ABORTION

An abortion is expulsion of products of conception whether spontaneous or induced before the 28 weeks of gestation.

CAUSES—


CHROMOSOMAL ABNORMALITY

  • Autosomal abnormalities such as autosomal Trisomy,Tetraploidy,Triploidy 
  • Faulty development of fertilized ovum
    TRAUMA-
  • Trauma of sexual intercourse
  • Accidental fall ( dislodge implanted ovum)

Placental abnormalities

  • Acute hydramnios
  • Multiple pregnancy
  • Hydatidiform mole
  • Placenta praevia

Maternal disease

  • Acute infections such as Malaria with high fever,Typhoid fever
  • Chronic infections such as Toxoplasmosis,Listeria,Mycoplasma,Genital herpes,rubella,cytomegalovirus,parvovirus B 19
  • Hypertension
  • Diabetes
  • Chronic nephritis.
  • Collagen vascular diseases-such as Systemic lupus erythematous,Antiphospholipid antibody syndrome
  • Thyroid Disease
  •  Blood ABO group incompatibility
  • Uterus deformities such as Bicornuate uterus,Septate,Subseptate,Arcuate uterus
  • Submucous or polypoid fibromyoma
  • Incompetent Os
  • Cervical laceration
  • Any surgical operation
  • Corpus Luteal Phase Defects
  • Any emotional disturbance

Faults in gamete

  • Aging of gamete(sperm/egg)
  • Abnormal sperm
  • Radiation exposure

Poor nutrition

Excess of alcohol and Smoking

 CLASSIFICATION—-

ON BASIS OF DEGREEON  BASIS OF CAUSEON BASIS OF INFECTION
THREATENEDSPONTANEOUSSEPTIC
INEVITABLERECURRENTNON-SEPTIC
INCOMPLETEINDUCED 
COMPLETE  
MISSED  

SIGNS AND SYMPTOMS—

TYPES  OF ABORTIONSIGNSSYMPTOMS
THREATENED

Bleeding through cervical canal

Closed Os

a.    Amenorrhoea of 2-3 months

b. Slight painless vaginal bleeding

c.    Bright red color bleeding

d.    Mild/no discomfort

INEVITABLE

Dilated cervical canal

Palpable lower pole of the sac

Size of uterus corresponds to the duration of amenorrhoea

a. Severe vaginal bleeding in the beginning

b. Then heavy bleeding with passage of clots

c. Painful uterine contractions

INCOMPLETE

Open internal Os

Admit one finger

Soft and enlarged uterus

a. Continuous bleeding/passage of large clots

b. Bleeding may continue for months

c. Regular menstruation is not established

d. Lower abdominal pain may be present

COMPLETEClosed cervix
Firm and bulky uterus

a. Less or no bleeding

b.  No pain

c.  Brownish vaginal  discharge stops with in 7-10 days

d. Regular menstruation is established within 1-2 months

MISSED

Uterus soft

Size less than period of amenorrhoea

Closed Os

a.    Amonorrhoea of 4-5 months with early pregnancy symptoms

b. Slight ,repeated vaginal bleeding which may subside on rest or aggravates despite treatment

c. No progressive enlargement of abdomen/breasts

SPONTANEOUSNon-specific

a. Heavy bleeding with products of conception

b. No/less abdominal pain

c. Bleeding subsides completely only after expulsion of sac

RECURRENTIncompetent Os

a. Abortion occurs at least 3 times

b. It is spontaneous

SEPTIC

Tender lower abdomen

Distension may be present

Tachycardia

Bowel sounds may be sluggish or absent

Os may or may not be open

Bulky, soft uterus

Firm and indurated adnexa with marked tenderness

a. Fever with chills and rigor

b. Pain in abdomen

c. Vomiting

d.  Diarrhoea

e. Dry,coated tongue

f. Scanty/heavy bleeding

g. Purulent offensive vaginal discharge

INVESTIGATIONS—

  1. Routine investigations such as ABORh,Hb,Urine c/e,RBS
  2. Ultrasonography
  3. Vaginal cytology
  4. Thyroid function test
  5. TORCH test
  6. Blood culture
  7. Kidney and Liver function test
  8. Endocervical swab and High vaginal swab (for septic abortion)

TREATMENT-—               

GENERAL        

  1. Bed rest
  2. Avoid coitus
  3. Anti-D immunoglobulin for Rh-ve mothers
  4. Treating maternal disease
  5. Adequate nutrition along with supplements of Iron,Calcium,folic acid and Multivitamins

COMPLICATIONS—

  • PLACENTAL POLYPI
  • SHOCK
  • HEMORRHAGE
  • SEPSIS
  • CERVICAL LACERATIONS
  • PERFORATION OF THE UTERUS
  • ASHERMAN SYNDROME
  • THROMBOPHLEBITIS
  • HYPOFIBRINOGEMIA
  • OLIGURIA
  • ANAEMIA
  • PARALYTIC ILEUS
  • GAS GANGRENE
  • TETANUS
  • DEATH