ABORTIONS

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ABORTIONS
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OBJECTIVES

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

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DEFINITIONS OF ABORTION

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

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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

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TYPES
TYPES OF ABORTIONS

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

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1. INDUCED ABORTION

• Intentional medical or surgical termination of a
  pregnancy
• Types
• Elective if performed for a womans desires
• Therapeutic if performed for reasons of
  maintaining health of the mother

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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

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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. Ashermans syndrome, etc
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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

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Threatened abortion cont

• Signs
• Stable general condition
• Fundal height corresponds to GA
• Cervix closed

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Management of threatened abortion

• Bed rest
• Avoid strenuous exercises
• If GA gt 16/40 give - tocolytics

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3. INEVITABLE ABORTION

• Refers to a stage in the abortion when it is not
  possible for the pregnancy to continue.

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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

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Management of Inevitable abortion

• Resuscitation IV fluids RL, NS
• Blood grouping Cross matching
• Evacuation
• MVA for GA lt 12/40
• Augment if the GA gt 12/40
• Oxytocin
• If some PoC remain after abortion manage like
  incomplete abortion.

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MANUAL VACUUM ASPIRATOR
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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

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Management of Incomplete abortion

• Resuscitation IV fluids RL, NS
• Blood grouping Cross matching ? BT if indicated
• Evacuation
• MVA for GA lt 12/40
• Augment if the GA gt 12/40
• Oxytocin
• If some PoC remain after abortion manage like
  incomplete abortion.
• 4. Antibiotics ampicilin, metronidazole
• 5. Analgesics

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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

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Complications of septic abortions

• Immediate cpx
• Haemorrhage
• Peritonitis
• Pelvic abscess, endometritis,
• Septicemia,
• Septic/haemorrhagic shock

• Late cpx
• PID
• Pelvic adhesions
• 2 Infertility
• Chronic LAP

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Management

• Resuscitation
• IV fluids RL, NS
• Insert urethral catheter
• Monitor Input/output
• Blood grouping Cross matching
• Antibiotics
• Preferably cephalosporins, if not available
  ampicilin and metronidazole
• Evacuation
• Haematenics

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6. RECURRENT PREGNANCY LOSSES

• Defined as 3 or more consecutive pregnancy losses
• Other names
• habitual abortions
• habitual miscarriage
• recurrent abortions
• recurrent miscarriages.

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Aetiology of RPL
Aetiology Can be established in only 30

• Genetic Factors
• Endocrine Factors
• Anatomic Causes
• Congenital anomalies, in competencies,
• Infectious causes
• Immunologic problems