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Abortion

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Abortion Dr. F Mardanian MD . Definition Abortion is termination of pregnancy before 20 weeks of gestation and the fetal weight is less tan 500g. – PowerPoint PPT presentation

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Title: Abortion


1
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2
Abortion
  • Dr. F Mardanian MD

3
?. Definition
  • Abortion is termination of pregnancy before 20
    weeks of gestation and the fetal weight is less
    tan 500g.
  • Abortion spontaneous 10
  • The early abortion occurs before 12w
  • The late abortion occurs after 12w

4
  • Miscarriage 8-20 ? under 20w
  • ?
  • 80 infirst 12 w
  • Subclinical ? 13-26 of all pregnancies

5
Risk factors
  • Age overall rate 11 20-30y?17
  • clinically SAb 35y ?20
  • 40 y ?40
  • 45 ?80
  • Previous SAb
  • 5 ? in first pregnancy
  • 20 ? after one miscarriage
  • 28 ? after 2 consecutive miscarriage
  • 43 ? after 3 consecutive miscarriage

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  • Heavy smoking (gt10/d)
  • Vasoconstrictive, antimetabolic effect
  • paternal smoking
  • Alcohol
  • Gravidity
  • Cocain

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  • NSAIDs (but not acetaminophen)
  • Fever gt 37/78c ? (euploid not aneupleid
    abortion)
  • Caffeine 100-300mg/d
  • Proloned ovulation to implantation interval
    (gt10d)
  • Prolonged time to pregnancy
  • Low plasma folate levels
  • Maternal weight
  • BMIlt18/5kg/m2
  • BMIgt25 kg/m2
  • Celiac Dis

8
Etiology
  • 1/3 ? before 8w ?blighted (anembryonic),
  • 2/3 with embnyo ?
  • Chromosomal abnormalities ? 50 all miscarrage
    (most are aneuploidies)
  • Autosomal ? 52
  • Monosomy X ? 19
  • Polyploidies ? 22
  • Other ? 7

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  • Congenital anomalies
  • Tratogens (D.M-Drug fever chemicals)
  • Genetic
  • Trauma
  • (CVS Amniocentesis)

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  • Host factors
  • Uterine anomaly
  • Acute maternal infections (TORCH-Listeria)
  • Maternal endocrinopathies (thyroid cushings yn
    -pco - thrombophilia)
  • Unexplained

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3.Pathologic change
  • Most commonly, necrotic changes occur in the
    decidual tissue about the placentation site and
    result in hemorrhage into this area. As bleeding
    continues, the sac and the placenta become
    detached from the uterine wall and are expelled
    by uterine contractions.

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4.Clinical classification and feature
  • (1) Threatened abortion
  • (2)Inevitable abortion
  • (3)Incomplete abortion
  • (4)complete abortion
  • (5)Missed abortion
  • (6)Habitual abortion
  • (7)Septic abortion(infect abortion)

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Differential diagnosis of varied abortions
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Missed abortion
  • It is that pregnancy has been retained for 2
    months or more following death of the fetus.
  • The abnormally protracted retention of a dead
    fetus in uterus in over 2 months that dont
    expelled.
  • Missed abortion is manifested by loss of symptoms
    of pregnancy and decrease in uterine size.

15
Habitual abortion(recurrent)
  • Recurrent, or habitual, is the sequential 3 or
    more spontaneous abortion.
  • Every abortion times is or not same month of
    pregnancy.

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Early cause
  • ?hypofunction of corpus luteum
  • ?emotion factor
  • ?hypopituitarism
  • ?chromosomal abonormalities

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Late abortion
  • (1)incompetence of the cervix
  • (2)congenital anomalies of the uterus
  • (3)myomas of the uterus
  • (4)blood type incompatibility between mother and
    fetus

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5. Diagnosis
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(1)History
  • ?amenorrhea, recurrent abortion symptoms of
    pregnancy
  • ?the degree of abdominal pain, vaginal bleeding
  • ?the products of gestation were expelled or not

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(2)Examination
  • ?general examination temperature , pulse,
    respiration, blood pressure.
  • ?vaginal examination
  • uterine size compared to the expected
  • date of pregnancy
  • cervical os open or close
  • uterine tendeness

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(3)anxillary examination
  • ?pregnancy test HCGlt625IU/L?abortion
  • ?measurement of HPL
  • 510w hpl0.01mg/L
  • ? measurement of E2(estroid)
  • E2lt740pmol/L
  • ?measurement of pregnanediol
  • 24h urinarylt15.6µ/24h, 95?abortion

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  • ?B-ultrasound
  • differential of varieties of abortion
  • gestation sac, embryo status, fetal heart
    tones, fetus movement
  • Incompetence of the cervix, cervical
    osgt19mm and have history of abortion

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  • Normal pregnancy

  • incomplete septic
  • threatened inevitable
    infection
  • proceed complete
  • delaied
  • treatment
  • missed habitual

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6. Treatment
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(1)Threatened abortion
  • Principle protect fetus treatment
  • ?bed rest
  • forbid sexual intercourse
  • ?drug
  • folic acid 5mg tid. Po.
  • If corpus luteum or low of uterine
    pregnanediol progesterone 20mg Qd. Im.
  • VE 3050mg Qd po.
  • Seditive valium 2.5mg po.

26
(2)Inevitable and incomplete abortion
  • At once DC(curettage) dilatation
  • if bleeding is brisk blood transfusion
  • oxytosin
    510u iv/im
  • incomplete abortion antibiotic used for
    preventive infection
  • tissue examination by a pathologist

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(3)Complete abortion
  • When the uterus is empty, there are no need for
    further interference.

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(4)Missed abortion
  • After diagnosis of it ,as soon as expelled
    product of conception is necessary.
  • Because the fetus dead, placenta release
    thrombocinatse into blood circulation ease occure
    in coagulability.lead to disseminated
    intravascular coagulation(DIC)

29
  • ?leveral uterine sentition
  • DES(diethylstibestrol)510mg tid po 5d
  • ?before curettage, preparey blood
  • during opreation oxytocin 10u im/iv
  • over than 3 month of pregnancy artificial
    inducte.

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(5)Habitual abortion
  • The first should be examinatin cause of habitual
    abortion and treatment.
  • 1)rest, increase nutrition,
  • 2)medical treatment hypofunction of corpus
    luteum--progesterone
  • 3)surgical treatment
  • ?correction of congenital anomalies of
  • uterus,removed of myomas
  • ?repair of the incompetent cervix.1220w

31
(7)Septic abortion
  • The principle of treatment
  • bleeding is a few first treat infection with
  • broad-spectrum
    antibiotiss
  • second DC
  • bleeding is sever

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  • ?The producte of conception from the cervix are
    removed with a sponge holder.
  • Dont used curette to curettage uterine wall
    prevent infection
  • avoid hematogeous dissemination of the infection.

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