Miscarriages and Abortions.pptx

Diagnosis and Management of Miscarriages

1. MISCARRIAGE/ABORTION DR TENO, O7G DEPT, MPHA 17TH AUGUST 2023

2. Definition ABORTION MISCARRIAGE D erived from latin word aboriri – to miscarry Induced termination of pregnancy to destroy the fetus S pontaneous fetal loss before viability T ermination/loss of pregnancy prior to 20 weeks gestation or with a fetus weighing < 500g

3. Classification

4. THREATENED MISCARRIAGE Pregnancy threatens to abort: fetus has a 50% of aborting and 50% chance of surviving to term. Symptoms: Bloody vaginal discharge/PV bleeding Abdominal cramps May persist for days or weeks Signs: USS: Gestational Sac or live intra-uterine pregnancy with cardiac activity Spec: Cervical Os closed, bleeding, no POC

5. I NEVITABLE MISCARRIAGE U navoidable event, hence pregnancy is most likely to abort. Symptoms: Abdominal cramps PV bleeding S ymptoms of infection: fever, abnormal vaginal doischarges, UTI symptoms Signs: USS: live intra-uterine pregnancy or fetal demise Speculum: cervical os dilated, SRM/leaking amnionic fluid, products of conception

6. MISSED MISCARRIAGE Fetus stops developing or fetus dies. Symptoms Progesterone maintains pregnancy symptoms: Breast tenderness Fatigue Morning sickness Absence of bleeding, abdo pain or loss of fetal tissue Signs: USS: fetal demise with no cardiac activity Speculum: cervical os closed, no bleeding and no products of conception

7. INCOMPLETE MISCARRIAGE P regnancy aborts, but partial POC are retained in utero whilst others are expelled. Symptoms: PV bleeding, abdominal cramps, p artial POCs expelled Signs: USS: POC in-utero Speculum: Cervical Os dilated, partial POCs dislodged at os, bleeding

8. COMPLETE MISCARRIAGE P regnancy aborts, and all POC are expelled. Symptoms: PV bleeding, abdominal cramps, POCs expelled including fetus Signs: USS: uterus empty Speculum: Cervical Os closed, no POC, POC expelled completely, little or no bleeding

9. SEPTIC ABORTION Abortion may either be: Spontaneous or “criminal” complete or incomplete. Associated with signs of “Sepsis” Symptoms: F ever, abdominal pain, offensive PV discharges, may/not come with PV bleeding Signs: USS: retained POCs or empty uterus Speculum: cervical Os closed, offensive PV discharges, tenderness Sepsis: fever, tachycardia, tachypnoea

10. EITIOLOGY Fetal Factors Maternal factors Uterine/cervical defects

11. FETAL FACTORS C hromosomal abnormalities Maternal gametogenesis errors – 95% Paternal errors – 5%

12. MATERNAL FACTORS I nfections: Syphilis, HIV, Group B streptococci Chronic Debilitating Diseases: TB, cancer Endocrine abnormalities: Polycyctic Ovarian Syndrome (PCOS) D iabetes mellitus Hypothyroidism Trauma

13. MATERNAL FACTORS Drug use: tobacco, alcohol, caffeine Radiation: therapeutric doses to treat malignancy are abortifacient. Contraceptives: Intra-uterine device Environemental toxins: arsenic lead, formaldehyde, benzene. E thylene oxide Maternal Surgery: abdominal or pelvic

14. Uterine Defects Acquired uterine defects Uterine Leiyomyoma/fibroid Asherman’s Syndrome Devlopmental Uterine Defects

15. Incompetent Cervix C haracterized by a shorter Cx < 4cm with painless cervical dilatation in T2 M embranes prolapse and balloon into the vagina I mmarture fetus is expelled

16. Management Expectant Medical Surgical

17. What is Expectant Management? Symptomatic relief, correct anaemia and antibiotic cover T ype of abortion T reatment Arm Threatened Expectant Inevitable Expectant Incomplete or Missed Expectant Insert Misoprostol 600mcg PR Dilatation and curettage (D&C): dilate the cervix and curette (scrape) the products of conception Septic 1. Misoprostol 600mcg PR 2. D&C 3. Expectant

18. D ilatation and curettage

19. C ervical incompetence: cervical cerclage

20. Complications Aanaemia Hypovolaemic shock Septicaemia/septic Shock Increases the risk of recurrent miscarriage in subsequent pregnancy Maternal Death

21. REFERENCES Cunningham. Et al. 2014. Williams Obstetrics 24 th Edition . McGraw Hill Education. New York. Edmonds. K. 2007. Dewhurst’s Textbook of Obstetrics and Gynae cology. 7 th Edition . Blackwell Publishing, California Norwitz E, and John Scchorge. 2001. Obstetrics and Gynaecology at a Glance . Blackwell Science Ltd, Oxford. Gupta, L.C. et al. New Concise Medical Dictionary (5 th Edition ). 2011. AITBS Publishers, India https://calgaryguide.ucalgary.ca/ectopic-pregnancy/ WHO. 2015. Pregnancy, Childbirth, Postpartum and Newborn Care: A guide for essential practice. [Online] Available: https://www.ncbi.nlm.nih.gov/books/NBK326667/