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. â˘
Types of abortion
Threatened abortion.
7 We Care
⢠Incomplete abortion.
⢠Complete abortion.
⢠Missed abortion
ďś Septic abortion: Any type of
abortion, which is complicated
by infection
22. ⢠History
CLINICAL APPROACH
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⢠Examination
⢠Special Investigations
23. History
⢠VAGINAL BLEEDING
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⢠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
⢠âWhite currant in red currant juiceâ
24. Pain abdomen
⢠Minimal
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⢠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
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⢠Previous cycles
⢠LMP
⢠Past history
⢠Similar episodes
⢠Infertility
⢠Details of contraceptive use
28. ⢠Classical triad of ectopic pregnancy
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â Amenorrhoea
â Pain abdomen
â Irregular vaginal bleeding
29. EXAMINATION
⢠General look
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â Lies quiet and conscious, perspires and looks blanched
â Looks more ill than accounted for- molar pregnancy
30. ⢠Temperature
VITALS
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â Febrile/afebrile
⢠Pulse
â Tachycardia/normal
⢠Blood pressure
â Low/normal
34. ⢠Trauma
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⢠Cervical pathology
⢠Open cervical os-
incomplete abortion
35. ⢠Bimanual examination
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⢠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
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â Positive UPT
â Intrauterine pregnancy
â Viable fetus
⢠Incomplete abortion
⢠Positive UPT
⢠Product of conception in-situ
⢠Non viable fetus
45. ⢠Complete abortion
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â Positive UPT
â Absent product of conception
⢠Ectopic pregnancy
â Positive UPT
â USG confirmation
â Product of conception absent in uterus
⢠Molar pregnancy
â Positive UPT
â 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:
â Manual vacuum aspiration (MVA) is preferred method
â If evacuation not immediately possible, give ergometrine OR
misoprostol
47
48. Incomplete Abortion
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⢠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 ¾g 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
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⢠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:
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â If cervical dilatation is needed, use a paracervical block
â Use vacuum aspiration (MVA preferred)
⢠Infuse oxytocin 20 units in I L IV fluids at 60 drops per min.