13) Abortion - Classification, Causes, CFs, Dx, Tx

Question 1

What is the definition of “Abortion”?

Answer 1

• Spontaneous or Induced expulsion of the Product of Conception (POC)
• From the Uterus at BEFORE 24 Gestational Weeks

EARLY = Upto 12 Weeks
LATE = AFTER 12 - 24 Weeks

NB! LEGAL ABORTION is Upto 12 weeks in Bulgaria

Question 2

What is the Classification of Abortion?

Answer 2

• Spontaneous
• Missed
• Habitual
• Septic
• Artificial = Induced, Therapeutic or Criminal

Question 3

What are the Types of Spontaneous Abortions? (Include Clinical Features)

Answer 3

1) Inevitable = Dilated Cervix, Vaginal Bleeding + Clots and Abdominal Cramps

2) Threatened = A viable pregnancy with fetal activity, but with abdominal pain + vaginal bleeding

3) Incomplete = Dilated Cervix, with incomplete emptying of uterus, as well as vaginal bleeding

4) Complete = When there’s complete expulsion of intrauterine pregnancy with NO REMAINS of POC

5) Missed = Fetal Death, BEFORE 20th Week

Question 4

What are the Types of Threatened Abortion?

Answer 4

1) Abortus IMMINENS = Pain + Bleeding WITHOUT Cervical Changes

2) Abortus INCIPIENS = Pain + Bleeding with MILD Cervical Changes

Question 5

What are the Causes of Abortion?

Answer 5

• Chromosomal abnormalities - common at 1st Trimester
• Uterine leiomyomas
• Cervical incompetence
• Diabetes, Hyper / Hypo-thyroidism, or Hypercoagulability

Question 6

What are the Risk Factors for Abortion?

Answer 6

• Increased Maternal + Paternal Ages
• Ethnicity
• Increased N.O of pregnancies
• History of previous loss

MATERNAL Factors - Infection, Trauma, Drugs, Smoking, Alcohol

Question 7

How is Abortion Diagnosed?

Answer 7

When a Patient presents with:

• +ve Pregnancy Test
• Vaginal Bleeding
• Abdominal / Pelvic Pain

Question 8

How is Abortion Managed?

Answer 8

IF Fetus is MORE than 12 GW, administer anti-D Prophylaxis

1) MEDICAL

• anti-progestin (mifepristone)
• prostaglandin (misoprostol)
• anti-metabolite

2) SURGICAL EVACUATION

• With Suction Curettage - done upto 14 GW
• Dilation + Evacuation - done AFTER 13 GW

3) INDUCTION of LABOUR

• Hypertonic Saline
• Prostaglandins
• Oxytocin

Question 9

What are the Complications of Abortion?

Answer 9

IMMEDIATE (Less than 3h)

• Hemorrhage
• Cervical Injury
• Uterine Perforation

DELAYED (More than 3h)

• Post-Abortal Infection
• Retained Tissue
• Asherman’s Syndrome (Uterine Adhesions)