Termination of pregnancy, either spontaneously or intentionally prior to 20 weeks gestation or less than 500-g birth weight The early abortion: occurs before 12w The late abortion: occurs after 12w Abortion occurring without medical or mechanical means to empty the uterus is referred to as spontaneous Another widely used term is miscarriage
Etiology
>80 percent occur in the first 12 weeks AOG At least half result from chromosomal anomalies After the first trimester, both the abortion rate & the incidence of chromosomal anomalies decrease
The risk of spontaneous abortion increases with parity as well as with maternal and paternal age
The frequency of abortion increases from 12 percent in women younger than 20 years to 26 percent in those older than 40 years
Hemorrhage into the decidua basinalis, followed by necrosis of tissues adjacent to the bleeding If early, the ovum detaches, stimulating uterine contractions that result in its ovulation Gestational sac is opened , fluid surrounding a small macerated fetus or alternatively no fetus is visible blighted ovum
The skin softens and peels off in utero or at the slightest tough
When amnionic fluid is absorbed, the fetus may become compressed and desiccated fetal compressus The fetus become so dry and compressed that it resembles parchment - a fetus papyraceous
Monosomy X
The second frequent chromosomal abnormality Usually results in abortion
Triploidy
Associated with hydropic placental (molar) degeneration Incomplete (partial) hydatidiform moles may contain triploidy or trisomy for only chromosome 16
Infections
Uncommon causes of abortion in human
Listeria monocytogenes Clamydia trachomatis Mycoplasma hominis Ureaplasma urealyticum Toxoplasma gondii
Endocrine abnormalities
Hypothyroidism
Diabetes mellitus
Progesterone deficiency
Alcohol Caffeine
Incompetent cervix
Painless dilatation of cervix in the 2nd or early in the 3rd trimester prolapse & ballooning of membranes into vagina rupture of membrane & expulsion of immature fetus
Little is known in the genesis of spontaneous abortion Chromosomal translocations in sperm can lead to abortion
Threatened
Inevitable
Imcomplete
Complete
Middlesevera Aggravate No
Slightno No Complete
Gynecologic examination
+ Protect fetus
+/Curettage
+/Curettage
+/no
INDUCED ABORTION
Induced abortion
The medical or surgical termination of pregnancy before the time of fetal viability Therapeutic abortion
Termination of pregnancy before of fetal viability for the purpose of saving the life of the mother
Induced abortion
Septic abortion manifested by fever, malodorous vaginal discharge, pelvic and abdominal pain, and cervical motion tenderness.
Most often associated with criminal abortion Metritis is usual outcome, but parametritis, peritonitis, endocarditis, and septicemia may all occur
Before 14 weeks, D&C or vacuum aspiration should be performed After 16 weeks, dilatation & evacuation (D&E) is performed
Wide cervical dilatation Mechanical destruction & evacuation of fetal parts
Ovulation may resume as early 2 weeks after an abortion Therefore, if pregnancy is to be prevented, effective contraception should be initiated soon after abortion