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Abortion

  • Complete - Complete abortion is the termination of a pregnancy before the age of viability almost in 50% cases. It occurs at less than 20 weeks from the first day of the last normal menstrual period or involving a fetus of weight less than 500gm.
  • Incomplete – It is the spontaneous passage of some of the products of conception associated with uniform pregnancy loss.
  • Inevitable – It is the pregnancy in which rupture of the membranes and/or cervical dilation takes place during the first half of the pregnancy period.
  • Missed - It is the retention of a failed intrauterine pregnancy, which can be detected by an ultrasound.
  • Septic – It is a variant of an incomplete abortion due to infection.
  • Threatened – It is a pregnancy in which vaginal bleeding or uterine cramping occurs. 50-60% such pregnancies come in the category of complete abortion.

CAUSES:

  • Endocrine abnormalities in about 25-50% cases.
  • Genetic factors in about 10-70% cases.
  • Trisomy in about 40-50% cases.
  • Monosomy in about 15-25% cases.
  • Reproductive tract abnormalities in about 6-12% cases.
  • Tripoidy and tetraploidy in about 5-15% cases.
  • Abnormality of placentation.
  • Effect of venereal diseases.
  • Chronic cardiovascular disease and chronic renal disease.
  • Diabetes mellitus.
  • Environmental factors such as alcohol, anesthetic gases, effect of drugs, radiation, smoking and toxins.
  • Other factors such as advanced maternal age, delayed fertilization, short interval between pregnancies.

SYMPTOMS:

  • Vaginal bleeding which would be bright red to dark coloured.
  • Abdominal cramping generally rhythmic accompanied by pelvic or low back pressure.
  • Cervical dilation with tissue visible at the cervical openings.
  • Severe vaginal hemorrhage.
  • Cervical polyps and cervicitis.
  • Urinary tract infection and lower abdominal discomfort.
  • Loss of early symptoms such as fullness of breasts or morning sickness.
  • Disseminated intra-vascular coagulopathy can occur when an intrauterine fetal demise in the second trimester has been retained beyond six weeks after the death of the fetus.

SPECIFIC MEASURES:

  • Rh-negative mothers should be treated with Rh immune globulin after completion of the abortion, because ovulation may occur as early as two weeks after an abortion.
  • After an abortion, control the bleeding, prevent infection and relieve pain.
  • Ensure that all the products of the conception have been expelled from the uterus. If retained tissues are present and cannot be ruled out, curettage must be performed immediately.
  • Septic abortion requires urgent and aggressive management. Antibiotics, fluid therapy and prompt evacuation of the uterus are indicated.
  • If significant pain or bleeding persists, especially bleeding leading to hemodynamic alterations, evacuation of the uterus should be conducted.

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