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Abortion or Miscarriage

ABORTION
- the termination of pregnancy before fetus is viable
- fetus is "viable" - defined as fetus of 20 weeks AOG, weighing below 350 gram
- abortion may be elective (planned, medical termination of pregnancy) or reproductive problem


Predisposing/precipitating factors of Abortion are:

1. Chromosomal defect
2. Teratogenic factor
3. Immunologic (anti-phospolipid antibody)
4. Faulty placental development
5. Infection
6. Hyperemesis
7. Trauma
8. Severe stress
9. Disease
10. Incompetent cervical os

Types of Abortion

1. Spontaneous - pregnancy ends of natural cause
2. Induced - therapeutic or elective reasons for terminating pregnancy
3. Inevitable - threatened loss that cannot be prevented 
  • save and count pads
  • monitor hemorrhage
  • emotional support
4. Incomplete - loss of some products of conception and retention of others
  • D & C
  • oxytocin
  • IV/Blood transfusion
5. Complete - loss of all products of conception in utero after fetal death
  • observe
  • may be given oxytocin
6. Missed - retention of products of conception in utero after fetal death
  • D & C
  • monitor for infection
  • DIC (disseminated intravascular coagulation)
7. Habitual - spontaneous abortions in three or more successive pregnancies
  • cerclage (encircling the cervix with suture)
  • shirodkar and McDonald technique
8. Septic - abortion due to infection
9. Threatened - bleeding, cramping and softening of uterus with CLOSED CERVIX 
  • bedrest
  • no intercourse
  • monitor bleeding

Manifestations of Abortion

Types of Abortion - Abdominal Pain - Vaginal Bleeding - Others

- Threatened ------ Mild ------------ Mild ---------- Closed Cervix
- Inevitable ------Mild to moderate - moderate ----- open cervix
- Complete ------ minimal --------- complete -- passage of fetus and placenta
- Incomplete ---- severe ----------- severe --------- open cervix
- Missed -------- mild to moderate - spotting ----- no uterine contraction
- Septic --------- severe --------- mild to severe -- fever, foul vaginal discharge
- Habitual ------ mild to moderate --intermittent; fetal discharge


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