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Abortion

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Abortion (miscarriage) – PowerPoint PPT presentation

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Title: Abortion


1
Abortion (miscarriage)
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2
Definition
  • The termination of pregnancy before the 20th
    week, when the fetus weight is less than 1000
    grams.
  • Early abortion lt12th week of pregnancy
  • Late abortion 12th-20th week of pregnancy
  • Spontaneous abortion
  • Artificial abortion

3
Etiology
  • Genetic factors
  • chromosomal abnormal accounts 5060
  • of the early abortions
  • Numeral abnormalities
  • polyploidy, triploidy, monosomy
  • Structural abnormalities
  • break, translocation, deletion

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5
Etiology
  • Extrinsic factors
  • Chemical mercury, lead, cadmium,
  • smoking,
  • Physical
  • radioactive materials,
    noise,
  • hyperthermia

6
Etiology
  • Maternal factors
  • General diseases
  • infection, heart diseases, hypertension,
    anemia
  • Reproductive organic diseases
  • congenital uterine malformation, pelvic
    tumor, cervical incompetence
  • Endocrine disorders
  • LPD, hypothyroidism
  • Injuries

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8
Etiology
  • Defects in the developing placenta
  • Immunologic factors paternal histo-compatibility
    antigen , maternal cellular immunity regular
    disorder, deficiency of maternal blocking antibody

9
Pathology
  • The death of the embryo or rudimentary analog
  • Hemorrhage into the decidua basalis

  • Uterine contraction, dilation of the cervix
  • Expulsion of the products conception

10
Pathology
  • Before the 8th week of the pregnancy, the abortus
    can be expelled completely
  • During the 8th-12th week of the pregnancy,
    retention of the tissue is common
  • After the 12th week of the pregnancy, the abortus
    may be expelled totally

11
Clinical subgroups of abortion
  • Threatened miscarriage
  • Inevitable miscarriage
  • Incomplete miscarriage
  • Complete miscarriage

12
The developing processes of the abortion
Threatened miscarriage
Normal pregnancy
Inevitable miscarriage
Complete miscarriage
Incomplete miscarriage
13
Classifications and characteristics
conceptus Vaginal abdominal Cervix os Uterine Subgroups expulsion bleeding pain dilation enlargement
Threatened no - - compatible miscarriage Inevitable no - compatible or miscarriage smaller Incomplete part - smaller miscarriage Complete all - - - normal miscarriage
14
Alternative classification
  • Blighted ovum
  • Missed abortion

15
Classification of miscarriage
Blighted ovum
Normal pregnancy
Missed miscarriage
Threatened miscarriage
Inevitable miscarriage
Continuing pregnancy
Incomplete miscarriage
Complete miscarriage
16
Special subgroups Missed abortion
  • Expulsion of the conceptus does not occur
  • despite a prolonged period after embryonic
  • death.
  • Symptoms of pregnancy regress
  • Pregnancy test becomes negative
  • No fetal heart motion is detected
  • Uterine enlargement ceases

17
Special subgroupsRecurrent abortion
(Habitual abortion)
  • Three or more consecutive spontaneous losses
  • of pregnancy
  • First-trimester LPD, hypothyroidism, chromosomal
    abnormalities, immunologic factors
  • Second-trimester uterine malformations, cervical
    incompetence, myomas

18
Special subgroupsSeptic abortion
  • Any type of spontaneous miscarriage is
  • complicated by infection
  • Endometritis, parametritis, peritonitis
  • Fever, abdominal tenderness, uterine pain
  • Septicemia, septic shock

19
Diagnosis
  • History amenorrhea, symptoms of pregnancy,
    vaginal bleeding
  • Examination general and pelvic
  • Ultrasounograph
  • Pregnancy test, ß-HCG
  • Others

20
Differential diagnosis
  • Ectopic pregnancy
  • Molar pregnancy
  • Dysfunctional uterine bleeding (DUB)
  • Pelvic infective diseases (PID)
  • Acute appendicitis

21
Management
  • Threatened miscarriage
  • rest, follow-up
  • Inevitable incomplete miscarriage Evacuation
    of the uterus,vacuum or suction curettage,
    oxytocin iv, antibiotics
  • Complete miscarriage
  • no further therapy is necessary.

22
ManagementMissed miscarriage
  • First- trimester
  • suction curettage
  • The second-trimester
  • DE(dilation and evacuation)
  • DC(dilation and curettage)
  • Induction of labor with intravaginal
    prostaglandin E2 or misoprostol

23
ManagementRecurrent miscarriage
  • A workup for possible causes of recurrent
    pregnancy loss (RPL) anatomic,
    hormonal,genetic,and autoimmune factors
    (underlying maternal factors)
  • Incompetent cervix cerclage designed to
    reinforce the cervix at the level of the internal
    os at the end of the first trimester, the suture
    is removed after 37 weeks gestation

24
ManagementSeptic miscarriage
  • Evacuation of the uterus within a few hours after
    antibiotics iv
  • High-dose, broad-spectrum coverage antibiotics,
    aggressive use before, during, and after removal
    of necrotic tissue by curettage
  • hysterectomy

25
Summary points
  • The most frequent etiology of miscarriage is a
    chromosomal abnormality of the conceptus and most
    of the abortions occur in the first-trimester.
  • The processes of the pathology decide the
    characteristics of the subgroups.
  • Ultrasound is helpful in diagnosis.

26
Problem-based learning (1)
  • A 22 year old women attends you with a 12 h
    history of vaginal bleeding accompanied by
    cramping lower abdominal pain. She has had 6
    weeks amenorrhoea and tells you that she recently
    used a urinary pregnancy test from her local
    pharmacy the test proved to be positive. She has
    had no previous pregnancies and was using no
    contraception.

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30
Problem-based learning (2)
  • What is the differential diagnosis?
  • What features would you look for on examination?
  • What investigations, if any, are required?

31
Problem-based learning (3)
  • On examination you find no abnormality on
    abdominal palpation and in particular, no
    tenderness. On vaginal examination, however, you
    find blood clot in the vagina and products of
    conception are present in the cervix, which is
    dilated. What is the diagnosis and how would you
    manage the situation?

32
Figure them out
  • May the miscarriage be converted in inevitable
    miscarriage?
  • What is the common important procedure of the
    management in inevitable, incomplete and missed
    miscarriage?

33
The End
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