ABORTION 1

• This is a very common gynecological

emergency; it could be spontaneous or
induced.
• Spontaneous Abortion: this complicate up to
15% of all pregnancies.
• It is defined by the WHO as the extraction or
expulsion of a product of conception weighing
500gm or less which correspond to about 24
weeks of gestation.
• It could also be define as the termination of
pregnancy before the age viability which is
taken as 28 weeks in our environment.
• The differences in the age of viability is due to
the availability of neonatal intensive care
facilities.
• Causes Of Abortion:
• 1. The commonest cause of abortion
especially in the first trimester is due to
chromosomal abnormality of which autosomal
trisomies are the most common as seen in
Edwards, Patau, and Down syndromes which
are due to trisomies involving chromosomes
18, 13 and 21 respectively.
• Others are triploidy and monosomies e.g
45XO.
• Structural chromosomal rearrangement like
translocations and inversions are significant
causes of recurrent abortion.
• 2. Endocrine diseases like diabetes mellitus, hypo
and hyper thyroidism are known causes.
• 3. uterine abnormalities like septate uterus are
important cause of recurrent abortions.
• Acquired conditions of the uterus like cervical
incompetence, Ashermans syndrome ,fibroids are
also implicated.
• 4. infections: any febrile illness can lead to
miscarriage or abortion. Examples; malaria, UTI,
pneumonia etc.
• 5. immunological disorders as seen in anti-
phospholipid syndrome and hereditary
thrombophilia.
• 6. agents like pesticides, tobacco, alcohol,
anesthetic gases can result in abortion.
 Classification of spontaneous Abortion
• 1. Threatened abortion: painless vagina
bleeding with closed cervix.
• 2. Inevitable abortion: abdominal pain, with
cervical dilatation or drainage of liquor before
the age of viability.
• 3. Incomplete abortion: some product of
conception already expelled.
• 4. Complete abortion: All the product of
conception has been expelled.
• 5. Septic abortion: sepsis as set in, this could
occur with or without retain product in the
uterus
• 6. Missed abortion: there is fetal demise but it
is still retain within the uterus.
• 7. Habitual or Recurrent Abortion: three or
more consecutive spontaneous abortions.
 Managements
• This is based on a good history, examination
and relevant investigations.
• Investigation may include;( a) FBC( b)( MP( c)
(GXM (d) ECS-MCS( f) Urine MCS( g) Urinalysis
(h) Pelvic USS.
 Post Abortion Care (PAC)
This is total care giving to a woman who has
just had an abortion either spontaneous or
induced in order to prevent related illnesses
and mortality. Its key element are
1 . The emergency treatment of incomplete
abortion and potentially life threatening
complications
2 . Post abortion family planning counseling
and services.
• 3. links between post abortion emergency
services and the reproductive health care
services.
• Emergency Treatment: These include;
• a) Initial assessment to confirm the presence of
abortion complications.
• B) Talking to the woman regarding her medical
condition and treatment plan
• C) Stabilization of emergency condition and
treatment of any complications which include
use of
• i) antibiotics
• ii) IVF
• iii) Oxytocics
• iv) Analgesics
• v) Uterine evacuation in cases of incomplete
abortion
• vi) Blood transfusion
• vii) treatment of severe complications like DIC,
renal failure, severe sepsis as the case may be.
• The post abortion family planning services. All
modern methods of contraception are
appropriate for use after abortion as long the
provider screens the woman for the standard
precaution for a method and gives adequate
counseling.
• Links to other reproductive health care
services. It is important to identify the
reproductive health services that each woman
may need and offer her a wide range of
services as possible. e.g cervical sceening.
 HOME WORK
• 1. Discuss the management of recurrent or
habitual abortion.
 ABORTION 2 (Unsafe Abortion)
• This is the procedure for termination of an
unintended pregnancy, either by persons
lacking the necessary skills or in an
environment lacking the minimal medical
standards or both.
• An estimated 70,000 women die from its
complications annually worldwide.
• It accounts for about 13% of maternal
mortality worldwide. Majority of this deaths
occurred in developing countries due to
restricted access to safe abortion services.
• Why Women Terminates Unintended
Pregnancies:
• 1. Lack of access to contraception
• 2. Failed contraception
• 3. Incest
• 4. Rape
• 5. Men’s denier of responsibility for pregnancy
 Methods Used
• 1. Systemic abortifacients for example High
doses of oral quinine, laundry blue, bleach etc.
• 2. vaginal/cervical abortifacients e.g herbal
preparations, potassium permanganate etc.
• 3. Intrauterine foreign bodies e.g stick, root,
leaf, wire, coat hanger, bicycle spook etc.
• 4. External trauma, e.g abdominal massage,
heavy weight etc.
 Complications(Early)
• 1. Hemorrhage
• 2. Trauma to the cervix
• 3. Uterine perforation
• 4. Perforation of viscous
• 5. Sepsis
• 6. Peritonitis
• 7. Acute renal failure
• 8. Tetanus
 Long time Complications
• 1. Tubal factor infertility
• 2. Ectopic pregnancy
• 3. Chronic PID
• 4. Chronic pelvic pain
• 5. Cervical incompetence
• 6. Asherman’s syndrome
 Primary Prevention
• 1. Education of the girl child and the populace
about the dangers of unsafe abortions
• 2. Contraception.
• 3. Provision of post abortion family planning
services.
• 4. Removal of barriers which denies access to
contraception for women.
 Secondary Prevention
• 1. Women with unintended pregnancies
should be encouraged to keep the pregnancy
and offer the child for adoption or fostering.
2. liberalization of abortion law though it is a
controversial, moral and religious issue.
• 3. Provision of safe abortion services as
permitted within the limit of the law.
• 4. training of middle level providers like the
midwives and the nurses to decentralize care and
increase acces of women to safe abortion services
where permissible within the limit of the law.
• 5. Inclusion of safe abortion procedure in the
curriculum of training of health care providers.
• 6. provision of MVA and medical abortion rather
than D&C and other harmful methods for the
treatment of incomplete abortion.
 Tertiary Prevention
• 1. Promotion of post abortion care (PAC)
• 2. Organization of services including referral
services for the management of severe
complications of unsafe abortion
• 3. Training and retraining of service providers
 Conclusion
• Unsafe abortion is the major cause of
maternal mortality and for developing
countries to achieve the targets of the
millennium development goals (MDG), the
prevention of unsafe abortion should be a
priority
 HOME WORK
• 1. Critically discuss the Nigeria abortion laws.
• 2. Discuss unsafe abortion and the attainment
of millennium development goals in Nigeria.