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 6th 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
woman’s 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. Asherman’s 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,
endometritis, • 2° Infertility

• Septicemia, • Chronic LAP

• 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