Report on Induced abortion –methods of termination of pregnancy till 12 wks of gestation , pre abortion
counseling
Def…. deliberate artificial termination of pregnancy until 22 ges. wks in a manner that ensures that the embryo\
fetus does not survive,
I incidence- 1:4 preg world wide.
Classification;1. early-till 12wks. –late-12-22wks
2.medical/planned-●decided by mother. no risk for preg.
-●due to complications of preg.(therapeutic)
maternal risk associated with contraction of preg/ fetal abortion associated with genetic chromosome structural
defects
note; chromosome defect anencephaly, down, fetal malformations
●w/out compli- malignancy, syphilis, rubella, cmv, hiv, hf, pulmonary failure ,kidney problems.
3.surgical
medical
indications
preg<22wks ●,continuance of preg would involve risk to the life of mother greater than if the preg was terminated.
● termination to prevent physical/ mental health ,injury of preg female or existing child of family.
●substantial risk if child born for physical/mental abnormalities.
4. On request of mother.
5. Social factors.
Methods
• Early surgical – 1.D&C
2.vaccum curettage till 5-6 wks maximum.
• Medical – 3. RU 486 (mifepristone) – antiprogesterone,
4.Laminaria – if products of conception are large.
Note:- Ru 486 – 400 – 600 μg – p/o followed in 36 – 48 hrs i/m or vaginal prostaglandin analog,
Used for preg < 7wks 79% effective.
- Methotrexate with Misoprostol (pg) – 800 μg 1wk +/- require ….cuation later i/vaginal a/f 2wks
(single) at 8wks Embryo’s expected Spontaneously if not check hCG
50mg/m³, 90% effective level
If abortion fails within 36hrs, PgE, methylester pesary (Gemeprost 1mg vaginaly to complete abortion,
process Misoprostol (Pg…)
• Surgical:
Done under local anesthesia / light general
D&C:
o Tapered dilatators in progressively ↑in size with the Ø of the …cannula is real size of the
cannula correlates with gestational age,
o Laminaria in cervical canal atleast for 4+ or overnight,
o Prostaglandin E1 analogue.
After dilation curette is inserted and taken out usually performed after 7 – 12 wks.
D&E is performed from 12 – 18 wks.
Methods of late abortion:
1. Vaginal prostaglandins:
Gemeprost vagitorium (Pg E1 analogue),(Cergem) 1mg every 3 hours until abortion has happened
(+vacuum curettage)
Misoprostol (Pg E1 analogue) vag. 200 μg every 3 hours
Dinoprostone supp. (Pg E2) 20 mg every 3 hours
Dinoprostongel (Prepidil) 0.5 mg.
2. RU - 486 Mifepristone (Mifepristone) 150 – 200 – 600 mg p/o then in 24-48 hours +prostaglandins .
3. Extra – amniotic: Intermittent injection or continuous infusion:
Dinoprost (Pg E2α) 0.25 mg followed by 0.75 mg every hour
Diniprostone 0.05 mg followed by 0.2 mg every hour.
LATE.
Induce the labour.
Medical – i/uterine Pg E2 / F2α
i/uterine hypertonic urea
Extrauterine Pg E2 / F2α
Vaginal Pg
D&E (13 – 18 wks)– dilate with laminaria or Pg E1 and evacuate with larger cannula. Paracervical blockage + i/v
sedation.
C.S (crporal) or/ Hysterectomy and Hysterotomy can be done at any stage of pregnancy, but ↑ risk for
rupture in next pregnancy. It ↑ morbidity + mortality neither is as a 1ْ met.
Indications: Failure to complete a midtrimester, abortion due to cervical steno sis or failure in management of
other complicant. Transverse cut’s impossible: lower segment is not developed (develops one after 30 GW) +
Istmus is 1 cm (12 cm labour).
Complications:
• retained placenta – 30-46% infection (prophylactic a/b)
• cervical laceration
• failure of labour (to expulse the products of concep.)
Late:
• infection – ascending ; Exogenous.
• Bleeding. 3-6 d after retention,
• Recurrent miscarriages
Report on Induced abortion –methods of termination of pregnancy till 12 wks of gestation , pre abortion counseling
Report prepared by
1. Dr. Sajid Mahmood, MD (EU), Accident & Emergency Department, NHS Royal infirmary Liverpool United Kingdom.
2. Dr. Adnan Akram, MD (EU), Department of Infectious Diseases. University Hospital Riga Latvia.
3. Dr. Aftab Ahmed, MD (EU), Infection Control Department, Kaunas Medical University Clinic. Lithuania.