12. Pathology
7 We Care
• Haemorrhage into the decidua basalis.
• Necrotic changes in the tissue adjacent
to the bleeding.
• Detachment of the conceptus.
• The above will stimulate uterine
contractions resulting in expulsion.
13. 7 We Care
ABORTION-DEFINITION
Termination of pregnancy before the fetus
is capable of extra-uterine survival i.e. 20
wks or 500gm birth wt
14. •
Types of abortion
Threatened abortion.
7 We Care
• Incomplete abortion.
• Complete abortion.
• Missed abortion
Septic abortion: Any type of
abortion, which is complicated
by infection
22. • History
CLINICAL APPROACH
7 We Care
• Examination
• Special Investigations
23. History
• VAGINAL BLEEDING
7 We Care
• Slight and bright red
• Associated with fleshy mass
• Associated with fowl smell and discharge
• Associated with grape like vesicle
• Sanguinous or dark coloured and continuous
• ‘White currant in red currant juice’
24. Pain abdomen
• Minimal
7 We Care
• Acute , agonising or colicky
• Shoulder pain
• Fever
25. Symptoms of early pregnancy
• Amenorrhoea
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• Morning sickness
• Frequency of micturition
• Breast discomfort
• Fatigue
26. • Hyperemesis
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• Breathlessness
• Thyrotoxic features
• Syncopal attack
27. • Careful menstrual history
7 We Care
• Previous cycles
• LMP
• Past history
• Similar episodes
• Infertility
• Details of contraceptive use
28. • Classical triad of ectopic pregnancy
7 We Care
– Amenorrhoea
– Pain abdomen
– Irregular vaginal bleeding
29. EXAMINATION
• General look
7 We Care
– Lies quiet and conscious, perspires and looks blanched
– Looks more ill than accounted for- molar pregnancy
30. • Temperature
VITALS
7 We Care
– Febrile/afebrile
• Pulse
– Tachycardia/normal
• Blood pressure
– Low/normal
34. • Trauma
7 We Care
• Cervical pathology
• Open cervical os-
incomplete abortion
35. • Bimanual examination
7 We Care
• Extreme tenderness on fornix palpation or rocking of
cervix
• Palpation of bilateral or unilateral enlargement of ovary -
molar pregnancy
• Palpation of adnexal mass- Ectopic pregnancy
43. 7 We Care
HYDATIFORM MOLE
(Snow storm appearance)
44. DIAGNOSIS
• Threatened abortion
7 We Care
– Positive UPT
– Intrauterine pregnancy
– Viable fetus
• Incomplete abortion
• Positive UPT
• Product of conception in-situ
• Non viable fetus
45. • Complete abortion
7 We Care
– Positive UPT
– Absent product of conception
• Ectopic pregnancy
– Positive UPT
– USG confirmation
– Product of conception absent in uterus
• Molar pregnancy
– Positive UPT
– Typical USG findings
46. Management of Threatened
Abortion 7 We Care
• Advise woman to avoid strenuous activity and sexual intercourse;
bed rest not necessary
• If bleeding stops, follow up in antenatal clinic. Reassess if bleeding
recurs
• If bleeding persists, assess for fetal viability.
47. Incomplete Abortion
7 We Care
• If bleeding light to moderate, use fingers or ring (or sponge) forceps to
remove products of conception protruding through cervix
• If bleeding heavy, evacuate uterus:
– Manual vacuum aspiration (MVA) is preferred method
– If evacuation not immediately possible, give ergometrine OR
misoprostol
47
48. Incomplete Abortion
7 We Care
• Infuse oxytocin 40 units in 1 L IV fluids at 40 drops/min. until expulsion of
products of conception occurs
• Evacuate any remaining products of conception from uterus by dilatation
and curettage
• If necessary, give misoprostol 200 µg vaginally every 4 hours until
expulsion
48
49. Management of Complete
Abortion 7 We Care
• Evacuation of the uterus usually not necessary
• Observe for heavy bleeding
• Ensure followup of woman after treatment
49
50. Follow up After Abortion
• Tell woman that spontaneous abortion is common
7 We Care
• Reassure woman that chances for subsequent successful pregnancy are
good
• Encourage her to delay next pregnancy until completely recovered
• Advise on contraception
51. Immediate Management of
Molar Pregnancy
• If diagnosis is certain, evacuate uterus:
7 We Care
– If cervical dilatation is needed, use a paracervical block
– Use vacuum aspiration (MVA preferred)
• Infuse oxytocin 20 units in I L IV fluids at 60 drops per min.
