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Definition Termination of pregnancy by any means (either spontaneously or intentionally) before the fetus is sufficiently developed by survive Termination of pregnancy before 20 weeks gestation or less than 500 g birth weight (conventional)
A) Spontaneous Abortion
Definition When abortion occurs without medical or mechanical means to empty the uterus, another widely used term is miscarriage Pathology Early Abortion Hemorrhage into the decidua basalis followed by necrotic of tissues adjacent to the bleeding The ovum becomes detached Stimulates uterine contractions Result in expulsion Blood or carneous mole => an ovum that is surrounded by a capsule of clotted blood, the capsule is of varying thickness with degenerated chorionic villi scattered through it Later Abortion Several outcomes: (the retained fetus may undergo maceration) The bones of the skull collapse The abdomen becomes distended with blood-stained fluid The skin softens and peels off in utero or at the slightest touch, leaving behind the corium Internal organs degenerate and undergo necrosis Amniotic fluid may be absorbed when the fetus becomes compressed upon itself and desiccated to form a fetus compressus Occasionally, the fetus eventually becomes so dry and compressed that it resembles parchment => fetus papyraceous Etiology The risk of spontaneous abortion increases with parity, maternal, and paternal age The exact mechanisms are not always apparent In the first trimester, spontaneous expulsion of the ovum is nearly always preceded by death of the embryo or fetus => etiological considerations of early abortion involve ascertaining whenever possible the cause of fetal death In the subsequent months, the fetus frequently does not die in utero before expulsion, and othe explanations for its expulsion must be invoked
A. Fetal Factors
1. Abnormal Zygotic Development The most common morphological finding in early spontaneous abortions is an abnormality of development of the zygote, embryo, early fetus, or at times the placenta
B. Maternal Factors
1. Infections Some chronic infections have been implicated in causing abortion => uncommon cause 2. Chronic Debilitating Disease In early pregnancy, chronic wasting diseases (such as tuberculosis or carcinomatosis) have seldom caused abortion. Celiac sprue has been reported to cause both male and female infertility and recurrent abortions 3. Endocrine Abnormalities Hypothyroidism Iodine deficiency may be associated with excessive miscarriages. There done appear to be an increased incidence if abortion with clinical hypothyroidism Diabetes Mellitus (insulin-dependent diabetes) Poor glucose control resulted in a market increase in the abortion rate Progesterone Deficiency Insufficient progesterone secretion by the corpus luteum or placenta (luteal phase defect), Insufficient progesterone production usually the consequence rather than the cause of early pregnancy failure
B. Inevitable Abortion
Clinical diagnosis: - Moderate effacement of the cervix - Cervical dilatation greater than 3 cm - Rupture of the membrane - Bleeding for more than 7 days - Persistent of cramps despite narcotic analgesics - Other signs of termination of pregnancy (e.g: partial extrusion of products of conception)
E. Recurrent Abortion
Three or more consecutive spontaneous abortions Two types of test as having a clear value in the investigation of recurrent miscarriage: - Parental cytogenetic analysis - Lupus anticoagulant and anticardiolipin antibodies assays
B) Induced Abortion
Definition The medical or surgical termination of pregnancy before the time of fetal viability Indications Disease that commonly lead to the operation: - Persistent heart disease after previous cardiac decompensation - Advanced hypertensive vascular disease - Invasive carcinoma of the cervix When continuation of pregnancy may threaten the life of the women or seriously impair her health When pregnancy has resulted from rape or incest When continuation of pregnancy is likely to result in the birth of a child with severe physical deformities or mental retardation