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Abortion by Dr rahat

  1. 1. ABORTION 1.SPONTANEOUS ABORTION • Threatened abortion • Inevitable abortion • Incomplete abortion • Complete abortion • Missed abortion • Septic abortion 2.RECURRENT ABORTION 3.INDUCED ABORTION
  2. 2. RECURRENT ABORTIONS • It is also known as habitual or repeated abortion.It is defined as three or more consecutive spontaneous abortions.Approx 1 in 100 women experience it.
  3. 3. AETIOLOGY 1 Genetic factors. a) chromosomal abnormalities (structural abnormalities) are mainly associated with recurrent abortions.These abnormalities are three times more common in females.Most common chromosomal abnormalities are: 1.Robertsonian translocation. 2.Reciprocal translocation. 3.Inversion. 4.Chromosomal mosaicism. b) Neural tube defects and Potter’s syndrome increases incidence of abortion.
  4. 4. • 2.Anatomical factors. • a) Congenital anomalies of uterus are present in 10-15% of cases.These include bicornuate , subseptate,unicornuate uteri.The mechanism through which these cause abortion is not clear though implantation on septum may lead to decreased plancental vascularization. • b) Intra uterine adhesions are also responsible presumably due to inadequate placentation. • c) Fibroid uterus. • d) Incompetent cervix.
  5. 5. • 3.Endocrinal factors. • a) Polycystic ovarian disease. • b) Corpus luteum insufficiency. • c) Diabetes mellitus. • d) Thyroid dysfunction.
  6. 6. • 4.Immunological factors. • a) Alloimmune factor e.g production of suppressor cells within decidua,blocking antibodies, trophoblastic leucocyte cross reacting antigens. • b) Auto immune diseases e.g in SLE , lupus anticoagulants, cardiolipins antibodies appear before clinical onset of disease which increases incidence of recurrent abortion.
  7. 7. • 5.Systemic Disorders e.g hypertension and renal disease. • 6.Smoking and Alcohol.The risk of abortion is doubled in these patients.
  8. 8. Management. History. Examination. Investigation in non- pregnant woman. 1.Karyotyping 2.Ultrasound 3.Hormonal assays 4.Biochemistry 5.Blood tests 6.TORCH studies 7.Antibody tests
  9. 9. Investigation in pregnant woman. Beta hCG Estradiol levels Progesterone Ultrasound Alpha feto proteins Chorion Villous Sampling, amniocentesis.
  10. 10. Treatment • Counselling is most important part of management during or before next pregnancy. • During pregnancy general treatment includes • Rest • Nutrition • Specific intervention • Cervical incompetence • Before next pregnancy causative factor is found and patient is treated accordingly.

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