This document discusses abortion and miscarriage. It defines abortion as the expulsion of an embryo or fetus weighing 500 grams or less that is not capable of survival outside the womb. It notes that 10-20% of clinical pregnancies end in abortion, which can be spontaneous, induced, threatened, inevitable, complete, incomplete, missed or septic. The main causes of first trimester abortion are listed as genetic/chromosomal abnormalities (50%), endocrine factors (10-15%), anatomical factors (10-15%), infections, immunological factors, and other maternal medical illnesses. Signs and symptoms, investigations, management, and complications of different abortion types are described in detail.
2. Abortion (miscarriage)
Expulsion or extraction from its mother of
an embryo or fetus weighing 500 gm or
less when it is not capable of independent
survival.
10. PROCESS OF ABORTION HAS STARTED BUT NT
PROGRSSED TO A STATE FROM WHERE
RECOVERY IS IMPOSSIBLE
SYMPTOMS
SLIGHT PV BLEED
BRIGHT RED IN COLOR
DULL ABDOMINAL/ BACK PAIN
11. P/S – BLEEDING + FROM EXTERNAL OS
P/V – CERVIX CLOSED
UTRUS- SOFT, CORRESPONDS TO GA
D/D – CERVICAL LESIONS LIKE EROSIONS AND
POLYP
12. BLOOD – HAEMATOCRIT AND BL GRP &TYPNG
USG – TO CONFIRM INTRA UTERINE VIABLE
PREGNANCY
13. REST
MONITOR VITAL AND VAGINAL BLEEDING
60-70% CONTINUS FOR >28 WEEKS
HIGH RISK FOR PRETERM LABOR,
IUGR, PLACENTA PREVIA, FETAL ANOMALIES
30% - INEVITABLE/ MISSED ABORTION
14. PROCESS OF ABORTION HAS REACHED A STAGE
FROM WHERE CONTINUATION OF PREGNANCY
IS NOT PPOSSIBLE
SYMPTOMS- PV BLEED & PAIN ABDOMEN
SIGNS –
GC DEPENDS ON AMOUNT OF BLOOD LOSS
DILATED INTERNAL OS- PRODUCTS FELT
THROUGH THE OS
MEMBRANES MAY BE RUPTURED
15. IMPROVE GC
IV FLUIDS
BLOOD TRANSFUSION PT IS IN SHOCK
EVACUATION OF PREGNANCY
<12WKS- DILATATION AND EVACUATION
>12WKS- T.MISOPROST 400MG 4HRLY IN 3
DOSES
OXYTOCIN DRIP 10U IN NS
IF PLACENTA IS RETAINED- EVACUATION UNDER
ANAESTHESIA
16. PRDUCTS OF CONCEPTION HAVE BEEN
EXPELLED EN MASS
H/O EXPULSION OF FLESHY MASS F/B
SUBSIDANCE OF PAIN ABDOMEN AND PV BLEED
UTERUS SIZE SMALLER THAN PERIOD OF
AMENORRHOEA
UTERUS FIRM
CERVIX CLOSED
17. PRODUCTS OF CONCEPTION HAVE BEEN
PARTLY EXPELLED FROM THE UTERINE CAVITY
H/O EXPULSION OF FLESHY MASS
PAIN ABDOMEN AND PV BLEED PERSISTS
UTERUS SIZE SMALLER THAN PERIOD OF
AMENORRHOEA
CERVIX PATULOUS
18. COMPLICATIONS
• PROFUSE BLEEDING
SEPSIS
PLACENTAL POLYP
MANAGEMENT
CORRECTION OF SHOCK – IVF, BLOOD
TRANSFUSION
IV ANTIBIOTICS
EVACUATION OF UTERUS
19. FETUS IS DEAD AND RETAINED INSIDE UTERINE
CAVITY FOR VARIABLE TIME
PATHOLOGY
BEFORE 12 WKS- CLOTTED BLOOD WITH
OVUM FORMS CARNEOUS/ FLESHY MLE
AFTER 12WKS- FETUS BECOME MACERATED
LIQUOR GETS ABSORBED
PLACENTA BECOMES PALE
20. SYMPTOMS
ABDOMINAL PAIN
BROWNISH VAGINAL DISCHARGE
SUBSIDANCE OF PREGNANCY CHANGES
SIGNS
RETROGRESSION OF BREAST CHANGES
UTERUS BECOMES SMALLER IN SIZE
ABSENT FHS
CERVIX FIRM
34. SURGICAL TREATMENT OF ANOMOLIES
METROPLASTY
HYSTEROSCOPIC RESECTION OF
INTRAUTERINE SEPTUM
SYNECHIE
SUBMUCUOS FIBROID
TREATMENT OF INFECTIONS
CONTROL OF DM AND THYROID DISODERS
35. REASSSURANCE
NATURAL MICRONISED PROGESTERONE 100MG
BD TILL 10-12 WKS
APLA +VE PTS
LMWH
ASPIRIN
o ENCIRCLAGE IN CERVICAL INCOMPETENCE
McDONALD METHOD
SHIRODKAR TECHNIQUE