Abortion - Presented By Mohammed Haroon Rashid
- 1. ABORTION
- 2. INTRODUCTION • Abortion is the ending of pregnancy by removing a fetus or embryo before it can survive outside the uterus.an abortion that occurs spontaneuosly is also known as a miscarrage. An abortion may be caused purposely & its then called an induced abortion
- 3. DEFINITON According to K. Nilam Abortion is termination of pregnancy by any means before the fetus is sufficiently developed to survive. According to Nina Bhaskar An abortion is the premature expusion of products of conception from uterus.It can be either spontaneous or induced
- 4. INCIDENCE The number of abortion performed world wide with 41.6 million having been performed in 2003 and 43.8 million in 2008. Abortion percentage of known pregnancies was at 28% worldwide with 26% in developed countries and 28% in developing countries. 38,000 Death from unsafe abortion annually worldwide.
- 5. ANATOMY AND PHYSIOLOGY OF UTERUS
- 12. ETIOLOGY SMOKING
- 13. PATHOPHYSIOLOGY Due to etiological factor like Genetic Trisomy chromoses are most common chromosomal anomaly Insufficient harmonal level Result in spontaneous miscarriage before 10 weeks of gestation
- 14. MECHANISM OF MISCARRAGE • In the early weeks death of the ovum occurs first followed by its expulsion in the later weeks maternal environmental factor are involved leading to expulsion of the fetus which may have signs of life but is too small
- 15. BEFORE 8 WEEKS The ovum surrouded the villi with the decidual covering is expelled out intact sometimes the external or fails to dilate to that dialated cervical canal and is called cervical miscarriage
- 16. BEFORE 8 TO 14 WEEKS Expulsion of the fetus commonly occurs leaving behind the placenta and the membranes. A part of it may be partially seprated with brisk hemorrahage or remains totally attached to the uterine.
- 17. 1.CLINICAL TYPE OF MISCARRIAGE Threatened Miscarriage :- It is a clonical entity where the process of miscarriage has started but has not progressed to a state from which recovery is impossible. CLINICAL FEATURE:- 1. Bleeding per vagina 2. Pain 3. History of Amenorrhea 4. Uterus soft
- 18. INVESTIGATION Blood:- ABOandRh grouping. Urine :- For immunological test of pregnancy is not helpful as the test remains positive for a variable period evenafferthefetaldeath. Ultrasonography:- Observationof thefetalcordination.
- 19. TREATMENT The patient should be in bed for few days until bleeding stops. Prologed restriction of activity has got no therapeutic balue. Drugs – Relief of pain may be ensured. Diazepam 5mg tablet twicedaily. Prgestrone supplement are given if progesteron dificiency is suspected to be the case of the threatened abortion. HCG humanchoriowgonatrophin injectioncanalsp prescribed.
- 20. 2.CLINICAL TYPE OF MISCARRIAGE Inevitable Miscarriage :- It is the clinical type of abortion where the change have progressed to a state from where continuation of pregnancy is impossible. External os open and bleeding. Conception products are not expelled. CLINICAL FEATURE:- 1. Increase vaginal bleeding 2. Pain 3. Hypotension 4. Tachycardia 5. pallor
- 21. INVESTIGATION Bloodgroup &Cross matching. Haemoglobin WBC,total&defferential Ultrasonography.
- 22. TREATMENT The aim of treatment is to prevent further pain and bleeding by emptying the uterus as early as possible. Resuscitation with IV fluids & blood if patient is in shock. Antibiotics. Tetnus toxoid & anti D for Rh negative mother.
- 23. TREATMENT
- 24. 3.Clinicaltype of miscarriage Complete Miscarriage:- In complete abortion the products of conception are expelled completely from the uterus and the uterine cavity is empty CLINICAL FEATURE:- Subsidence of abdominal pain. Vaginal bleeding becomes trace or absent Lower abdominal pain & vaginal bleeding with passage of a fleshy mass. Cervical as is closed. Uterus is smaller than the period of gestation on internal examination.
- 25. INVESTIGATION Ultrasonography :- Uterinecavity foundempty. TREATMENT Sedatives. Haematincs itblood losswassignificant. Tetanus toxiod Rarelycurettage maybe necessary ifbleedingcontinuous. Rh Negative mother :- A Rh negative mother with out antibody in her system should be protected by anti D gamma globulin 50 Mg to 100 mg intramusculary incase of earlymiscarriage.
- 26. 4.Clinical type of miscarriage Incomplete Miscarriage :- When the entire products of conception are not expelled instead a part of it is left inside the uterine cavity, It is called incomplete miscarriage. CLINICAL FEATURE:- Variable period of amenorrhea. Vaginal bleeding continuos or recurrent Passage of fleshy mass per vagina Lower abdominal pain of colicky nature Uterus smallest than the period of amenorrhea Internal or open may be found soft.
- 27. INVESTIGATION Ultrasonography Blood group and crossmatching. Wbc MANAGEMENT Resuccitation ifpatientisinshock withintravenous fluidand blood. In recent cases :- Dilation & Curretage to empty the uterus using blunt curreteunder generealanesthesia. Inold cases :- Suction curettege underantibiotic cover. Tetnus toxoid Anti Dto Rhnegative mother. Haemotinics toCorrectanemia.
- 28. 5.CLINICAL TYPE OF MISCARRIAGE Missed Carriage :- When the fetus is dead & retained inside the uterus for a variable period, It is called missed Miscarriage or early fetal demise. The patient usually comes with a complaint of missed menstrual periods for a month or two. CLINICAL FEATURE:- 1. Persistence of brownish vaginal discharge 2. Subsidence of pregnancy symptoms. 3. Retrogression of breast change. 4. Immunological test for pregnancy become negative. 5. Cervix feel firm
- 29. INVESTIGATION Pregnancytest becomes negative. Ultrasonography. MANAGEMENT Progestaglandin E1analog Oxytocin
- 30. 6.CLINICAL TYPE OF MISCARRIAGE Septic Abortion :- Any abortion associated with clinical evidence of infection of the uterus & its contents is called clinical abortion. CLINICAL FEATURE:- The common looks sick & anxious. Temperature >38c Abdominal pain Diarrhea & Vomiting Tachypnea RR > 20/min
- 31. INVESTIGATION Complete blood count Urinalysis Vaginalswabs Bloodculture whensepticemiais suspected. Blood gas analysis in severecases Pelvic USG
- 32. MANAGEMENT GENERALMANAGEMENT:- HOSPITALIZATION To take high vaginal or cervical swab VAGINAL EXAMINATION
- 33. MANAGEMENT GRADE – I Drugs :- Antibiotics Analgesics & Sedations Blood transfusion is given t GRADE– II Anti microbialtherapy Clindamycin Gentamycin Metronidazole
- 36. GRADE– III Drugs :- Antibiotics Supportive theroy The laparotomy should be doneby experienceof the uterusshould be doneirrespetive of parity. MANAGEMENT
- 37. Unsafe abortion is defines as the procedure of termination of unwanted pregnancy either by 90% person lacking the necessary skills or in an environment lacking the minimal standard or both. About 90% of unsafe abortion are in the developing countries comparising 13% of all maternal death ( WHO 1998).
- 38. Unsafe abortion is defines as the procedure of termination of unwanted pregnancy either by 90% person lacking the necessary skills or in an environment lacking the minimal standard or both. About 90% of unsafe abortion are in the developing countries comparising 13% of all maternal death ( WHO 1998).
- 39. In practice the following are the indication for termination under the MTP act :- o To save two life of the mother. o Social indication :- To prevent grove injury to the physical & mental health of the pregnant woman. o Eugenic :- These is done under the provision of sustantial risk of the child being born with serious physical & mental abnormalities.
- 40. METHOD OF TERMINATION OF PREGNANCY MEDICAL :- MIFEPRISTONE MIFEPRISTONE & MISOPROSTOL PGE METHOTRERATE & MISOPROSTOL TANOXIFEN & MISOPROSTOL FIRST TRIMESTER (UP TO 12 WEEKS
- 41. SURGICAL VACCUM ASPIRATION MVA/EVA DILATION & EVACUATION SUCTION EVACUATION & OR CUROTTAGE METHOD OF TERMINATION OF PREGNANCY
- 42. METHOD OF TERMINATION OF PREGNANCY PROSTAGLANDINS PGE DIALATION & EVACUATION OXYTOCIN INFECTION HYSTRECTOMY (ABDOMINAL) SECOND TRIMESTER (UP 13-20 WEEKS
- 43. SURGICAL ABORTION, DIALATION & EVACUATION
- 44. NURSINGMANAGEMENT Complete bed rest is essential. Assess for sign of shock. Diet :- Fresh fruit pulses cereals whose grain fresh veget. Give the education to avoid the alcohol smoking refined foods. Avoid heavy work of lifting or heavy exercise.
- 45. THANK YOU…