abortion

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ABORTION

DEFINITION : 

DEFINITION Abortion is a termination of pregnancy before the period of viability which is considered to occur at 28th week.

CAUSES OF ABORTION:-: 

CAUSES OF ABORTION:- FEATEL FACTORS: Chromosomal abnormality MATERNAL FACTORS :Infection, chronic illness, ENDOCRINE FACTORS PATERNAL FACTORS : Defective chromosomal affect

TYPES OF ABORTION : 

TYPES OF ABORTION 1. SPONTANEOUS ABORTION :- Threatened abortion Invitable abortion Complete abortion Incomplete abortion Missed abortion Septic abortion 2. INDUCED ABORTION :- Legal Illegal

THREATENED ABORTION : 

THREATENED ABORTION DEFINITION : It is clinical entity where the process of abortion has started but has not progressed to a state from which recovery is impossible.

CLINICAL FEATURES : 

CLINICAL FEATURES Bleeding per vagina is usually slight and bright red in colour. Pain may be mild backache or dull pain in lower abdomen

INVITABLE ABORTION : 

INVITABLE ABORTION DEFINITION : It is a clinical type of abortion where the changes have progressed to a state from where continuation of pregnancy is impossible

CLINICAL FEATURES : 

CLINICAL FEATURES Increased vaginal bleeding Aggravation of pain in lower abdomen. Dilatation of internal os

MANAGEMENT : 

MANAGEMENT To take appropriate measures for look after of general condition. 2. Morphine 15mg is given I/M 3. Excessive bleeding should be controlled by giving Methergin 0.2 mg ACTIVE TREATMENT : BEFORE 12 WKS : Dilatation and evacuation followed by curettage under general anaesthesia. AFTER 12 WKS : The uterine contractions is accelerated by oxytocin drip 40to50 drops / min . The retained placenta is removed by ovum forcep

COMPLETE ABORTION : 

COMPLETE ABORTION DEFINITION : When the products of conception are expelled it is called complete abortion

MANAGEMENT : 

MANAGEMENT The effect of blood loss should be assessed and treated Uterine curettage should be done if there is doubt in complete expulsion of products

COMPLETE ABORTION : 

COMPLETE ABORTION When the entire products of conception are not expelled instead a part of it is left insite the uterine cavity it is called complete abortion

CLINICAL FEATURES : 

CLINICAL FEATURES Continuation of pain lower abdomen , colicky in nature Varying amount of bleeding

MANAGEMENT : 

MANAGEMENT IN RECENT CASES : Dilatation and evacuation under general anaesthesia IN LATE CASES : Dilatation and curettage operation is done to remove the bits of tissues left behind.

MISSED ABORTION:: 

MISSED ABORTION : DEFINITION : When the fetus is dead and retained inside the uterus for a variable period it is called missed abortion

CLINICAL FEATURES: 

CLINICAL FEATURES 1. Brownish vaginal bleeding 2. Cessation of uterine growth 3.Cervix feels firm COMPLICATIONS : 1. Psychological upset 2. Infection 3. Blood coagulation disorders 4. Retained placenta and PPH

. METHODS OF TERMINATION IN FIRST TRIMESTER : 

. METHODS OF TERMINATION IN FIRST TRIMESTER 1. DILATATION AND EVACUATION 2.PROSTAGLANDINS 3. MIFEPRISTONE

MANAGEMENT : 

MANAGEMENT UTERUS IS LESS THAN 12 WKS : This can be done effectively by suction evacuation or slow dilatation of cervix under general anaesthesia. UTERUS MORE THAN 12 WKS: OXYTOCIN: To start with 10-20 units of oxytocin in 500 ml of 5% dextrose saline is administered in drip with 30 drops / min. PROSTAGLANDINS: More effective in some cases than oxytocin

SEPTIC ABORTION : 

SEPTIC ABORTION DEFINITION: Any abortion associated with clinical evidences of infection of the uterus and the contents is called septic abortion. CLINICAL FEATURES: 1. Pyrexia 2. Pain abdomen 3. A rising pulse rate of 100-120/ mins 4. Offensive purulent discharge from vagina

MANAGEMENT : 

MANAGEMENT 1. Hospitalisation even with a case of mild infection . Pt. should be kept in isolation. GRADE-I 1.DRUGS: Antibiotics Analgesics and sedatives 2.BLOOD TRANSFUSION 3. EVACUATION OF UTERUS GRADE-II 1. ANTIBIOTICS 2.EVACUATION OF UTERUS 3. COLOPOTOMY GRADE-III ANTIBIOTICS ACTIVE SURGERY LAPAROTOMY

MEDICAL TERMINATION OF PREGNANCY : 

MEDICAL TERMINATION OF PREGNANCY Since legalisation of abortion in INDIA deliberate induction of a abortion is registered by medical practitioner in the interest of mother’ s life and health . Provisions for MTP are 1. The continuation of pregnancy would involve serious risk of life or injury to physical or mental health of mother 2. Child born with physical or mental abnormalities 3. When pregnancy is caused by rape. 4. Preg. Caused as result of failure of contraceptives

RECOMMENDATIONS : 

RECOMMENDATIONS 1. In revised rules a registered medical practitioner is qualified to Perform an MTP 2. Termination can be performed only in hospitals published by GOVT. 3. Pregnancy can be terminated on the written consent of the woman 4. Pregnancy in minor girl can not be terminated without written consent of parents 5. Termination is permitted upto 20 wks of pregnancy.

METHODS OF TERMINATION IN FIRST TRIMESTER : 

METHODS OF TERMINATION IN FIRST TRIMESTER 1. SUCTION EVACUATION AND CURETTAGE 2. DILATATION AND EVACUATION 3.PROSTAGLANDINS 4. MIFEPRISTONE

MID TRIMESTER TERMINATION 13-15WKS : 

MID TRIMESTER TERMINATION 13-15WKS 1. PROSTAGLANDINS 2. HYSTERECTOMY BETWEEN 16-20 WKS: 1.PROSTAGLANDINS 2.OXYTOCIN 3HYSTEROTOMY

COMPLICATIONS:: 

COMPLICATIONS : Thrombosis or embolism Menstrual disturbances Pelvic inflammations Infertility Ectopic pregnancy or premature labour

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