ABORTIONS

OBJECTIVES

At the end of this session you should

be able to:
1. Define various types of abortions.
2. Outline the causes and management
approach for various types of abortions.
3. Describe the relation between
complications of abortions and maternal
mortality
DEFINITIONS OF ABORTION

1. Termination of pregnancy
before 28/40

2. Delivery of a fetus of
weight less than 500
grams
STATISTICS OF ABORTIONS

50 - 60% of all pregnancies end in

spontaneous abortion (SAB) since 2-4 wk
pregnancies will often go unnoticed.
15% of all recognized pregnancies 4-20 wks
end in SAB.

30% lost between implantation and the 6 th wk.

70% of first trimester losses are due to

chromosomal abnormalities
TYPES OF ABORTIONS

1. Induced
2. Threatened
3. Inevitable
4. Incomplete
5. Complete
6. Septic
7. Missed
8. Recurrent
1. INDUCED ABORTION
Intentional medical or surgical
termination of a pregnancy

Types
Elective: if performed for a
womans desires

Therapeutic: if performed for

reasons of maintaining health of
the mother
INDUCED ABORTION MEDICO-
LEGAL ASPECTS IN TANZANIA

Only allowed for medical indications

If continuation of pregnancy is risk to
life of the woman

At least two medical doctors should

reach the decision and sign
Elective abortions are unlawful
INDUCED ABORTIONS -
COMPLICATIONS

Because most induced abortions are done by

less skilled persons they are usually associated
with fatal complications including:

1. Perforation of uterus, intestines, etc

2. Severe haemorrhage,
3. Sepsis and its associated complications,
4. Ashermans syndrome, etc
 2. THREATENED ABORTION

Refers to a stage in the abortion

that suggests potential
miscarriage may take place.
Symptoms
Minimal or no lower abdominal pain or
cramps
Slight abd pain
Minimal draining of liquor
Threatened abortion cont

Signs
Stable general condition
Fundal height corresponds to
GA
Cervix closed
Management of threatened abortion

1. Bed rest
Avoid strenuous exercises
2. If GA > 16/40 give - tocolytics
3. INEVITABLE ABORTION

Refers to a stage in the

abortion when it is not
possible for the pregnancy to
continue.
INEVITABLE ABORTION CONT

Symptoms
Moderate to severe vaginal bleeding
Severe abd pain
Significant draining of liquor
Signs
Dilatation of cervix with evidence of
imminent expulsion of the PoC
Fundal height corresponds to GA
Presence of contractions
Management of Inevitable abortion

1. Resuscitation: IV fluids: RL, NS

2. Blood grouping & Cross matching
3. Evacuation
MVA for GA < 12/40
Augment if the GA > 12/40
Oxytocin
If some PoC remain after abortion
manage like incomplete abortion.
MANUAL VACUUM ASPIRATOR
4. INCOMPLETE ABORTION

Some POC have been expelled from the

uterine cavity and other are retained
inside.
Symptoms
Moderate to severe vaginal bleeding
Cramping/severe abd pain
Partial expulsion of POC
Signs
Uterus smaller than dates
Cervix is dilated of cervix
Management of Incomplete abortion

1. Resuscitation: IV fluids: RL, NS

2. Blood grouping & Cross matching BT if indicated
3. Evacuation
MVA for GA < 12/40
Augment if the GA > 12/40
Oxytocin
If some PoC remain after abortion manage like
incomplete abortion.
4. Antibiotics: ampicilin, metronidazole
5. Analgesics
 5. SEPTIC ABORTION

An abortion complicated by infection

Symptoms
Abdominal pain
Fever
Vaginal discharge (foul smelling)
Signs
Sick looking, febrile or jaundiced
Tender uterus
Offensive vaginal discharge or bleeding
Cervix is usu. soft and may be dilated
Complications of septic abortions

Immediate cpx Late cpx

Haemorrhage PID
Peritonitis Pelvic adhesions
Pelvic abscess,
2 Infertility
endometritis,
Chronic LAP
Septicemia,
Septic/haemorrhagic
shock
Management

1. Resuscitation
IV fluids: RL, NS
2. Insert urethral catheter
Monitor Input/output
3. Blood grouping & Cross matching
4. Antibiotics:
Preferably cephalosporins, if not available
ampicilin and metronidazole
5. Evacuation
6. Haematenics
 6. RECURRENT PREGNANCY LOSSES

Defined as 3 or more consecutive

pregnancy losses

Other names:
habitual abortions
habitual miscarriage
recurrent abortions
recurrent miscarriages.
 Aetiology of RPL
Aetiology: Can be established in only 30%

Genetic Factors
Endocrine Factors
Anatomic Causes
Congenital anomalies, in competencies,

Infectious causes
Immunologic problems