ABORTION 2.pptx

7/28/2019 ABORTION 2.pptx

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- Termination of pregnancy beforethe fetus develops sufficiently tosurvive

- Terminatio prior to 20 weeksgestation or less than 500g

birthweight

Definition


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1. Spontaneous

2. Induced

Classification


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- Occur without medical ormechanical means to empty theuterus

- Miscarriage

Spontaneous Abortion


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Etiology:- 80% occur in first 12 weeks (50%

from chromosomal abnormalities)- Increases with- Parity

- Maternal and paternal age- Conception within 3 months after aterm birth

Spontaneous Abortion


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1. Abnormal zygotic development- Of 1000 spontaneous abortions, half

demonstrated degenerated or absent

embryos, that is, blighted ova Hertig and Sheldon (1943)

- Morphological disorganization of growth in40% of abortuses that were expelledspontaneously before 20 weeks

- Poland and Co-workers (1981)

Fetal Factors


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2. Aneuploid Abortion- Autosomal trisomy MC

- Monosomy X (45,X)- Triploidy molar pregnancy

3. Euploid Abortion- abort later in gestation

Fetal Factors


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1. Infections- Mycoplasma hominis- Ureaplasma urealyticum

- Treponema pallidum- HIV-12. Endocrine Abnormalities

- Hypothyroidism- DM- Progesterone deficiency

Maternal Factors


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3. Nutrition- Dietary deficiency of one or more

nutrients may cause abortion

3. Drug use and Environmental Factors- Tobacco- Alcohol

- Caffeine- Radiation- Contraceptives

Maternal Factors


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4. Immunologic Factors- Antiphospholipid Antibodies: Lupus anticoagulant

and Anti cardiolipin antibodies- Placental thrombosis and infarction- Prostacyclin and Protein C inhibition

5. Inherited Thrombophilia

6. Laparotomy

7. Physical Trauma

- contributes minimally to incidence of abortion

Maternal Factors


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8. Uterine DefectsAcquired Uterine Defects

- Leiomyomas does not usually cause abortion

- Ashermans syndrome uterine synechiae , usuallyresults from destruction of large areas of endometrium by curettage

Developmental Defects- Abnormal mullerian duct formation

Maternal Factors


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9. Incompetent Cervix- painless cervical dilatation with prolapse and

ballooning of membranes into the vagina

followed by expulsion of an immature fetus- previous trauma, abnormal development

- Cerclage

Maternal Factors


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Chromosomal abnormalities in sperm have beenassociated with abortion

Paternal Factors


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1. Threatened Abortion- Bloody vaginal discharge or bleeding through a

closed cervical os during the first half of pregnancy

- With lower abdominal pain and persistently lowback pain

- Bleeding anterior rhythmic crampy pain

- DDx: Ectopic pregnancy, Inevitable abortion,endocervical polyp, cervical lesions- Bed rest, Acetaminophen-based analgesics

Categories of Spontaneous abortion


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2. Inevitable Abortion- Gross rupture of membranes in the presence

of cervical dilatation

- Pain, fever, or bleeding- Tx: Prompt evacuation by curettage



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3. Complete and Incomplete Abortion- Placenta detaches from uterus causes bleeding

- Complete: complete detachment andexpulsion of the conceptus with cervix closed

- Incomplete: retained products of conceptionwith cervix remained open

- Tx: Evacuation extraction using forceps orsuction curettage



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3. Missed Abortion- Uterus retains dead products of conception

behind a closed cervix for days or even weeks

- Uterine and breast changes of pregnancyregress

- May terminate spontaneously expulsion of

the abortus



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5. Recurrent or Habitual Abortion- 3 or more consecutive spontaneous abortions

- Occur in 0.3 0.4% of women

- Autoimmune disorders and parentalcytogenetics

- Prognosis: Majority of women who attemptpregnancy after being diagnosed withrecurrent abortion will have successfuloutcomes, with or with out treatment



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Definition- The medical or surgical termination of

pregnancy before the time of fetal viability

Indications:- Persistent heart disease, advanced

hypertensive vascular disease, invasive

carcinoma of the cervix

Induced Abortion


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Surgical Techniques1. Dilatation and Curettage- Dilating the cervix

- Evacuating pregnancy by mechanicallyscraping out the contents (sharp curettage), bysuctioning out the contents (suctioncurettage), or both.

- Vaccum aspiration MC form of suctioncurettage

- < 16 weeks

Induced Abortion


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Surgical Techniques1. Dilatation and Curettage

- > 16 weeks : Dilatation and Evacuation widemechanical dilatation by metal or hygroscopicdilators.

- Dilatation and Extraction : suction evacuation of extracranial contents after delivery of fetal body,minimizes uterine or cervical injury (partial birthabortion)

Induced Abortion


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Surgical TechniquesHygroscopic Dilators

- Devices that slowly dilates the cervixminimizing trauma from mechanical dilatation

- Draw water from cervical tissues and expandgradually dilating the cervix

- Laminaria digitata, Laminaria japonica,

Induced Abortion


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Medical Induction of Labor1. Early Abortion

- Mifepristone ( antiprogestin), Methotrexate

( antimetabolite): increase uterine contractility byreversing the progesterone-induced inhibition of contractions

- Misoprostol (prostaglandin): direct myometriumstimulation

Induced Abortion


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Medical Induction of Labor2. Second-Trimester Abortion

- Oxytocin: Given as single agent in high dose,

mixed with isotonic solution- Prostaglandin E2 : 20mg suppositories placed in

the posterior vaginal fornix, nausea and vomiting,fever and diarrhea

- Prostaglandin E1 : Misoprostol

Induced Abortion


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Consequences of Elective AbortionSeptic Abortions

- Usually caused by pathogenic organisms of vaginal flora and bowel: Anaerobic bacteriaand coliforms

- Diagnostic Criteria Fever (38 C or higher) for 24 hrs History of Mechanical interference Discharge from the cervix Tenderness of the Uterus, parametrium or adnexae

Induced Abortion


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- Treatment:- Prompt intravenous evacuation of broad

spectrum antimicrobial followed by evacuationof products of conception

Induced Abortion


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- Treatment:- Prompt intravenous evacuation of broad

spectrum antimicrobial followed by evacuationof products of conception

Induced Abortion

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ABORTION 2.pptx

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