ABORTIONS-Ist TRIMESTER Dr Sathisha Nayak Dept. of OBG MMMC.

ABORTIONS-Ist ABORTIONS-Ist TRIMESTERTRIMESTER

Dr Sathisha NayakDr Sathisha Nayak

Dept. of OBGDept. of OBG

MMMCMMMC

WE BEGIN..WE BEGIN..

CASE SCENARIO-1CASE SCENARIO-1• 23YR,PRIMI,8WEEKS,OPD• C/O-BLEEDING P/V - 1 DAY PAIN ABDOMEN-6 HOURSO/E- STABLE,NO PALLOR P/A-SOFT,P/S-BLEED+ FROM OS P/V- OS CLOSED,NO

TENDERNESS

CASE SCENARIO-1CASE SCENARIO-1• NORMAL OR ABNORMAL..?• GIVE 4 POSSIBILITIES/CAUSES• CAN WE SEND HER HOME?• WHAT INVESTIGATIONS NEEDED?• WHAT IF U DON’T TREAT HER?

CASE SCENARIO-2CASE SCENARIO-2• 30YRS,G3P2,10WEEKS,ER• BROUGHT COLLAPSED IN ER• H/O –SEVER BLEEDING P/V-1 DAY• --PAIN ABDOMEN -12 HRS• O/E- NO PULSE,NO BP,RESTLESS PALLOR+++.P/A-SOFT P/V-BLEEDING++

+,PRODUCTS+

CASE SCENARIO-2CASE SCENARIO-2• WHAT IS YOUR FIRST STEP..?• WHATS WRONG WITH THIS PATIENT?• HOW WOULD YOU EVALUATE HER?• WHATS MANAGEMENT AND WHEN• WILL U DO IT?

CASE SCENARIO-3CASE SCENARIO-3• 35 YRS,12 WEEKS,OPD• ANTENATAL CLINIC• NO COMPLAINTS• EXAMINATION-P/A SOFT,OS CLOSED• P/V-UTERS 8 WEEKS• USG SCAN- IRREGULAR GEST.SAC NO FETAL CARDIAC ACT.

CASE SCENARIO-3CASE SCENARIO-3• DO U THINK THIS IS OK?

• WHAT IS THE CONDITION?

• WHAT WILL YOU DO.?

CASE SCENARIO-4CASE SCENARIO-4• 18YRS GIRL,7WEEKS,ER• C/ HIGH FEVER -3 DAYS• PAIN ABDOMEN - 3 DAYS SHE HAS NOT PASSED URINE 24H• O/E-40* C,P/A TENDER P/S-FOUL SMELLING DISCH.

CASE SCENARIO-4CASE SCENARIO-4• CAN U IDENTIFY THE CONDITION..?

• WHAT WOULD HAVE CAUSED THIS?

• HOW CAN WE AVOID & MANAGE?

OBJECTIVESOBJECTIVES• DEFINE ABORTION• LIST TYPE OF ABORTIONS• IDENTIFY TYPE OS ABORTION• LIST 4 COOMON CAUSES• KNOW 4 COMMON SYMPTOMS &SIGNS• LIST 4 COMPLICATIONS• EVALUATION• MANAGEMENT OUTLINE

ABORTIONABORTION• COMMON OBG COMPLICATION

• 15% OF ALL PREGNANCYS

• ONE OF COMMON AVOIDABLE CAUSE OF MAT MORTALITY

DEFINITIONDEFINITION

‘ EXPULTION OF PRODUCT OF CONCEPTION BEFORE PERIOD OF VIABILITY’

ABORTION TYPESABORTION TYPES-SPONTANEOUS- THREATENED INEVITABLE INCOMPLETE COMPLETE MISSED SEPTIC- INDUCED -MTP

ABORTION-CAUSESABORTION-CAUSES• CHROMOSOMAL ABNORMALIY-50%• GENETIC DEFECTS -

20%• UNKNOWN?-ENDOCRINAL-THYROID,?LFD-IMMUNOLOGICAL--MATERNAL SYS DISEASE-SLE

ABORTION-CLINICAL ABORTION-CLINICAL FEATURESFEATURES

-SYMPTOMS :-PAIN ABDOMEN BLEEDING P/V PASSING PRODUCTS P/V FOUL DISCHARG/FEVER -SIGNS : BLEEDING P/V NO P/A TENDERNESS CERVIX OPEN +/- PRODUCTS IN CX CANAL

ABORTION-CLINICAL ABORTION-CLINICAL FEATURESFEATURES

-BLEEDING P/V+OS CLOSE = T.A-BLEEDING P/V+OS OPEN =INEVITABLE-BLEED.PV+OS OPEN+PRODUCTS

HALFWAY IN CX OR VAGINA= INCOMPLETE-BLEED PV+PRODUCT OUT=COMPLETE-BLEED PV+/-,OS CLOSED,FETUS DEAD == MISSED ABOTION

ABORTION-COMPLICATIONSABORTION-COMPLICATIONS• HAEMORRHAGE• HYPOVOLEMIC SHOCK• SEPSIS- SEPTIC ABORTION• MATERNAL DEATH• SEVERE ANAEMIA

ABORTION-EVALUATIONABORTION-EVALUATION• DETAILED HISTORY• CLINICAL EXAM-GE+P/A+PV• INVESTIGATIONS -BL.GROUP,HB% -ULTRASOUND SCAN PELVIS

ABORTION-MANAGMENTABORTION-MANAGMENT STABILISE PATIENT-BLOOD/IVFLUIDSPECIFIC MANAGEMENT• T.A : REST/OBSERVATION• INEVITABLE : EVACUATION OF UT.• INCOMPLETE :EVACUATION OF UT.• COMPLETE : CHECK FOR RPOC• MISSED : D & EVACUATION OF UT.• SEPTIC :ANTIBIOTICS,EVACUATION SURGICAL DRAINAGE

THANK YOUTHANK YOU