs at the same gestational age,
mostly after 16 weeks.
Cause may be genetic or immunological
Management-complete bed rest at the time
of occurrence
Special treatment if cause is identified

18. INDUCED ABORTION
MTP (medical termination of pregnancy)
(legal abortion)
Legal abortion is the deliberate induction of
abortion prior to 22 weeks of gestation by a
register medical practitioner in the interest
of mothers health and life

19. PROVISION FOR MTP UNDER THE MTP ACT.
The continuation of pregnancy would involve serious
risk of life or grave injury to the physical or mental
health of the pregnant women.
There is substantial risk of the child being born with
serious physical and mental abnormalities so as to be
handicapped in life
The pregnancy is the result of rape
The pregnancy is the result of failure of contraceptives
Foreseeable environment (social or economical)

20. INDICATIONS FOR MTP
THERAPEUTIC-
Deteriorating health due to pulmonary TB
Cardiac disease
Chronic glomerulonephritis
Malignant hypertension
intractable hyperemesisgravidarum
Cervical or breast malignancy
Diabetes mellitus with retinopathy
Psychiatric illness

21. SOCIAL
Parouswomen having unplanned pregnancy
with low socioeconomic status
Pregnancy caused by rape
Pregnancy due to failure of contraceptives

22. EUGENIC
Risk of baby born with various physical and mental
abnormalities like-
Chromosomal and gene disorders
Exposure to drugs or radiation
Rubella infection in first trimester
One or both parents are mentally ill
Congenital malformation in siblings

23. CONDITIONS TO BE MET PRIOR TO
THE PROCEDURE
Register medical practitioner is required for MTP to
save the mother
The procedure can only be performed in hospital
Written consent is necessary of pregnant women
If minor is pregnant consent from parents is required
for legal purpose
Procedure has to be reported to the directorate of
Health Services of state

24. METHODS OF MTP
Suction evacuation and curettage
Dilation and evacuation
Pharmacological method
Histerotomy

25. SUCTION EVACUATION AND
CURETTAGE
Inthismethodtheproductofconceptionis
suckedoutfromtheuteruswiththehelpof
cannulaattachedwiththesuction
apparatus.Cervixdilatedwithmetaldilators
andthencannulaintroducedintouterine
cavityandwithasmallflushingcurettage
uterinecavitycurettedandsuctionoutthe
remainingportionoftheconception.Adose
ofMethergineisadministeredIVtocontrol
bleeding

26. DILATION AND EVACUATION
There are two methods of D&E that is two stage
method (slow method) and one stage method (rapid
method)
(1) In slow method cervix is dilated by introducing
laminariatent into the cervical canal and women kept
12 hours in bed during which time tent swell up and
dilate the cervix. (2) After 12 hours with dilators cervix
further dilated and with ovum forceps conception
products are removed, curette can also done,
antibiotics and methergineare administered.

27. PHARMACOLOGICAL METHOD
Mifepristone –200 mkgr-1 day per os
Mizoprostole-400 mkgr-3 day per osor per
vaginum

28. SEPTIC ABORTION
This abortion is characterized by infection of he
products of the conception and the uterus. This
condition is most commonly complication of
induced or incomplete abortion. Illegal abortion
carried out in non sterile conditions are often leads
to septic abortion.
Causes-
Criminal abortion-inexpert attempts
Abortion with infection
MTP with infection

29. CLINICAL MANIFESTATION
Pyrexia
Headache
Nausea
Foul smelling vaginal discharge
Tenderness in lower abdomen
Septicemia
Peritonitis
Shock
TREATMENT
IV antibiotics
Hospitalization