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ABORTIONS AND

IT’S
COMPLICATIONS

BY
DR.OKONGWU.C.A

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 DEFINITION

 EPIDEMIOLOGY

 CLINICAL VARIETIES OF
ABORTION

 INTRODUCTION

 AETIOLOGY \ CAUSES
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INTRODUCTION:

 Many pregnancies are lost in the early


weeks than at any other stage of gesitation

 While early pregnancy losses are often


considered to be less important than the
loss of the baby in later pregnancy,the loss
of a wanted pregnancy is always distressing
to the mother irrespective of the timing.

 This is particularly true of recurrent


abortions

 Abortion is one of the complications of early


pregnancy and can either be spontaneous
or induced
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DEFINITION:

 Abortion is termed the termination of


pregnancy before the period of fetal
viability usually taken in our
environment to be the 28th week of
gesitation.
Or
 By WHO; The expulsion or extraction
from it’s mother of a fetus weighing
500gm or less.

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EPIDEMIOLOGY:
 It is virtually impossible to state the
accurate frequency of spontaneous
abortions because some of the early
cases are not definitely diagnosed
and may be regarded as delayed or
abnormal menstrual period.
 The incidence of spontaneous
abortion is generally estimated to
be 15-17% of all pregnancies
 WHO estimates that about 46
million cases of abortion occur
annually.
35/1000 women
 10/14/08 aged
Dr Okongwu CA 15-45 years 5
 About 90-95% of this figure occurs in the
developing countries and more than 80%
of this are unsafe abortions.
 The incidence in Nigeria is about 61,000
cases per annum,constituting 40% of the
total number of cases in West-
Africa.25/1000 of women aged 15-44 years
of age.
 It is estimated that unsafe abortions
account for 20-50% of the over 500,000
maternal deaths that occur globally every
year.
 Nigeria as in most developing nation,
induced abortion is illegal except to save
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the life the pregnant woman.
 This restrictive abortion law has not
stopped the practice but have merely
driven it underground,making it
dangerous and unsafe.
 Over the last three decades the

debate on the need for a review of


the abortion law in Nigeria has
generated much controversies in
political,social,religious and medical
circles.
 While the issue have been set aside

the problem remains,making the


goal of safe motherhood initiative in
reducing maternal
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mortality largely 7
Dr Okongwu CA
CLINICAL VARIETIES OF ABORTION

 THREATENED ABORTION:

 At least 20% of pregnant women


have some first trimester bleeding.

 This in most cases is thought to be


implantation bleed.

 The cervical os is closed.

 There is no painful uterine


contractions Dr Okongwu CA
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INEVITABLE ABORTION
 Increased bleeding.

 Painful uterine contractions or


back pain.

 Cervical effacement and


dilatation and/or rupture of
membranes
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INCOMPLETE ABORTION
 The products of conception has
been partially passed from the
uterine cavity.

 Abdominal cramps are usually


present.

 Bleeding is generally persistent


and is often severe,leading to
shock.
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COMPLETE ABORTION

 All the products of have been


expelled.

 Uterine contractions and pain


ceases.

 Uterus usually smaller than the


period of amnorrhoea would
suggest.
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SEPTIC ABORTION
 Following an incomplete abortion
there is a risk of an ascending
infection into the uterus.
 Septic abortion is manifested by
fever, offensive vaginal
discharge,pelvic and abdominal pain.
 The commonest infecting organisms
are,staph.aureus,coliforms,bacteroids
and clostridium welchii.
 Infections may spread to structures
arround the uterus,causing pelvic or
generalised peritonitis,pelvic cellulitis
or salpingitis.
 These organisms may invade the
bloodstream to cause septicaemia.
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MISSED ABORTION
 This occurs when the embryo
dies but the gesitation sac is
retained in the uterus for several
weeks or months
 There is disappearance of
symptoms of pregnancy.
 Immunological test for
pregnancy usually become
negative about ten days after
the death of an embryo.
 A rare complication is defective
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RECURRENT ABORTION
 This term refers to any case in which
there is have been three or more
consecutive spontaneous miscarriages.
 Unless each successive abortion
occurred about the same time and in a
similar fashion it should not be assumed
that there is a common underlying cause.
 Approximately 1-4% are habitual
aborters
 There is increased risk of abortion after a
previous abortion.
 Repeated midtrimester abortions may
result
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AETIOLOGY
MORPHOLOGIC AND GENETIC
ABNORMALITY:

 Aneuploidy accounts for about 50% of


all early pregnancy losses.
 Autosomal trisomies have been noted
for every chromosome except
chromosome one.together they make
up over 50% of all aneuploid losses.
 Monosomy X is the single most
common aneuploidy in spontaneous
losses.(20%)
 Polyploidy usually in form of triploidy
is found in about 20% of of all
miscarriages.They usually result in
empty sacs or Drblighted
10/14/08 Okongwu CA ovum but may
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MATERNAL FACTORS
 SYSTEMIC DISEASES:
 Maternal infections;acute matenal

infections such as pyelitis or


appendicitis, which can lead to toxic
illness with high temperature can
stimulate uterine activity and loss of
pregnancy.
 Bacteria infections;T.pallidium , N

Gonorrhoeae,Strept.agalactiae.
 Viral infections;TORCH organisms

 OTHER DISEASES:Diabetes

mellitus,hyper and
hypothyroidism,systemic
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 UTERINE DEFECTS:
 Uterine anomalies

 Diethylstilbesterol (DES)-related

anomaly such as T-shaped uterus


or hyperplastic uterus.
 Acquired anomalies-uterine

fibriods,
Asherman’s syndrome.
 Cervical in competence

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IMMUNOLOGIC DISORDERS

 BLOOD GROUP INCOMPATIBILITY:e.g


ABO,Rh,Kell etc.

 Similar maternal and paternal HLA


may enhance the possibility of
abortion by causing insufficient
maternal immunologic recognition of
the fetus.

 MALNUTRITION
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TOXIC FACTORS
 RADIATIONS
 Antineoplastic drugs.
 Alcohol.
 Nicotine
 Other agents suchs as ethylene
oxide, lead,and fomaldehyde may
also be toxic.

 TRAUMA:
 Direct trauma such as injury to uterus
eg.Gunshot injury or indirect trauma
such as surgical removal of an ovary
containing a corpus luteum cyst of
pregnancy may result in spontaneous
abortion.
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