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Miscarriages and Abortions.pptx

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Mitilam Oliver
Mitilam Oliver

This document defines miscarriage and abortion, and classifies miscarriages as threatened, inevitable, missed, incomplete, complete, or septic. It describes the symptoms and signs of each type of miscarriage. Causes of miscarriage include fetal factors like chromosomal abnormalities, and maternal factors like infections, medical conditions, drug use, environmental toxins, and uterine defects. Management options for miscarriage are expectant, medical, or surgical, such as cervical cerclage for cervical incompetence. Complications can include anemia, shock, sepsis, recurrent miscarriage, and maternal death.

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MISCARRIAGE/ABORTION DR TENO, O7G DEPT, MPHA 17TH AUGUST 2023
Definition ABORTION MISCARRIAGE Derived from latin word aboriri to miscarry Induced termination of pregnancy to destroy the fetus Spontaneous fetal loss before viability Termination/loss of pregnancy prior to 20 weeks gestation or with a fetus weighing < 500g
Classification Threatened Inevitable Missed Incomplete Complete Septic
THREATENED MISCARRIAGE Pregnancy threatens to abort: fetus has a 50% of aborting and 50% chance of surviving to term. Symptoms: Bloody vaginal discharge/PV bleeding Abdominal cramps May persist for days or weeks Signs: USS: Gestational Sac or live intra-uterine pregnancy with cardiac activity Spec: Cervical Os closed, bleeding, no POC
INEVITABLE MISCARRIAGE Unavoidable event, hence pregnancy is most likely to abort. Symptoms: Abdominal cramps PV bleeding Symptoms of infection: fever, abnormal vaginal doischarges, UTI symptoms Signs: USS: live intra-uterine pregnancy or fetal demise Speculum: cervical os dilated, SRM/leaking amnionic fluid, products of conception
MISSED MISCARRIAGE Fetus stops developing or fetus dies. Symptoms Progesterone maintains pregnancy symptoms: Breast tenderness Fatigue Morning sickness Absence of bleeding, abdo pain or loss of fetal tissue Signs: USS: fetal demise with no cardiac activity Speculum: cervical os closed, no bleeding and no products of conception
INCOMPLETE MISCARRIAGE Pregnancy aborts, but partial POC are retained in utero whilst others are expelled. Symptoms: PV bleeding, abdominal cramps, partial POCs expelled Signs: USS: POC in-utero Speculum: Cervical Os dilated, partial POCs dislodged at os, bleeding
COMPLETE MISCARRIAGE Pregnancy aborts, and all POC are expelled. Symptoms: PV bleeding, abdominal cramps, POCs expelled including fetus Signs: USS: uterus empty Speculum: Cervical Os closed, no POC, POC expelled completely, little or no bleeding
SEPTIC ABORTION Abortion may either be: Spontaneous or criminal complete or incomplete. Associated with signs of Sepsis Symptoms: Fever, abdominal pain, offensive PV discharges, may/not come with PV bleeding Signs: USS: retained POCs or empty uterus Speculum: cervical Os closed, offensive PV discharges, tenderness Sepsis: fever, tachycardia, tachypnoea
EITIOLOGY Fetal Factors Maternal factors Uterine/cervical defects
FETAL FACTORS Chromosomal abnormalities Maternal gametogenesis errors 95% Paternal errors 5%
MATERNAL FACTORS Infections: Syphilis, HIV, Group B streptococci Chronic Debilitating Diseases: TB, cancer Endocrine abnormalities: Polycyctic Ovarian Syndrome (PCOS) Diabetes mellitus Hypothyroidism Trauma
MATERNAL FACTORS Drug use: tobacco, alcohol, caffeine Radiation: therapeutric doses to treat malignancy are abortifacient. Contraceptives: Intra-uterine device Environemental toxins: arsenic lead, formaldehyde, benzene. Ethylene oxide Maternal Surgery: abdominal or pelvic
Uterine Defects Acquired uterine defects Uterine Leiyomyoma/fibroid Ashermans Syndrome Devlopmental Uterine Defects
Incompetent Cervix Characterized by a shorter Cx < 4cm with painless cervical dilatation in T2 Membranes prolapse and balloon into the vagina Immarture fetus is expelled
Management Expectant Medical Surgical
What is Expectant Management? Symptomatic relief, correct anaemia and antibiotic cover Type of abortion Treatment Arm Threatened Expectant Inevitable Expectant Incomplete or Missed 1. Expectant 2. Insert Misoprostol 600mcg PR 3. Dilatation and curettage (D&C): dilate the cervix and curette (scrape) the products of conception Septic 1. Misoprostol 600mcg PR 2. D&C 3. Expectant
Dilatation and curettage
Cervical incompetence: cervical cerclage
Complications Aanaemia Hypovolaemic shock Septicaemia/septic Shock Increases the risk of recurrent miscarriage in subsequent pregnancy Maternal Death
REFERENCES Cunningham. Et al. 2014. Williams Obstetrics 24th Edition. McGraw Hill Education. New York. Edmonds. K. 2007. Dewhursts Textbook of Obstetrics and Gynae cology. 7th Edition. Blackwell Publishing, California Norwitz E, and John Scchorge. 2001. Obstetrics and Gynaecology at a Glance. Blackwell Science Ltd, Oxford. Gupta, L.C. et al. New Concise Medical Dictionary (5th Edition). 2011. AITBS Publishers, India https://calgaryguide.ucalgary.ca/ectopic-pregnancy/ WHO. 2015. Pregnancy, Childbirth, Postpartum and Newborn Care: A guide for essential practice. [Online] Available: https://www.ncbi.nlm.nih.gov/books/NBK326667/

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Miscarriages and Abortions.pptx

  • 1. MISCARRIAGE/ABORTION DR TENO, O7G DEPT, MPHA 17TH AUGUST 2023
  • 2. Definition ABORTION MISCARRIAGE Derived from latin word aboriri to miscarry Induced termination of pregnancy to destroy the fetus Spontaneous fetal loss before viability Termination/loss of pregnancy prior to 20 weeks gestation or with a fetus weighing < 500g
  • 4. THREATENED MISCARRIAGE Pregnancy threatens to abort: fetus has a 50% of aborting and 50% chance of surviving to term. Symptoms: Bloody vaginal discharge/PV bleeding Abdominal cramps May persist for days or weeks Signs: USS: Gestational Sac or live intra-uterine pregnancy with cardiac activity Spec: Cervical Os closed, bleeding, no POC
  • 5. INEVITABLE MISCARRIAGE Unavoidable event, hence pregnancy is most likely to abort. Symptoms: Abdominal cramps PV bleeding Symptoms of infection: fever, abnormal vaginal doischarges, UTI symptoms Signs: USS: live intra-uterine pregnancy or fetal demise Speculum: cervical os dilated, SRM/leaking amnionic fluid, products of conception
  • 6. MISSED MISCARRIAGE Fetus stops developing or fetus dies. Symptoms Progesterone maintains pregnancy symptoms: Breast tenderness Fatigue Morning sickness Absence of bleeding, abdo pain or loss of fetal tissue Signs: USS: fetal demise with no cardiac activity Speculum: cervical os closed, no bleeding and no products of conception
  • 7. INCOMPLETE MISCARRIAGE Pregnancy aborts, but partial POC are retained in utero whilst others are expelled. Symptoms: PV bleeding, abdominal cramps, partial POCs expelled Signs: USS: POC in-utero Speculum: Cervical Os dilated, partial POCs dislodged at os, bleeding
  • 8. COMPLETE MISCARRIAGE Pregnancy aborts, and all POC are expelled. Symptoms: PV bleeding, abdominal cramps, POCs expelled including fetus Signs: USS: uterus empty Speculum: Cervical Os closed, no POC, POC expelled completely, little or no bleeding
  • 9. SEPTIC ABORTION Abortion may either be: Spontaneous or criminal complete or incomplete. Associated with signs of Sepsis Symptoms: Fever, abdominal pain, offensive PV discharges, may/not come with PV bleeding Signs: USS: retained POCs or empty uterus Speculum: cervical Os closed, offensive PV discharges, tenderness Sepsis: fever, tachycardia, tachypnoea
  • 10. EITIOLOGY Fetal Factors Maternal factors Uterine/cervical defects
  • 11. FETAL FACTORS Chromosomal abnormalities Maternal gametogenesis errors 95% Paternal errors 5%
  • 12. MATERNAL FACTORS Infections: Syphilis, HIV, Group B streptococci Chronic Debilitating Diseases: TB, cancer Endocrine abnormalities: Polycyctic Ovarian Syndrome (PCOS) Diabetes mellitus Hypothyroidism Trauma
  • 13. MATERNAL FACTORS Drug use: tobacco, alcohol, caffeine Radiation: therapeutric doses to treat malignancy are abortifacient. Contraceptives: Intra-uterine device Environemental toxins: arsenic lead, formaldehyde, benzene. Ethylene oxide Maternal Surgery: abdominal or pelvic
  • 14. Uterine Defects Acquired uterine defects Uterine Leiyomyoma/fibroid Ashermans Syndrome Devlopmental Uterine Defects
  • 15. Incompetent Cervix Characterized by a shorter Cx < 4cm with painless cervical dilatation in T2 Membranes prolapse and balloon into the vagina Immarture fetus is expelled
  • 17. What is Expectant Management? Symptomatic relief, correct anaemia and antibiotic cover Type of abortion Treatment Arm Threatened Expectant Inevitable Expectant Incomplete or Missed 1. Expectant 2. Insert Misoprostol 600mcg PR 3. Dilatation and curettage (D&C): dilate the cervix and curette (scrape) the products of conception Septic 1. Misoprostol 600mcg PR 2. D&C 3. Expectant
  • 20. Complications Aanaemia Hypovolaemic shock Septicaemia/septic Shock Increases the risk of recurrent miscarriage in subsequent pregnancy Maternal Death
  • 21. REFERENCES Cunningham. Et al. 2014. Williams Obstetrics 24th Edition. McGraw Hill Education. New York. Edmonds. K. 2007. Dewhursts Textbook of Obstetrics and Gynae cology. 7th Edition. Blackwell Publishing, California Norwitz E, and John Scchorge. 2001. Obstetrics and Gynaecology at a Glance. Blackwell Science Ltd, Oxford. Gupta, L.C. et al. New Concise Medical Dictionary (5th Edition). 2011. AITBS Publishers, India https://calgaryguide.ucalgary.ca/ectopic-pregnancy/ WHO. 2015. Pregnancy, Childbirth, Postpartum and Newborn Care: A guide for essential practice. [Online] Available: https://www.ncbi.nlm.nih.gov/books/NBK326667/

Editor's Notes

  1. Hypothyroidism: Autoimmune disorder where Thyroid autoantibodies associated with miscarriages DM:poor glucose control increases rate of abortions in insulin dependent diabetes Coffee: rate of abortion increases in women who consume 5cups of coffee/day.