Chapter 9 Abortion
Abortion
Spontaneous abortion
Induced abortion
Pathology
Etiology
Fetal Factors
Maternal Factors
Paternal Factors
Categories of Spontaneous Abortion
History of abortion
Indications
Elective (Voluntary) Abortion
Abortion
Spontaneous abortion
Spontaneous abortion
Pathology
The skull bones collapse, the abdomen distends with bloodstained fluid, and the internal organs degenerate
The skin softens and peels off in utero or at the slightest tough
Spontaneous abortion
Etiology
After the first trimester, both the abortion rate & the incidence of
chromosomal anomalies decrease
F9-1
Spontaneous abortion
Etiology
F9-2
Spontaneous abortion
Etiology
In subsequent months
F9-3
Aneuploid abortion
T9-1
Monosomy X
Triploidy
Tetraploid abortuses
Rarely are liveborn and most often are aborted early in gestation
Euploid abortion
Infections
Listeria monocytogenes
Clamydia trachomatis
Mycoplasma hominis
Ureaplasma urealyticum
Toxoplasma gondii
Celiac sprue
Endocrine abnormalities
Hypothyroidism
Diabetes mellitus
Progesterone deficiency
Nutrition
Tobacco
Alcohol
Caffeine
Radiation
Contraceptives
Environmental toxins
Allogeneity
Inherited thrombophilia
Laparotomy
Physical trauma
Spontaneously
Induced by in utero exposure to DES (diethylstilbestrol)
Incompetent cervix
The more advanced the pregnancy, the more likely the risk that surgical
intervention stimulate preterm labor or membrane rupture
Sonography
: Confirm living fetus & exclude major fetal anomalies
Cervical cytology
McDonald
Modified Shirodkar
85~90% success rate
Indications
Membranes ruptures
Chorioamnionitis
Intrauterine infection
Operation fails
Signs of imminent abortion or delivery
Threatened abortion
Inevitable abortion
Missed abortion
Recurrent abortion
Threatened abortion
Definition
Frequency
Prognosis
Threatened abortion
Symptoms
Treatment
Threatened abortion
Vaginal sonography
Serial serum quantitative hCG
Serum progesterone
can help ascertain if the fetus is alive & its location
Vaginal sonography
Threatened abortion
Inevitable abortion
Complete abortion
Incomplete abortion
Expulsion of some but not all of the products of conception during 1st
half of pregnancy
The internal cervical os remains open & allows passage of blood
The fetus & placenta may remain entirely in utero or may partially
extrude through the dilated os
Remove retained tissue without delay
Missed abortion
Recurrent abortion
Postconceptional evaluation
hCG>1500mIU/ml USG
Prognosis
INDUCED ABORTION
Induced abortion
Therapeutic abortion
Induced abortion
Indication
Induced abortion
Hygroscopic dilators
: swell slowly & dilate cervix cervical trauma can be minimized
Laminaria tents
: stem of brown seaweed ( Laminaria digitata or japonica)
drawing water from proteoglycan complexes of cervix
dissociation allow the cervix to soften & dilate
2 important determinants
Menstrual aspiration
Laparotomy
Indications
Early abortion
nd
trimester abortion
Oxytocin
Prostaglandins
PG E1, E2, F2
Technique
: Can act effectively on the cervix & uterus (86~95% effectiveness)
Death
Hyperosmolar crisis (early into maternal circulation)
Cardiac failure
Septic shock
Peritonitis
Hemorrhage
DIC
Water intoxication
Antiprogesterone RU 486
Side effects
Epostane
Maternal mortality
Ectopic pregnancy
2nd trimester spontaneous abortions
LBW infants
Septic abortion
Management