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    Abortion Kuliah

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    Ikhlas Beramal
    1) Abortion, also known as miscarriage, is defined as the termination of pregnancy before 20 weeks when the fetus weighs less than 500 grams. It can be spontaneous or artificial. 2) The most common cause of early abortion is chromosomal abnormalities in 50-60% of cases. Other causes include genetic, chemical, physical, maternal health, placental, immunological, and cervical factors. 3) Abortion is diagnosed through history, examination, ultrasound, and pregnancy tests. Differential diagnoses include ectopic pregnancy, molar pregnancy, and infections. Management depends on classification but may include expectant management, surgical evacuation, antibiotics, or cerclage for recurrent abortions.

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    Abortion Kuliah

    Uploaded by

    Ikhlas Beramal
    36 views38 pages
    1) Abortion, also known as miscarriage, is defined as the termination of pregnancy before 20 weeks when the fetus weighs less than 500 grams. It can be spontaneous or artificial. 2) The most common cause of early abortion is chromosomal abnormalities in 50-60% of cases. Other causes include genetic, chemical, physical, maternal health, placental, immunological, and cervical factors. 3) Abortion is diagnosed through history, examination, ultrasound, and pregnancy tests. Differential diagnoses include ectopic pregnancy, molar pregnancy, and infections. Management depends on classification but may include expectant management, surgical evacuation, antibiotics, or cerclage for recurrent abortions.

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    Abortion Kuliah

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    1) Abortion, also known as miscarriage, is defined as the termination of pregnancy before 20 weeks when the fetus weighs less than 500 grams. It can be spontaneous or artificial. 2) The most common cause of early abortion is chromosomal abnormalities in 50-60% of cases. Other causes include genetic, chemical, physical, maternal health, placental, immunological, and cervical factors. 3) Abortion is diagnosed through history, examination, ultrasound, and pregnancy tests. Differential diagnoses include ectopic pregnancy, molar pregnancy, and infections. Management depends on classification but may include expectant management, surgical evacuation, antibiotics, or cerclage for recurrent abortions.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    36 views38 pages

    Abortion Kuliah

    Uploaded by

    Ikhlas Beramal
    1) Abortion, also known as miscarriage, is defined as the termination of pregnancy before 20 weeks when the fetus weighs less than 500 grams. It can be spontaneous or artificial. 2) The most common cause of early abortion is chromosomal abnormalities in 50-60% of cases. Other causes include genetic, chemical, physical, maternal health, placental, immunological, and cervical factors. 3) Abortion is diagnosed through history, examination, ultrasound, and pregnancy tests. Differential diagnoses include ectopic pregnancy, molar pregnancy, and infections. Management depends on classification but may include expectant management, surgical evacuation, antibiotics, or cerclage for recurrent abortions.

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    Abortion

    (miscarriage)

    Departemen Obsteri & Ginekologi


    FK – USU / RS. H. ADAM MALIK
    Definition
    The termination of pregnancy before the 20th week,
    when the fetus weight is less than 500 grams.

    Early abortion: <12th week of pregnancy


    Late abortion: 12th-20 th week of pregnancy

    Spontaneous abortion
    Artificial abortion
    Etiology
    Genetic factors:
    chromosomal abnormal accounts 50～60%
    of the early abortions
    • Numeral abnormalities:
    polyploidy, triploidy, monosomy
    • Structural abnormalities:
    break, translocation, deletion
    Etiology
    Extrinsic factors
    • Chemical: mercury, lead, cadmium,
    smoking,
    • Physical: video display terminals,
    radioactive materials, noise,
    hyperthermia
    Etiology
    Maternal factors
    • General diseases:
    infection, heart diseases, hypertension, anemia
    • Reproductive organic diseases:
    congenital uterine malformation, pelvic tumor,
    cervical incompetence
    • Endocrine disorders:
    LPD, hypothyroidism
    • Injuries
    Etiology
    Defects in the developing placenta

    Immunologic factors: paternal histo-


    compatibility antigen , maternal cellular
    immunity regular disorder, deficiency of
    maternal blocking antibody
    Pathology

    The death of the embryo or rudimentary analog

    Hemorrhage into the decidua basalis

    Uterine contraction, dilation of the cervix

    Expulsion of the products conception


    Pathology
    Before the 8th week of the pregnancy, the
    abortus can be expelled completely

    During the 8th-12th week of the pregnancy,


    retention of the tissue is common

    After the 12th week of the pregnancy, the


    abortus may be expelled totally
    Normal US Findings

    Normal gestational sac at arrow,


    Yolk sac (at curved arrow) with
    endometrial cavity at curved arrow
    embryo (between X’s)
    “Double decidual sac” sign

    GS=gestational sac, DP=decidua


    parietalis, * = endometrial cavity,
    arrow=decidua capsularis
    Normal US Findings

    Embryo (black arrow); amnion (small arrow) does not fuse


    with chorion (large arrow) until 12-16wks gestation.
    Clinical subgroups
    of abortion
    Theatened miscarriage

    Inevitable miscarriage

    Incomplete miscarriage

    Complete miscarriage
    Abortion
    Complet Abortion
    ► Presentation: Varies greatly
    depending on type of
    abortion, but often presents
    with vaginal bleeding and
    uterine cramps or back pain.
    ► β-hCG: Falling or rising
    abnormally slow
    ► US findings vary depending
    on classification and
    cause of abortion
    Anembryonic pregnancy: large (>18mm)
    gestational sac without embryo
    Abnormal US Findings: Spontaneous
    Abortion

    Abortion in progress: low-lying gestational Missed abortion: embryo (at arrow) is


    sac (thick arrow), decidual reaction and relatively small compared to large
    hemorrhage (mixed hyper- and hypo-echoic gestational sac. No cardiac activity was
    material between arrowheads) present.
    Abnormal US Findings: Spontaneous
    Abortion

    Patient presented with continued vaginal Abnormally shaped gestational sac at 5


    bleeding after spontaneous abortion. US wks. Patient later had a complete
    shows retained products of conception. spontaneous abortion.
    The developing processes
    of the abortion

    Threatened miscarriage

    Normal pregnancy Inevitable miscarriage

    Complete miscarriage Incomplete miscarriage


    Classifications and
    characteristics
    conceptus Vaginal abdominal Cervix os Uterine
    Subgroups expulsion bleeding pain dilation enlargement

    Threatened no ＋ －＋ － compatible
    miscarriage

    Inevitable no ＋＋ ＋＋ ＋－ compatible
    or miscarriage smaller

    Incomplete part ＋＋＋ ＋ ＋－ smaller


    miscarriage

    Complete all ＋－ － － normal


    miscarriage
    Alternative
    classification

    • Blighted ovum

    • Missed miscarriage

    • Live miscarriage
    Classification of miscarriage

    Blighted
    Normal pregnancy
    ovum

    Missed
    miscarriage

    Threatened Inevitable
    miscarriage miscarriage

    Continuing Incomplete Complete


    pregnancy miscarriage miscarriage
    Special subgroups:

    Missed Miscarriage
    Expulsion of the conceptus does not occur
    despite a prolonged period after embryonic
    death.
    Symptoms of pregnancy regress
    Pregnancy test becomes negative
    No fetal heart motion is detected
    Uterine enlargement ceases
    Special subgroups:

    Recurrent miscarriage
    (Habitual abortion)
    Three or more consecutive spontaneous losses
    of pregnancy
    First-trimester: LPD, hypothyroidism,
    chromosomal abnormalities, immunologic
    factors
    Second-trimester: uterine malformations,
    cervical incompetence, myomas
    Special subgroups:

    Septic miscarriage
    Any type of spontaneous miscarriage is
    complicated by infection
    Endometritis, parametritis, peritonitis
    Fever, abdominal tenderness, uterine pain
    Septicemia, septic shock
    Diagnosis
    • History: amenorrhea, symptoms of
    pregnancy, vaginal bleeding……
    • Examination: general and pelvic
    • Ultrasounograph
    • Pregnancy test, ß-HCG
    • Others:
    Differential diagnosis
    • Ectopic pregnancy
    • Molar pregnancy
    • Dysfunctional uterine bleeding (DUB)
    • Pelvic infective diseases (PID)
    • Acute appendicitis
    Ectopic Pregnancy

    • 95% are in the


    fallopian tube (70%
    ampulla, 12% isthmus,
    11% fimbria, 2%
    interstitial/cornual)
    • Ovarian occurs about
    3% of the time,
    abdominal 1% of the
    time and cervical <1%
    of the time
    Abnormal US Findings: Ectopic

    Gestational sac (between arrowheads) Pseudogestational sac of ectopic


    and embryo (between calipers) outside pregnancy. Note central location and
    of the uterus. Normal ovary is seen at absence of double decidual sign.
    arrow.
    Anembryonic gestation

    • No yolk sac or fetal


    pole
    • Mean gestational sac
    diameter of 20 mm
    Management

    Threatened miscarriage:
    rest, follow-up
    Inevitable & incomplete miscarriage:
    Evacuation of the uterus,vacuum or suction
    curettage, oxytocin iv, antibiotics
    Complete miscarriage:
    no further therapy is necessary.
    Management
    Missed miscarriage
    First- trimester:
    suction curettage
    The second-trimester:
    D&E(dilation and evacuation)
    D&C(dilation and curettage)
    Induction of labor with intravaginal
    prostaglandin E2 or misoprostol
    Management
    Recurrent miscarriage

    A workup for possible causes of recurrent


    pregnancy loss (RPL): anatomic,
    hormonal,genetic,and autoimmune factors
    (underlying maternal factors)
    Incompetent cervix: cerclage designed to
    reinforce the cervix at the level of the internal os
    at the end of the first trimester, the suture is
    removed after 37 weeks’ gestation
    Management
    Septic miscarriage
    • Evacuation of the uterus within a few
    hours after antibiotics iv
    • High-dose, broad-spectrum coverage
    antibiotics, aggressive use before, during,
    and after removal of necrotic tissue by
    curettage
    • hysterectomy
    Summary points

    • The most frequent etiology of


    miscarriage is a chromosomal
    abnormality of the conceptus and most of
    the abortions occur in the first-trimester.
    • The processes of the pathology decide
    the characteristics of the subgroups.
    • Ultrasound is helpful in diagnosis.
    Take-home Points
    ►Along with β-hCG, ultrasound is the mainstay
    in determining the cause of first-trimester
    vaginal bleeding
    ►Important causes of bleeding include: Ectopic
    pregnancy, spontaneous abortion,
    hydatidaform mole, subchorionic hematoma,
    and uterine AVM.
    ►It is vital to determine the cause of bleeding in
    order to select appropriate treatment
    Problem-based learning (3)
    • On examination you find no abnormality
    on abdominal palpation and in particular,
    no tenderness. On vaginal examination,
    however, you find blood clot in the vagina
    and products of conception are present in
    the cervix, which is dilated. What is the
    diagnosis and how would you manage the
    situation?
    The End

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