Abortion

Dr. Rajni Wadhwa

Termination of pregnancy before the period of viability which is 20th week or foetus weighing less than 500 gm is termed as abortion. Miscarriage is synonymous with abortion.

Causes of abortion

Infection – Viral infections such as rubella, cytomegalic virus, hepatitis virus causes death and expulsion of the foetus. Parasitic infections like malaria and protozoal infections like Toxoplasmosi may produce abortion in early pregnancy. Abortion may be precipitated by high fever.

Respiratory disease, heart failure, severe anemia, severe gastroenteritis are other important factors causing abortion. < Chronic illness like high blood pressure, chronic kidney diseases and other long standing wasting diseases can lead to abortion. Endocrine factors - An increase association of abortion is found in thyroid disorders and diabetes mellitus. Trauma - Direct trauma on the abdominal wall by bow or fall r other operative trauma may be related to abortion. Congenital malformation of the utreus, cervical incompetence, uterine tumour or fibroid, retroverted utreus are common causes of recurrent abortion. Blood group incompatibility - ABO and Rh incompatibility show a higher incidence of abortion. Premature rupture of the membranes leads to abortion. Some deficiency disorders like folic acid or Vitamin E deficiency may lead to abortion. Defective sperms which contribute half of the number of chromosomes to the ovum may result in abortion. In many cases the cause can not be traced. Threatened Abortion Here the process of abortion has started but has not progressed to a state from which recovery is impossible. Clinical features The pregnant woman complaint of bleeding from vagina and pain following haemorrhage. Investigations a blood investigations like haemoglobin investigations, ABO grouping and Rh typing is done ultra sonogrophy is an important investigation to identify the presence or absence of a normal conceptus. Management Bed rest is advised to the patient. For sedation and relief of pain, drugs are prescribed. The patient should limit her activities and avoid heavy work and excitement. Coitus is contraindicated during this period. The patient should report the doctor if bleeding or pain becomes aggravated. Inevitable Abortion Here the abortion has progressed to a state from where continuation of pregnancy is impossible. Clinical features The patient complains of increased vaginal bleeding & aggravation of the pain in lower abdomen. The general condition of the patient is proportionate to the visible blood loss. Management The process of expulsion is accelerated. If abortion occur before 12 weeks of pregnancy. Suction, evacuation & curettage is done. After 12 weeks of pregnancy the uterine contractions are accelerated by oxytocin drip which leads to expulsion of the abortus. Missed Abortion When the foetus is dead & retained inside the uterus for more than four weeks it is called missed abortion. After 12 weeks the retained foetus becomes macerated or mummified. The liquor gets absorbed & the placenta becomes pale, this & may get adherent. Clinical features There is vaginal bleeding followed by persistent brownish vaginal discharge. The symptoms of pregnancy subside. There is retrogression of breast changes. Uterine growth stops which in fact becomes smaller in size. Investigations Routine blood & urine investigation are done. Ultrasonography is an important investigation in diagnosing missed abortion. Management Vaginal evaluation is done under anaesthesia if uterus is less than 12 weeks. If uterus is more than 12 weeks induction is done either by oxytocin or prostaglandins. Septic Abortion Abortion which is associated with evidence of infection of the uterus & its contents is called septic abortion. About 10% of abortion requiring admission to hospitals are septic. In majority of these cases, the infection occurs following illegal induced abortion but can also occur after spontaneous abortion. Clinical features - Fever of at least 100.40f (380 C) for 24 hours or more. Fever can be associated with chills & rigors. There is lower abdominal pain & tenderness An offensive, purulent vaginal discharge is present Investigations Blood for haemoglobin estimation, complete blood count & blood grouping is done coagulation profile & serum electrolytes are also done. Cervical swab or high vaginal swab is taken to detect the organism microscopically or by culture. X-ray of abdomen & pehis to detect any foreign body left behind in the uterus or abdomen. Management Hospitalization of the patient is done. Antibiotics, sedatives & pain killers are given to the patient. Antigasgangrene serum & antitetanus serum are given prophylactically. Blood transfusion is done if required. Evaluation of the uterus is done following antibiotic therapy. vigorous curettage is avoided. The fluid & electrolyte in balance is corrected. Active surgery is indicated if there is pelvic abcess, injury to the uterus or intestine, presence of foreign body in the abdomen, decreased urinary output not responding to conservative treatment.