1. Dr Win Pe
Clinical Professor / Consultant
Department of Obstetrics & Gynaecology
University of Medicine, Mandalay

2. • Accounts for ¾ of gynaecological
admissions
• Important cause of maternal morbidity
and mortality

3. Causes of early pregnancy bleeding
• Spontaneous miscarriage
• Ectopic pregnancy
• Gestational trophoblastic disease
• Implantation bleeding

4. Gynaecological complications
• Cervical cancer
• Infections
• Cervical polyp

5. The normal pregnancy
Symptomatology
• Classical trial
• Amenorrhoea
• Pelvic or low abdominal pain
• Vaginal bleeding

6. First test is to demonstrate the
presence of HCG - HCG
• Glycoprotein
• 2 subunits
• Half life 6 to 24 hours
• Peak level at 9 to 13 weeks

7. Urine test
• Sensitivity is around 25 IU/Ltr
• Positive results around 14 days after
ovulation
Plasma HCG
• 0.1 to 0.3 iu/L is able to detect a
pregnancy 6 to 7 days after ovulation

8. Definition
• The expulsion of the concepts before
24 weeks of pregnancy

9. Aetiological factors of early pregnancy
disorders
Miscarriage
Chromosomal Trisomies (Down’s syndrome)
abnormalities (Material Triploidies and tetraploides
age >35 yrs) Monosomy X (Turner’s syndrome)
Transiocation (hereditary)
Endocrine disorders Diabetes, hypothyroidsm, luteal phase
deficiency, polycytic ovarian syndrome
Abnormalities of the Uterine septa (bicornute utetus)
uterus Endometrial adhesions (post-curettage or
Asherman’s syndrome)

10. Miscarriage
Infections Salmonella typhi, malaria, cytomegalvirus,
Brucella, toxoplasmnosis, Mycoplasma
hominis, Chlamydia trachomatis, and
Ureaplasma urealyticum
Chemical agents Tobacco, anaesthetic gases, arsenic, benene,
solvents, ethlene oxide, formaldehyde, pesticides,
lead, mercury, and cadmium
Pshychological disorders Antiphospholipid syndrome
Immunological disorders Thrombophilia (hereditary)

11. Different types of abortion
1.Threaten abortion is characterised by
• Bleeding aft amenorrhoea
• No uterine contraction and pain
• The cervix is closed
• Uterus size is similar to date

12. 2.Inevitable abortion
• There will be – more bleeding
• Uterine contraction and pain
• The cervix is dilated

13. 3. Complete abortion
• The whole conceptus is expelled
• Uterus contracts to normal size
• Bleeding stops
• The cervix is closed

14. 4. Incomplete abortion
• There will be products of conception
• Bleeding continue and severe
accompanied by shock
• There will be pain
• Infection may supervene

15. 5. Missed abortion
• Dead fetus retained in the uterus
• Size of uterus is smaller than dates
• Signs + symptoms of pregnancy reduced
• Brownish discharges per vaginum
• The os is closed
• In ultrasound there is no fetal heart
movement

16. 6. Septic abortion
• Caused by incomplete abortion
complicated by infection
• There will be pyrexia
• Abdominal pain + pelvic tenderness
• Foul smelling purulent discharge per vagina

17. 7. Habitual abortion
• Three or more consecutive abortion
(spontaneous)

18. Management of different types of
abortion
• Threatened abortion
• Reassurance
• Bed rest
• Sedation
• Uterine relaxants
• Hormone (progestogen)
• USS to check viability
• All pads + everything passed may be saved
for examination
• Modern approach – no treatment has
proved the value

19. Management of different types of
abortion
• Inevitable abortion
• Incomplete abortion
• Missed abortion
• Complete abortion
– No treatment required
– Habitual abortion
• Treat the cause if cause is found
• Treat general disease if present

20. Management of septic abortion
• General
• Nursing care
• Nutrition
• Fluid and electrolytes balance
• Correct anaemia
• To note urine out put

21. Specific
• Cervical swab
• High vaginal swab for C & S
• Blood culture
• IV Antibiotics
• C Pen & ampicillin – gm(+)
• Gentamycin – gm (-)
• Metronidazole – anaerobes
• Antitetanus toxoid
• Remove the septic focus

22. • Management of septic abortion
• Evacuation and curettage for RPOC
• POD puncture and drainage
• Laparotomy and drainage
• TAH if perforation detected

23. Septicaemic shock
• Keep is ICU
• O2
• Correct acidosis
• Blood transfusion if require
• Antibiotics intravenously
• Blood and heparin for DIC

24. Renal failure (Urine output < 30 ml/hr)
increased urea and electrolytes
• Restrict fluid
• High carbohydrate, low protein
• Restriction of sodium and potassium
• Dialysis if blood urea more than 25 mmol/l
• Manitol
• frusemide