Prevention And Management Of Abortions And Its Complications

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

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

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Induced – an elective termination of abortion. 

Infected – abortion associated with infection of the genital tract.

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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
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Essentials of Diagnosis (S&S)
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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.
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Incomplete / Inevitable Abortion
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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
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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.
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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.
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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.
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Prevention
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Most abortion can not be prevented – result of chromosomal abnormalities
Study and treatment of maternal disorders before pregnancy.
Early obstetric care
Adequate treatment of diabetes and HPN
Protection of pregnant women from environment hazards to health and from exposure to rebulla and other infections diseases
Closure of incompetent cervix is effective in prevention of mid trimester abortion.