1. Liza Tarca-Cruz, MD

2. 
Abortion (L – aboriri)
 To
miscarry
 Premature birth before a live birth is possible
(New Shorter Oxford Dictionary 2002)
Pregnancy
termination prior to
20 weeks gestation base on LMP
 Fetus with birth weight of ≤ 500
grams

WHO
NCHS, CDCP,

3. 
31% of losses occur after implantation
(Wilcox et
al 1988)

Increases with parity, maternal and paternal
age (Gracia 2005)
 Frequency




<20
>40
<20
>40
years
years
years
years
doubles
old –
old –
old –
old –
12%
26%
12%
20%
Maternal
Paternal

6. 
Abnormal Zygotic Development
 Abnormality

Zygote, Embryo, Early Fetus, Placenta
 40%

in the development of:
are expelled SPONTANEOUSLY
Aneuploid Abortion – before 8 weeks AOG
 Chromosomal


95% maternal gametogenesis errors
5% paternal gametogenesis errors
 Autosomal

abnormalities
Trisomy
most frequently identified(autosomes 13, 16, 18, 21,22)

7.  Monosomy

X (45X)
2nd most frequent (abortion & live female – Turner
Syndrome)
 Triploidy


Hydrophic placental (molar) degeneration
Incomplete/Partial H. Mole – triploidy or trisomy
chromosome 16
 Tetraploid
 Chromosomal


Structural Abnormalities
Infrequently cause abortion
Euploid Abortion – 13 weeks AOG
 Abort
later
 Increase incidence with increase maternal age

9. 
Infections
 Syphilis
 HIV
 Group
B Streptococci
 Bacterial vaginosis

Endocrine Abnormalities
 Hypothyroidism

Iodine deficiency  miscarriage
 Diabetes

Mellitus
Insulin dependent DM  metabolic control
 Progesterone
Deficiency (Luteal Phase Defect)

10. 

Nutrition – does not cause abortion
Drug Use & Environmental Factors
 Tobacco


Increase risk of euploid abortion
>14 sticks/day
 Alcohol

First 8 weeks of pregnancy
 Caffeine

>5 cups /day (500mg caffeine/day) – paraxanthine
 Radiation
 Contraceptives

IUD – septic abortion

11.  Environmental


Toxins
Arsenic, Lead, Formaldehyde, Benzene, Ethylene
Oxide, Nitrous Oxide
Immunological Factors
 Autoimmune
(immunity against self)
Antiphospholipid antibody (IgG, IgA, IgM isotype) –
Lupus Anticoagulant & Anticardiolipin Antibody
 placental thrombosis & infarction
 prostacyclin (vasodilator inhibitor platelet
aggregation)
 inhibit protein C activation (coagulation & fibrin
formation)

 Alloimmune
(immunity against another person)

12. 

Inherited Thrombophilia
Laparatomy
 Removal
of corpus luteum cyst < 10 weeks AOG
 progesterone supplement


Physical Trauma
Uterine Defects
 Acquired


Leiomyoma (location not size)
Asherman Syndrome (uterine synechiae)
 Developmental

Abnormal mullerian duct formation/fusion or DES
exposure

13. 
Incompetent Cervix
 Painless
cervical dilatation in the 2nd trimester
with prolapse & ballooning or members into
vagina, followed by expulsion of immature fetus
 “Funneling”
 Etiology: previous trauma to cervix, abnormal
cervical development
 Treatment: CERCLAGE

14.  Surgical
reinforcent of weak cervix by purse
string suturing
 Contraindication to Cerclage: bleeding, uterince
contractions, ruptured BOW
 12 to 16 weeks but not later than 23 weeks
 Cervical examination: 1 to 2 weeks
 Types:



McDonald
Shirodkar
Transabdominal cerclage – suture placed at uterine
isthmus
 Complications:
infection, ruptured membranes

16. 


80% - first 12 weeks
½ due to chromosomal anomalies
BLIGHTED OVUM – embryo is degenerated
or absent

17. Bleeding
Uterine
Contraction
Cervix
BOW
Uterine
size
+
+/-
Close
+
C
Inevitable
+/-
+
Open
-
NC
Curettage
Imminent
+
+
Open
+
C
Expectant
Incomplete
+
+/-
Open
-
NC
Completion
Curettage
+/-
-
Close
-
NC
Observation
+/spotting
-
Close
+/-
NC
Expectant
Medical PGE
Curettage
+
+/-
Open
+/-
C
Threatened
Complete
Missed
Habitual
(Recurrent)
Management
Bedrest,
Tocolysis
Cerclage

18. 

≥3 consecutive spontaneous abortions
Parental cytogenetic analysis, LAC, ACA

19. 

Medical or surgical termination of pregnancy
before the time of fetal viability
Therapeutic abortion – for the purpose of
saving the life of the mother

21. 
SURGICAL
 Cervical
dilatation followed by uterine
evacuation




Curettage – sharp or suction
Vacuum aspiration (suction curettage)
Dilatation and Evacuation (D&E) – 16 weeks
Dilatation and Extraction (D&X)
 Menstrual
aspiration
 Laparotomy


Hysterotomy
Hysterectomy
Complications: uterine
perforation, cervical
laceration, hemorrhage,
infection, incomplete
removal of the fetus &
placenta

22. 
MEDICAL
 Intravenous
oxytocin
 Intra-amnionic hyperosmotic fluid

20% saline & 30% urea
 Prostaglandin





E2, F2α, E1 and analogues
Intra-amnionic injection
Extraovular injection
Vaginal insertion
Parenteral injection
Oral ingestion
 Antiprogesterone
– RU 486 (mifepristone) & epostane
 Methotrexate – intramuscular & oral