Prevention And Management Of Abortions And Its Complications

Topics: Pregnancy, Childbirth, Obstetrics Pages: 20 (551 words) Published: July 10, 2015
Prevention and
Management of
Abortions and Its
Complications

Abortion
Pregnancy terminating before completing
20 weeks of gestation.
 Implies expulsion of the fetus as well as
any or all of the placenta or membranes.


Types










Spontaneous
Threatened
Inevitable
Complete
Incomplete
Missed
Recurrent
Induce
Infected

Spontaneous Abortion – Expulsion of all
products of conception before the 20 th
completed weeks of gestation.
 Threatened Abortion – Intrauterine
bleeding occurring before the 20 th
completed weeks of gestation, w/ or w/o
uterine contractions, w/o expulsion of the
product of conception and without
dilatation of cervix


Inevitable Abortion – intrauterine
bleeding before the 20th completed week
w/ continuous and progressive dilation of
the cervix but w/o expulsion of the product
of conception.
 Complete – Expulsion of all products of
conception before the 20th completed
weeks of gestation.
 Incomplete – some but not all of the
product of conception in the same interval.




Missed – Retention of a failed intrauterine
pregnancy for an extended period usually
defined as more that two menstrual cycle.



Recurrent – when the patient has more
than 2 consecutive or a total of 3
spontaneous abortions.



Induced – an elective termination of
abortion.



Infected – abortion associated with
infection of the genital tract.



Septic abortion in where there is infected
abortion with dissemination of infection.

Causes
Genetic factors (10-50%)
 Endocrine abnormalities (25-50%)
 Reproductive tract abnormalities (6-12%)
 Infection
 Maternal systemic disease such as
diabetes mellitus, hyperthyroidism
 Environment factors


Essentials of Diagnosis (S&S)








Suprapubic pain and uterine cramping
Vaginal bleeding
Cervical dilation
Extrusion of products of conception
Disappearance of symptoms and signs of
pregnancy
Negative pregnancy tests
Adverse ultrasonic findings (e.g. Gestational
sac, fetal disorganization. Lack of fetal growth)

Management and
Treatment

Threatened Abortion
Bed rest, avoid sexual intercourse and
observe the patient’s progress
 Mild sedative but drug therapy generally
ineffective in preventing abortion because
so many of these uncertain pregnancies
are abnormal.


Incomplete / Inevitable Abortion


D & C – to remove possible retained
placenta



Evacuate the uterus promptly; suction
curettage is most effective.

Complete Abortion
Patient should be observed for further
bleeding
 All product of conception should be
carefully examined for completeness and
characteristics


Missed Abortion
1st Trimester – suction curettage
 2nd Trimester – Evacuation, use
prostaglandin suppositories


Warning Signs After Abortion
(Infected or Septic)

Fever – 37.8-40 0C
 Hypothermia is suggestive of endotoxic
shock
 Malodorous discharge from vagina or cervix
 Pelvic and abdominal pain
 Marked suprapubic tenderness
 Tenderness with movement of the cervix or
uterus
 Jaundice secondary to septicemia.


Management of Septic / Infected
Abortion

Diagnostics – chest x-ray
 Out-patient care – antibiotics, oxytoxics
and fluid replacement
 Hospitalize patient if seriously ill
 D & C should be performed to make
certain that all the products of conception
have been removed.


Treatment – Complications of
Abortion

Coitus and douche are contraindicated
 Pelvic rest will decrease port abortal
infection
 When uterine rupture or perforation is
suspected – laparoscopy is indicated to
determine the extent of laceration and
bowel injury.
 Pelvic thrombophlebitis and septic
embolism; consider the use of antibiotics,
anticoagulants and ligation of internal and
ovarian veins.


Prevention








Most abortion can not be prevented – result of
chromosomal...
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