TYPES OF ABORTION part 1 IN ENGLISH

                                               

                                  TYPES OF ABORTION part 1 IN ENGLISH

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Types of Abortions PART 1

Threatened Abortion-

This is a type of abortion where the process of miscarriage has started but has not progressed to a state from which recovery is impossible.  about 80% of women with threatened abortion have a viable pregnancy .

Clinical manifestations-

(1) Bleeding per vagina is usually slight and may be brownish or bright red in color. On rare occasion, the bleeding may be brisk, especially in the late second trimester. The bleeding usually stops spontaneously. On examination cervical os is closed.

(2) Pain: Bleeding is usually painless but there may be mild backache or dull pain in lower abdomen.

Diagnostic Investigations-

•        Blood test —for hemoglobin, hematocrit, ABO and Rh grouping.

•        Ultrasonography to assess fetal wellbeing

•        Serum progesterone level

•        serum hCG level

Management-

Bed rest- The patient should be in bed for few days until bleeding stops.

Drugs- Relief of pain may be ensured by pain killers.

The patient should limit her

activities for at least 2 weeks and avoid heavy work. Coitus is avoided during this period.

She should be followed up with repeat sonography at 3–4 weeks’ time

Inevitable Abortion-

This is a type of abortion where the process of miscarriage has   progressed to a state from which continuation of pregnancy is impossible.

               Clinical manifestations-

Initial clinical manifestations are same as in threatened abortion than The patient develops the following additional manifestations:

(1)    Increased vaginal bleeding.

(2)    Aggravation of pain in the lower abdomen which may be colicky in nature.

(3)    Internal examination reveals dilated internal os of the cervix through which the products of conception are felt

(4)    In the second trimester, it may start with rupture of the membranes or intermittent lower abdominal pain

Management-

If the pregnancy is up to 12 weeks:-

 (1) Dilatation and evacuation followed by curettage of the uterine cavity by blunt curette using analgesia or under general anesthesia.

(2) Some times suction evacuation is done followed by curettage of the uterine cavity by blunt curette using analgesia or under general anesthesia.

 If the pregnancy is more than12 weeks:-

(1)    The uterine contraction is accelerated by oxytocin drip (10 units in 500 mL of normal saline) 40–60 drops per minute.

(2)    If the fetus is expelled and the placenta is retained, it is removed by ovum forceps, if lying separated. If the placenta is not separated, digital separation followed by its evacuation is to be done under general anesthesia.

Complete Abortion-

In this is a type of abortion the products of conception are expelled completely. It can occur naturally during a miscarriage or as the result of a successful medical abortion or surgical procedure. 

Clinical manifestations-

There is history of expulsion of a fleshy mass per vagina followed by:

(1)    Subsidence of abdominal pain.

(2)    Vaginal bleeding becomes trace or absent.

(3)    Internal examination reveals:

               (a) Uterus is smaller than the period of amenorrhea and a little firmer.

               (b) Cervical os is closed

               (c) Bleeding is trace.

(4) Examination of the expelled fleshy mass is found complete.

(5) Ultrasonography(TVS): reveals empty uterine cavity.

Management-

•        Transvaginal sonography is useful to see that uterine cavity is empty, otherwise evacuation of uterine curettage should be done.

•        A Rh-negative patient without antibody in her system should be protected by anti-D gamma globulin 50 μg or 100 μg intramuscularly in cases of early miscarriage or late miscarriage respectively within 72 hours.

Incomplete Abortion-

When the entire products of conception are not expelled, instead a part of it is left inside the uterine cavity, it is called incomplete miscarriage.

Clinical manifestations-

There is history of expulsion of a fleshy mass per vagina followed by:

(1)    Continuation of pain in lower abdomen.

(2)    Persistence of vaginal bleeding.

(3)    Internal examination reveals—

(a) uterus smaller than the period of amenorrhea 

(b) Patulous cervical os often admitting tip of the finger and

(c) Varying amount of bleeding.

       (4) On examination, the expelled mass is found incomplete.

       (5) Ultrasonography reveals echogenic material (products of conception) within the cavity.

Management-

Early abortion: Dilatation and evacuation under analgesia or general anesthesia is to be done.  Evacuation of the uterus may be done using MVA also. 

Late abortion: The uterus is evacuated under general anesthesia and the products are removed

by ovum forceps or by blunt curette. In late cases, dilatation and curettage operation is to be done.