SPONTANEOUS ABORTIONS
Spontaneous abortions occur in about 15% of pregnancies
and amongst these about 75% take place before 12 weeks. The risk of abortions increases
with age of the mother, order of pregnancy and number of previous abortions. The causes of
spontaneous abortions are many
- Most early abortions are due to genetic defects. This may
be due to delayed ovulation, faulty sperm formation, aging etc.
- Maternal diseases: infections like rubella, Toxoplasmosis
etc.
- Injury, exposure to X-rays, chemicals.
- Endocrinal: like progesterone and thyroid deficiency.
- Malnutrition including deficiency of Vitamin E and folic
acid
- Anatomical defects like uterine anomalies; septate uterus
are important causes of habitual abortions. Incompetent internal os ; lacerations of
cervix; uterine fibroids may also lead to 2nd trimester abortions.
- ABO blood group is important than due to Rh.
The examination of aborted material does not always give
a clue as to cause and the possibility of multiple factors has to be kept in mind.
A woman will present with h/o bleeding PV after having
missed her periods for some weeks; acute pain in lower abdomen and h/o products expelled.
Ultrasound can guide for further management. If it shows
products remained inside uterus then check currette is necessary.
THREATENED ABORTION
There is history of Amenorrhoea, bleeding or spotting PV
and pain in the abdomen but no products have been expelled.
Trans vaginal sonography gives us excellent result. It
shows all the details presence of gestational sac, foetal pole, cardiac pulsation and
placental condition. Here your doctor will try and save the pregnancy by conservative
management of sedation and rest for at least 48 hours after bleeding stops. Inspite of it
about 25% proceed to abortion.
INEVITABLE OR INCOMPLETE ABORTION
In the treatment of incomplete abortions; vacuum suction
curettage is done and it has reduced the complications of excess bleeding and perforation
of uterus.
HABITUAL ABORTION
When three or more consecutive abortions occur at about
the same period of pregnancy it is termed as habitual abortion. About 1% of all abortions
are habitual abortions. Amongst the general causes are diabetes, kidney disease, high BP
and hypothyroidism, the local anatomical factors stated earlier and luteal or placental
deficiencies have also to be considered.
Your doctor will mostly ask for Complete Blood picture,
Haemoglobin estimation, blood group, blood sugar, VDRL test and urine routine &
microscopic. In repeated abortions TORCH test is also advisable. Examination of vaginal
smear for Karyopyknotic index, cervical mucous for fern pattern and HSG in some cases will
also be useful.
Only in about 1/3 of the cases, cause is found and
rectified. In others the treatment is mainly empirical with rest, vitamins, assurance and
advice against strenuous exercise and sexual intercourse.
In certain cases of deficiency, progesterones orally or
weekly injections are advised. The hormones are continued to about 36 weeks but at regular
intervals clinical assessment is made of progressive uterine growth, amount of liquor and
placental site. The concept of regular use of ultrasonography has changed the entire
picture in management of habitual abortion.
When the cause is structural defect of the uterus like
septate uterus and there is no other cause of habitual abortion, the surgical excision of
septum is called for. In cases of cervical incompetence the famous Shirodkar's stitch is
extremely useful. This is best done after 14th week of pregnancy. The suture is removed at
38 weeks or when the woman gets into labour. In cases of fibroids, fibroid removal is
advised.
MISSED ABORTION
Missed abortion is one where inspite of abortion, the
product of conception are not expelled and are retained in utero for two months or more
after its death. The diagnosis may be made from the history: failure of uterus to grow
when examined at adequate intervals and negative pregnancy test with urine or blood.
Regular use of ultrasound can clear the picture earlier.
There is evidence of absence of heartbeats.
The treatment of early missed abortion is dilation and
evacuation of products from the uterus. In late abortion whole foetus & placenta may
be expelled out completely with use of extra amniotic injection of ethacrydine lactate.
Nowadays with better concept or oral, local & injectable prostaglandins the procedure
is somewhat smoother then before.
With advent of ultrasonography, use of 5000 IU hCG (human
chorionic gonadotrophins) is continued till 12 weeks or 14 weeks of pregnancy and then
patient can be given oral progesterones.
| Spontaneous Abortions | Induced Abortion |
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