ABORTION INEVITABLE ABORTION

CLINICAL CASE

• Mrs M aged 24 yrs and 11 weeks pregnant presented to the Emergency Department with abdominal cramping and heavy vaginal bleeding and clots. Over the past 2 days, she has experienced light spotting, which has increased in severity that morning. Mrs M reported no fever , chills, burning on urination, nausea or vomiting.

• Past obstetric H/o : G-4, P-2, A-1 she was receiving prenatal care from her

obstetrician. • Physical Examination: BP- 125/85 mm Hg Heart Rate- 83beats/min RR- 18 breaths/min O2 saturation- 100% on room air Lungs - were clear, s1 and s2 normal,

• PELVIC EXAMINATION: O/E- Moderate active bleeding was noted in

the vaginal vault with cx os open. Product of conception are felt through OS. No cervical motion tenderness or adnexal

tenderness was observed.

Diagnostic workup

• WBC – 10,000/uL (normal- 4,500-11,000)

• Hb - 13.7g/dl (normal 12.1-15.1)

• Hematocrit – 39.7% (normal 36%-44%)

• Blood Type- B+ve• Beta-HCG – 9400.0mlU/mL• TV USG- Appeared to be an abnormal G.Sac

near to cervical canal

Differential Diagnosis

• Cervical Abnormalities- Malignancy, polyps or trauma

• Ectopic Pregnancy• Idiopathic bleeding in a viable pregnancy• Infection of the vagina or cervix• Molar Pregnancy• Spontaneous Abortion• Vaginal Trauma

DISCUSSION

INTRODUCTION / DEFINITION

• TERMINATION OR LOSS OF PREGNANCY BEFORE THE AGE OF VIABILITY (28,24,22 wks or <500g)

• WHO- 24wks or 500g• In our environment- officially still 28 wks

• Significant public health problem, important cause of maternal mortality in the developing countries.

• Appox. 70,000 women die from complications of induced Abortions.

• Around 99% of deaths are due to unsafe procedures.

CLASSIFICATION ABORTIONS

SPONTANEOUSINDUCED

ISOLATED RECURRENT

THREATENED INEVITABLE COMPLETE INCOMPLETE MISSED SEPTIC

CAUSES

GENETIC FACTORS

INFECTION

ENDOCRINE AND METABOLIC FACTORS

IMMUNOLOGICAL FACTORS

ANATOMIC FACTORS

OTHERS

INEVITABLE ABORTION

DEFINITION & CLINICAL FEATURES

- It a clinical type where the change have progressed to a state from where continuation of pregnancy is impossible.

- Pregnancy cannot be redeemed and must be terminated

- vaginal bleeding with severe abdominal pain and dilatation of the cervix

MANAGEMENT• To take appropriate measures to look after the

general condition.• To accelerate the process of expulsion.• To maintain strict aseptic measures.

ACTIVE TREATMENT

Before 12 weeks

•D&E followed by CURETTAGE•Suction EVACUATION

After 12 weeks

• oxytocin drip 10 units in 5oo NS Acceleration of Uterine contraction

• Abdominal Hysterotomy

DILATATION AND EVACUATION

INSTRUMENTS

PROCEDURE

COMPLICATIONS• Injury to the uterine lining or cervix• Uterine Perforation• Moderate to Severe Bleeding ( tissue

remaining in Uterus) • Shock• Sepsis( endometritis, myometritis, pelvic

pertonitis)• Increased morbidity

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