abortion ppt
TRANSCRIPT
Mujib Ur RahmanMujib Ur Rahman
Termination of pregnancy, either
spontaneously or intentionally
prior to 20 weeks’ gestation or less than 500-g birth weight
The early abortion: occurs before 12w The late abortion: occurs after 12w
Abortion occurring without medical or mechanical means to empty the uterus is referred to as spontaneous
Another widely used term is miscarriage
>80 percent occur in the first 12 weeks AOG
At least half result from chromosomal anomalies
After the first trimester, both the abortion rate & the incidence of chromosomal anomalies decrease
Etiology
The risk of spontaneous abortion increases with
parity as well as with maternal and paternal age
The frequency of abortion increases from 12 percent in women younger than 20 years to 26 percent in those older than 40 years
If a woman conceives within 3 months following a term birth
→ incidence of abortion ↑
Hemorrhage into the decidua basinalis, followed by
necrosis of tissues adjacent to the bleeding If early, the ovum detaches, stimulating uterine
contractions that result in its ovulation Gestational sac is opened , fluid surrounding a small
macerated fetus or alternatively no fetus is visible → blighted ovum
Spontaneous abortion Pathology
In later abortion, the retained fetus may undergo
maceration The skull bones collapse, the abdomen distends with
blood-
stained fluid, and the internal organs degenerate The skin softens and peels off in utero or at the
slightest tough
When amnionic fluid is absorbed, the fetus may
become compressed and desiccated → fetal compressus
The fetus become so dry and compressed that it resembles parchment - a fetus papyraceous
Abnormal zygotic development
Early spontaneous abortion commonly display a developmental abnormality of the zygote, embryo, early fetus, or placenta
Spontaneous abortion –factors Fetal factors
Aneuploid abortion - Autosomal trisomy The most frequently identified chromosomal anomaly
associated with first-trimester abortionsAutosomes 13, 16, 18, 21, and 22 – most common
Spontaneous abortion - Fetal factors
Monosomy X
The second frequent chromosomal abnormality Usually results in abortion
Triploidy
Associated with hydropic placental (molar) degeneration
Incomplete (partial) hydatidiform moles may contain triploidy or trisomy for only chromosome 16
Spontaneous abortion - Fetal factors
Infections
Uncommon causes of abortion in human
Listeria monocytogenes Clamydia trachomatis Mycoplasma hominis Ureaplasma urealyticum Toxoplasma gondii
Spontaneous abortion – Maternal factors
Chronic debilitating diseases Celiac sprue
Spontaneous abortion – Maternal factors
Endocrine abnormalities
Hypothyroidism
Diabetes mellitus
Progesterone deficiency
Spontaneous abortion – Maternal factors
Drug use and environmental factor
Tobacco ↑ Risk for euploid abortion More than 14 cigarettes a day → the risk twofold
greater ↑AlcoholCaffeine
Immunological factors – alloimmune factors
Allogeneity Human fetus is allogenic transplant tolerated by mother
Spontaneous abortion – Maternal factors
Uterine defects – acquired uterine defects
Uterine leiomyoma : Uterine synechiae (Asherman syndrome)
Incompetent cervix Painless dilatation of cervix in the 2nd or early in the
3rd trimester → prolapse & ballooning of membranes into vagina → rupture of membrane & expulsion of immature fetus
Spontaneous abortion – Maternal factors
Little is known in the genesis of spontaneous
abortion
Chromosomal translocations in sperm can lead to abortion
Spontaneous abortion – Paternal factors
(1) Threatened abortion (2)Inevitable abortion (3)Incomplete abortion (4)complete abortion (5)Missed abortion (6)Habitual abortion (7)Septic abortion(infect abortion)
Clinical classification /differential's
Threatened Inevitable Imcomplete Complete
History
Bleeding Slight Middle→ severa Slight→ severa Slight→ no
Abdominal pain No/slight Aggravate Decrese No
Tissues are expelled No No Yes(partial) Complete
Gynecologic examination
Cervical os Close Open Open/tissue blochk Close
Uterine size Consistent with =/slight small < =/slight larger
Pregnancy test + +/- +/- +/-
Treatment principle Protect fetus Curettage Curettage no
INDUCED ABORTION
The medical or surgical termination of pregnancy
before the time of fetal viability
Therapeutic abortion
Termination of pregnancy before of fetal viability for the purpose
of saving the life of the mother
Induced abortion
Elective (voluntary) abortion
Interruption of pregnancy before viability at the request of the women, but not for reasons of impaired maternal health or
fetal disease
Induced abortion
Septic abortion manifested by fever, malodorous vaginal discharge,
pelvic and abdominal pain, and cervical motion tenderness.
Most often associated with criminal abortion Metritis is usual outcome, but parametritis, peritonitis,
endocarditis, and septicemia may all occur
Consequences of elective abortion
Dilatation and curettage
Performed first by dilating the cervix & evacuating the product of conception Mechanically scraping out of the contents (sharp curettage) Vacuum aspiration (suction curettage) Both
Before 14 weeks, D&C or vacuum aspiration should be performed
After 16 weeks, dilatation & evacuation (D&E) is performed Wide cervical dilatation Mechanical destruction & evacuation of fetal parts
Surgical techniques for abortion
Ovulation may resume as early 2 weeks after an
abortion
Therefore, if pregnancy is to be prevented, effective contraception should be initiated soon
after abortion
Resumption of ovulation after abortion