case discussion of Inevitable Abortion

1. ABORTION
INEVITABLE ABORTION

2. 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.

3. • 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,

4. • 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.

5. 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

6. 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

7. DISCUSSION

8. 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

9. • 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.

10. CLASSIFICATION
ABORTIONS
SPONTANEOUS
INDUCED
ISOLATED RECURRENT
THREATENED INEVITABLE COMPLETE INCOMPLETE MISSED SEPTIC

11. CAUSES
GENETIC FACTORS
INFECTION
ENDOCRINE AND METABOLIC FACTORS
IMMUNOLOGICAL FACTORS
ANATOMIC FACTORS
OTHERS

12. INEVITABLE ABORTION

13. 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

14. MANAGEMENT
• To take appropriate measures to look after the
general condition.
• To accelerate the process of expulsion.
• To maintain strict aseptic measures.

15. ACTIVE TREATMENT
•D&E followed by
CURETTAGE
•Suction EVACUATION
Before
12 weeks
• oxytocin drip 10 units in
5oo NS Acceleration of Uterine
contraction
• Abdominal Hysterotomy
After 12
weeks

16. DILATATION AND EVACUATION

17. INSTRUMENTS

18. PROCEDURE

19. 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

20. THANK YOU