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36 Cards in this Set
- Front
- Back
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Define abortion |
It is the termination of pregnancy before fetal viability (28 weeks GA & fetal weight of 1000g).
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Incidence of abortion |
12.5% - 1 in 8 pregnancies In Nigeria 11% |
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Classify abortion |
A. Mode of onset •spontaneous •induced B. Clinical classification •threatened •inevitable •incomplete •complete •missed or delayed •recurrent or habitual abortion •septic abortion |
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Incidence of spontaneous abortion |
10-17% of all pregnancies |
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Most first trimester abortions are due to |
Chromosomal abnormalities |
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Second trimester abortions are due to |
Uterine abnormalities like cervical incompetence |
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Causes of abortion |
•abnormal conceptus like chromosomal abnormalities, structural abnormalities and genetic abnormalities •immunological like antiphospholipid syndrome, rhesus iso-immunization •uterine abnormalities e.g fibroid, bicornuate uterus, uterine septum •cervical incompetence •toxins e.g smoking, alcohol intake, drug abuse •endocrine e.g luteal phase deficiency leading to progesterone deficiency, thyroid disease •maternal chronic disease like DM •Maternal infections that can cause fever e.g malaria, typhoid fever, urinary tract infection, appendicitis |
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Features of threatened abortion |
•fetus is still viable •vaginal bleeding is present •mild or no abdominal pain •no cervical dilatation •no passage of products of conception •uterine size is equal to the calculated gestational age |
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Diagnosis of threatened abortion |
USS which will show a viable fetus |
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Management of threatened abortion |
Counseling Bed rest Admission Avoidance of coitus & travel |
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Features of inevitable abortion |
•abortion has progressed up to the level that it is no longer reversible e.g PROM or cervical dilatation of up to 4cm •severe vaginal bleeding •severe abdominal pain •cervical dilatation •no passage of products of conception •uterine size is equal to the GA |
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Management of inevitable abortion |
•give oxytocics to stop bleeding •group & cross match blood •if POC is seen plugging the external cervical os, removal can reduce pain and bleeding •evacuate the uterus using MVA
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Features of incomplete abortion |
•part of pregnancy has been lost •severe vaginal bleeding •severe abdominal pain •dilated cervix •passage of some POC •uterine size smaller than estimated GA |
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Diagnosis of incomplete abortion |
Confirmed by USS |
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Features of complete abortion |
•whole POC have been extruded •minimal or no vaginal bleeding •no abdominal pain •cervical os is closed •uterine size is smaller than estimated GA |
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Diagnosis of complete abortion |
Confirmed by USS |
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Management of complete abortion |
•counseling •correction of anaemia if present |
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Features of missed/delayed abortion |
•fetus died many days or weeks ago •no or mild brownish vaginal bleeding •no abdominal pain •no dilation of cervix •no passage of POC •uterine size may be smaller than the GA •absence of fetal kick •bleeding abnormalities (DIC) |
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Management of missed abortion |
•USS, platelet count, clotting time (bed side), prothrombin time, grouping and cross matching of fresh whole blood •if GA is </=12 weeks, do MVA or use medical means of TOP e.g misoprostol •if GA >/=12 weeks use medical methods only •give supportive counseling |
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Features of septic abortion |
Characterized by features of the type of abortion with associated fever, lower abdominal pain, offensive vaginal discharge, vaginal bleeding, shock. |
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Management of septic abortion |
•use of parenteral antibiotics •blood transfusion •evacuation of the uterus few hours (12-24hrs) after commencing antibiotic therapy •laparotomy if there is pelvic abscess or intestinal injury •hysterectomy if uterus is gangrenous •if there is shock resuscitate patient with oxygen, fluid therapy with monitoring of input and output, blood transfusion, parenteral antibiotics |
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Define recurrent/habitual abortion |
This is when abortion occurs 3 or more consecutive times |
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Commonest cause of recurrent abortion in our environment |
Cervical incompetence |
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WHO definition of unsafe abortion |
A procedure for termination of an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards or both |
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Causes of unsafe induced abortion |
•poor knowledge & acceptance of contraception •prohibition of discussion of sexual issues with adolescent •declining age at sexual debut •stigma of child birth outside marriage •fear of being driven out of school •restrictive abortion laws |
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Complications of unsafe induced abortion |
Early •hemorrhage •infection •trauma to the genital tract (uterus, cervix, vagina) •shock •ARF •socioeconomic problems •death Late •chronic PID •pelvic abscess •pelvic adhesions •dyspareunia •asherman's syndrome •rhesus iso-immunization •ectopic pregnancy •infertility |
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Prevention of induced abortion |
•provision of reproductive health information to men and women to help them make informed choices to prevent unwanted pregnancies •promotion of abstinence and other forms of family planning methods especially among sexually active groups like the adolescents •organizing programmes and activities aimed at providing counseling and information to women with unwanted pregnancy to help them decide against termination of pregnancy •tertiary prevention involves the provision of services for the treatment of women suffering from the complications of induced abortions e.g post-abortion care |
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What is post-abortion care |
An approach for reducing morbidity and mortality from incomplete and unsafe abortion and resulting complications and for improving women's sexual and reproductive health and lives |
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Elements of post abortion care |
•Community and service providers partnerships for prevention of unwanted pregnancies and unsafe abortion •Counseling to identify and respond to women's emotional and physical health needs and other concerns •Treatment of incomplete and unsafe abortion and complications that are potentially life threatening including the use of MVA •Contraceptive and family planning services to help women prevent unwanted pregnancy and practice birth spacing •Reproductive and other health services that are preferably provided onsite or via referrals to other accessible facilities in provider's networks |
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Countries where abortion is permitted by law |
USA, UK, S/A, Romania |
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Countries having restrictive abortion laws |
Nigeria, Kenya, Ethiopia |
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Methods of termination of pregnancy |
1. Surgical a) Suction Evacuation: electrical or manual (MVA). For pregnancies less than 12 weeks b) Dilatation and Curettage: carries more complications. Rarely done c) Hysterotomy: rare. <28 weeks GA 2. Medical Mainly for pregnancies greater than 12 weeks gestation a) Prostaglandin & its analogues e.g misoprostol b) Oxytocin c) Mifepristone (RU 486) - an anti-progesterone d) antiprogesterone combined with misoprostol for better effect |
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Complications of termination of pregnancy |
Early •Haemorrhage •Infections •Cervical lacerations, uterine perforation •Intestinal injuries Late •Cervical incompetence •Infertility |
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Components of Manual vacuum aspiration machine |
•canulae of various sizes •valve •syringe •plunger •stopper •O ring |
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Procedure for conducting an MVA |
•place pt in lithotomy position •clean the perineum/vagina with antiseptics •empty the bladder •drape the patient •anaesthesize the patient (sedation, paracervical, rarely G.A) •do bimanual exam and use the finger to dislodge some products of conception plugging the os •insert the speculum •stabilize the cervix with ring forceps or vulselum •remove bigger products with ring forceps •do MVA •give oxytocics e.g ergometrine or oxytocin •clean up and apply vulval pad for monitoring vaginal bleeding •cover with antibiotics •+/- discharge |
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Signs of complete emptying of the uterus |
•pink coloured foam in the cannula •gritty sensation while moving the cannula •clamping of the cervix on the cannula •contracted uterus with reduced bleeding |
