abortions and treatment in pregnancy.ppt

Abortion

1. ABORTIONS

2. OBJECTIVES
At the end of this session you should
be able to:
1.Define various types of abortions.
2.Outline the causes and management
approach for various types of abortions.
3.Describe the relation between complications
of abortions and maternal mortality

3. DEFINITIONS OF ABORTION
1.Termination of pregnancy
before 28/40
2.Delivery of a fetus of weight
less than 500 grams

4. STATISTICS OF ABORTIONS
•50 -60% of all pregnancies end in
spontaneous abortion (SAB) since 2-4 wk
pregnancies will often go unnoticed.
•15% of all recognized pregnancies 4-20 wks
end in SAB.
•30% lost between implantation and the 6
th
wk.
•70% of first trimester losses are due to
chromosomal abnormalities

5. TYPES
1.Induced
2.Threatened
3.Inevitable
4.Incomplete
5.Complete
6.Septic
7.Missed
8.Recurrent
TYPES OF ABORTIONS

6. 1. INDUCED ABORTION
•Intentional medical or surgical
termination of a pregnancy
•Types
–Elective:if performed for a
woman’s desires
–Therapeutic:if performed for
reasons of maintaining health of
the mother

7. INDUCED ABORTION –MEDICO-
LEGAL ASPECTS IN TANZANIA
•Only allowed for medical indications
–If continuation of pregnancy is risk to life
of the woman
•At least two medical doctors should
reach the decision and sign
•Elective abortions–are unlawful

8. INDUCED ABORTIONS -COMPLICATIONS
Because most induced abortions are done by
less skilled persons they are usually associated
with fatal complications including:
1. Perforation of uterus, intestines, etc
2. Severe haemorrhage,
3. Sepsis and its associated complications,
4. Asherman’s syndrome, etc

9. 2. THREATENED ABORTION
Refers to a stage in the abortion
that suggests potential
miscarriagemay take place.
Symptoms
•Minimal or no lower abdominal pain or
cramps
•Slight abd pain
•Minimal draining of liquor

10. Threatened abortion cont
Signs
•Stable general condition
•Fundal height corresponds to
GA
•Cervix closed

11. Management of threatened abortion
1.Bed rest
–Avoid strenuous exercises
2.If GA > 16/40 give -tocolytics

12. 3. INEVITABLE ABORTION
Refers to a stage in the
abortion when it is not
possible for the pregnancy to
continue.

13. INEVITABLE ABORTION CONT
Symptoms
•Moderate to severe vaginal bleeding
•Severe abd pain
•Significant draining of liquor
Signs
•Dilatation of cervix with evidence of
imminent expulsion of the PoC
•Fundal height corresponds to GA
•Presence of contractions

14. Management of Inevitable abortion
1.Resuscitation: IV fluids: RL, NS
2.Blood grouping & Cross matching
3.Evacuation
•MVA for GA < 12/40
•Augment if the GA > 12/40
Oxytocin
If some PoC remain after abortion
manage like incomplete abortion.

15. MANUAL VACUUM ASPIRATOR

16. 4. INCOMPLETE ABORTION
•Some POC have been expelled from the
uterine cavity and other are retained
inside.
Symptoms
–Moderate to severe vaginal bleeding
–Cramping/severe abd pain
–Partial expulsion of POC
Signs
–Uterus smaller than dates
–Cervix is dilated of cervix

17. Management of Incomplete abortion
1.Resuscitation: IV fluids: RL, NS
2.Blood grouping & Cross matching → BT if indicated
3.Evacuation
–MVA for GA < 12/40
–Augment if the GA > 12/40
•Oxytocin
•If some PoC remain after abortion manage like
incomplete abortion.
4. Antibiotics: ampicilin, metronidazole
5. Analgesics

18. 5. SEPTIC ABORTION
An abortion complicated by infection
Symptoms
–Abdominal pain
–Fever
–Vaginal discharge (foul smelling)
Signs
–Sick looking, febrile or jaundiced
–Tender uterus
–Offensive vaginal discharge or bleeding
–Cervix is usu. soft and may be dilated

19. Complications of septic abortions
Immediate cpx
•Haemorrhage
•Peritonitis
•Pelvic abscess,
endometritis,
•Septicemia,
•Septic/haemorrhagic
shock
Late cpx
•PID
•Pelvic adhesions
•2°Infertility
•Chronic LAP

20. Management
1.Resuscitation
–IV fluids: RL, NS
2.Insert urethral catheter
–Monitor Input/output
3.Blood grouping & Cross matching
4.Antibiotics:
•Preferably cephalosporins, if not available
ampicilin and metronidazole
5.Evacuation
6.Haematenics

21. 6. RECURRENT PREGNANCY LOSSES
•Defined as 3 or more consecutive
pregnancy losses
Other names:
•habitual abortions
•habitual miscarriage
•recurrent abortions
•recurrent miscarriages.

22. Aetiology of RPL
•Genetic Factors
•Endocrine Factors
•Anatomic Causes
–Congenital anomalies, in competencies,
•Infectious causes
•Immunologic problems
Aetiology:Can be established in only 30%