Miscarriage abortion - PowerPoint Presentation

Slide1

Miscarriage

abortion

Done by :

Samah

Al

Najjar

Alaa

Jamal

Definition :

Is the expulsion or extraction of products of conception before fetal viability : before 24 weeks of gestation.

Incidence :

Is the commonest gynecological & obstetric disorder About 15% pf clinically recognized pregnancies end in abortion ( this rise 30% if unrecognized pregnancies are included)

Most abortions occur between 8 and 12 weeks of pregnancy.

Types of abortion :

1- Spontaneous abortion - first trimester abortion - second trimester abortion

2- Legal

abortion

-

therapeutic abortion

3- Illegal abortion

The Etiology for spontaneous abortion:

A- first trimester abortion

Fetal chromosomal abnormalities ( 50-70%)

An embryonic pregnancy – blighted ovum

Multiple pregnancy

Parental balanced translocation

Infections

Endocrine disorders ( Diabetes , thyroid disorders ..

Etc

Uterine disorders : Uterine anomalies ,

submucus

fibroid &

Asherman’s

syndrome.

Thrombophilia : congenital deficiency of protein C & S, & anti-thrombin III

Immunological disorders :

Anticardiolipin

syndrome & SLE

Cigarette smoking ,anesthetic agents , chemical agents.

11

. Psychological disorders

Second trimester abortion :

Multiple pregnancyCervical incompetence ( Congenital and acquired )

Uterince

anomalies and

submucous

fibroid

Genital tract infection

Legal abortion :

Therapeutic abortion : defined as the termination of pregnancy for medical indications , including : Medical illness in the mother in which continuation of the pregnancy has the potential to threaten the life or health of the mother is a factor .

If there is a genetic condition in the embryo or fetus which is incompatible with life ( sever case of certain genetic condition , sever case of profound mental impairment , cerebral hemispheres , anencephaly )

Legal termination of pregnancy

When carried out with proper facilities, legal abortion has an extremely low mortality rate, being less than the mean death rate associated with pregnancy. The usual methods are vacuum aspiration, dilatation and curettage, or

hysterotomy

in later pregnancy.

A few deaths are reported from time to time, the causes including

:

■ pulmonary embolism from leg vein

thrombosis

■ mishaps associated with

anaesthesia

■ disseminated intravascular coagulation and cerebral

damage

■ air embolism following vacuum aspiration

■

bleeding or infection, which failed to respond to treatment

Illegal abortion

This has a much wider range of causes. The risks vary according to the skill, experience and facilities of the abortionist. When this is carried out by a doctor with aseptic and antiseptic methods, together with antibiotic cover if needed, the risk may be small compared with the crude methods of a lay person using makeshift instruments. The most common methods together with the associated dangers to health and life are as

follows :

Illegal abortion

Instrumental

Interference

The intention is to disturb the pregnancy sac so that, once damaged, it will be expelled by uterine

contractions

All manner of instruments have been used, from surgical dilators to bicycle

spokes.

The dangers of such instrumentation are bleeding and infection. Perforation o f the wall o f vagina or uterus may cause severe

bleeding.

Another less common danger o f the use of instruments (including syringes) is cervical shock. The mere act of dilating the cervix with an instrument in an

unanaesthetized

patient may trigger a vagal reflex, the efferent pathway being via the parasympathetic nervous system, causing a cardiac arrest.

2

.

Dilation of the

cervix

Another crude method was to introduce a ‘tent’ into the cervical canal. This was a strip of substance that absorbed water and became greatly enlarged , The risks were perforation of the cervix and also

infection .

3.Physical Violence

Women anxious to lose their pregnancy have resorted to extremes of physical activity and even violence in efforts to dislodge the

fetus.

some unfortunate women went on to seek violent treatment from husbands or consorts. Punching and kicking of the abdomen were most common, and death from visceral rupture, such as liver, spleen or intestine

A rubber pump, usually a Higginson enema syringe, is used to introduce fluid under pressure into the cavity of the uterus. This strips the chorionic sac from the wall of the uterus, exposing the placental bed. If sufficient detachment is achieved, then abortion will occur.

The main danger – part from the usual risks of bleeding and infection from damage to the tissues by the stiff nozzle – was air embolism

4- INSUFFLATION

OF AIR

5. Syringe

aspiration

The suction method most often used in therapeutic abortion has also come to be used for illegal operations, mainly by medical or nursing

personnel.

The method is safe as long as aseptic methods are used, though, if evacuation is incomplete, some products of conception may be left behind that can form a nidus for infection

.

Whatever method is used to evacuate the uterus, the risk of

haemorrhage

or sepsis is always present

.

6. Drugs & chemicals

Substances applied locally include phenols and Lysol, mercuric chloride, potassium permanganate, arsenic, formaldehyde and oxalic acid. All have their own dangers, both from local corrosion and systemic effects if absorbed. A necrotic

pseudomembrane

may form in the vagina and severe damage to the cervix may also ensue.

Pennyroyal, tansy, rue,

savin, laburnum, colocynth, aloes, castor oil, nutmeg, hellebore, cantharides, cotton root, wintergreen and turpentine. Many of these may cause purging, gastrointestinal irritation and general illness if taken in quantity.

Also Quinine can be dangerous, as the dosage required for any effect on the uterus is likely to cause

cinchonism

This woman insufflated her uterus with a Higginson syringe and had time to clean up the equipment before collapsing with air embolism

Burns from a hot-water bottle on the inner side of the upper thigh in an attempt to resuscitate the victim of a criminal abortion who died from air embolism.

THE AUTOPSY IN ABORTION DEATHS :

If death in pregnancy

or criminal abortion is

suspected,

usual full autopsy with fullest possible history is

required .

a

careful external examination must be carried out, noting

especially

:

1-

Abnormal coloration of the skin, such as in the bronzing of

clostridial

septicaemia

and the jaundice of liver damage

.

2-

Signs and duration of pregnancy, such as abdominal swelling and breast changes.

3- Signs

of injury, including bruising or abrasion of the vulva from instrumentation, and vaginal

bleeding or

burns

the

abdomen .

4- The

vagina should be examined for signs of recent or current pregnancy, and attempted or successful recent abortion

.

5- Where any possibility of air embolism is considered, pre-autopsy radiology of the chest and abdomen must be performed

Complication of abortion :

1. Hemorrhage 2. Complication related to surgical evacuation Uterine perforation Cervical tear & excessive cervical dilation – which may lead to cervical incompetence

Infection which may lead to infertility and

Asherman’s

syndrome

3.

Rh-iso-immunisation

if the anti-D is not given or if the dose is

inadequte

4. psychological trauma