what is Abortion? What is Stillbirth what is the different between them? How can we manage them?

2. Placental Abnormalities and
Hemorrhagic Complications
1. Antepartum Hemorrhage (APH)
2. Postpartum Hemorrhage (PPH)
3. Ectopic Pregnancy
4. Abortion

3. 4. Abortion
• Abortion is the spontaneous or
elective ending of pregnancy
before the fetus is able to survive
on its own in the first 24 weeks of
pregnancy.
• Losing of the fetus after the 24
week called Stillbirth. 3

4. 4. Abortion
• There are two type:
1. Elective abortion (Induced): Ending
of pregnancy at the request of the
mother. it may done medically or
surgically.
2. Spontaneous abortion (Miscarriage):
Is the end of the pregnancy on its
own. 4

5. Miscarriage
• A miscarriage refers to naturally
death of the embryo/fetus, not to
medical or surgical abortions.
• 80% of miscarriage happen in the
first 12 weeks (1st trimester).
• 20% happen in the second 12 weeks
(13th – 24th week).
5

6. Miscarriage Symptoms
• Low back pain.
• Abdominal pain and cramps (similar
to period pain).
• Tissue or clot-like material that
passes from the vagina.
• Vaginal bleeding.
• Fever.
6

7. Miscarriage Causes
• The major cause is baby’s chromosomes abnormality, that
prevent the baby from developing well.
Other cause:
• Infection such as HIV
• Exposure to radiation or other toxins
• Uterine abnormalities and trauma
• Smoking, drinking alcohol, and drugs
• Immune system disorders; as Systemic lupus erythematosus
• Kidney, heart, and thyroid disease
• Diabetes that is not controlled
• Severe malnutrition
• Old mother
• Blood clotting problems 7

8. Miscarriage Types
1. Threatened abortion:
• Miscarriage has started but
recovery is possible.
• Or woman with miscarriage
signs but loss of the pregnancy
has not yet occurred.
• Management:
− Rest
− Good nutrition (folic acid
should be taken)
− Fetus and uterus monitoring 8

9. Miscarriage Types
2. Complete abortion:
• This is the most common
type of miscarriage, when
all of the contents of the
uterus leave the body.
• Management:
− Control bleeding
− Ultrasound to observe the
uterus
9

10. Miscarriage Types
3. Incomplete abortion:
• Only some of the products of
uterus leave the body.
• Treatment:
− Dilatation and Curettage (D&C): is
a procedure to remove tissue
from inside the uterus, by
opening (dilate) the cervix and
using a surgical instrument called
a curette to remove any
remaining pregnancy tissue.
− Antibiotics
− Complete uterine evacuation 10

11. Dilatation
and
Curettage
(D&C)
11

12. Miscarriage Types
4. Missed abortion:
• The pregnancy is ended without
any symptoms and the products of
uterus do not leave the body.
• There is brownish discharge.
• In this type the death will be
discovered at a routine scan.
• Treatment:
− Oxytocin
− Antibiotics
− Complete uterine evacuation
− D&C 12

13. Miscarriage Types
5. Septic infected abortion:
• The lining of the uterus and any remaining
products of pregnancy become infected after
miscarriage.
• Treatment:
− Hospitalization IV antibiotics
− Complete uterine evacuation
− D&C
13

14. General Management
• Medical management depends on
type and signs and symptoms.
• The main goal of treatment during or
after a miscarriage is to prevent
hemorrhage and/or infection.
• We should support the mother
psychologically. 14

15. 4-5 Weeks miscarriage 6 Weeks miscarriage15

16. 7-8 Weeks miscarriage 10 Weeks miscarriage16

17. 12 Weeks miscarriage 16 Weeks miscarriage17

18. Types of pregnancy loss
Other types of pregnancy loss could be:
• Blighted Ovum: A fertilized egg implants
into the uterine wall, but fetal development
never begins.
• Molar Pregnancy: The result of a genetic
error during the fertilization process that
leads to the growth of abnormal tissue
within the uterus.
• Ectopic Pregnancy. 18

21. * Stillbirth
• Stillbirth is the intrauterine fetal death
or antenatal death after the 24th week
of pregnancy, or, during the birth.
• If the length of gestation (pregnancy) is
not known, the birth will be considered a
stillbirth if the baby weighs 400 grams or
more. 21

22. Cause of stillbirth
• Congenital anomalies while it is developing in the uterus
• Low level of Folic acid
• A medical condition of the mother, such as diabetes, renal
disease, heart disease or pre-eclampsia
• complications during birth
• A premature birth, where the baby is too immature to survive
• Problems with the umbilical cord or placenta
• Maternal age <35
• Obesity Mother
• Infection as; (malaria, syphilis and HIV)
• Having multiple pregnancy
• Smoking, drinking alcohol or taking drugs during pregnancy
• A trauma to the mother’s abdomen
• Taking of medication 22

23. Warning Signs
• If the baby has stopped moving or is moving differently or less
than usual
• Strong pain or cramping in the abdomen or back
• Receiving a hard knock or trauma on the abdomen
• Bleeding or leaking more discharge from vagina
• Feeling dizzy, experience changes to the vision, or have severe
or long-lasting headaches
• The face, feet or hands suddenly swell or you have painful
swelling in your legs
• Severe nausea and vomiting that affects eating or drinking
• High fever
23

24. Prevention of Stillbirth
• Healthy lifestyle and diet
• Taking folic acid before becoming pregnant
• Avoiding smoking, drinking alcohol and
taking drugs
• High blood pressure or diabetes and other
conditions should be controlled and managed
• Sleep on the side particularly during the third
trimester
• Inducing labour or having a caesarean if the
pregnancy goes past the due date 24

25. Delivery of Stillbirth Baby
• In most cases, inducing a vaginal
birth is better than a caesarean.
• Vaginal birth of a stillborn baby may
take longer than with a live baby
25