ABORTIONS
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
DEFINITIONS OF ABORTION
1. Termination of pregnancy
before 28/40
2. Delivery of a fetus of weight
less than 500 grams
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 6th wk.
• 70% of first trimester losses are due to
chromosomal abnormalities
TYPES OF ABORTIONS
1.
2.
3.
4.
5.
6.
7.
8.
Induced
Threatened
Inevitable
Incomplete
Complete
Septic
Missed
Recurrent
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
INDUCED ABORTION – MEDICOLEGAL 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
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
2. THREATENED ABORTION
Refers to a stage in the abortion
that suggests potential
miscarriage may take place.
Symptoms
• Minimal or no lower abdominal pain or
cramps
• Slight abd pain
• Minimal draining of liquor
Threatened abortion cont
Signs
• Stable general condition
• Fundal height corresponds to
GA
• Cervix closed
Management of threatened abortion
1. Bed rest
– Avoid strenuous exercises
2. If GA > 16/40 give - tocolytics
3. INEVITABLE ABORTION
Refers to a stage in the
abortion when it is not
possible for the pregnancy to
continue.
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
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.
MANUAL VACUUM ASPIRATOR
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
Management of Incomplete abortion
Resuscitation: IV fluids: RL, NS
Blood grouping & Cross matching → BT if indicated
Evacuation
1.
2.
3.
–
–
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
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
Complications of septic abortions
Immediate cpx
Late cpx
• Haemorrhage
• PID
• Peritonitis
• Pelvic abscess,
endometritis,
• Septicemia,
• Septic/haemorrhagic
shock
• Pelvic adhesions
• 2° Infertility
• Chronic LAP
Management
1.
Resuscitation
–
2.
IV fluids: RL, NS
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
6. RECURRENT PREGNANCY LOSSES
• Defined as 3 or more consecutive
pregnancy losses
Other names:
• habitual abortions
• habitual miscarriage
• recurrent abortions
• recurrent miscarriages.
Aetiology of RPL
Aetiology: Can be established in only 30%
• Genetic Factors
• Endocrine Factors
• Anatomic Causes
– Congenital anomalies, in competencies,
• Infectious causes
• Immunologic problems