Abortion

Question 1

1. What is the definition of abortion?
2. At what stage of pregnancy does abortion typically occur?
3. What are the two main categories of abortion?
4. What are the potential complications of abortion?

Answer 1

Abortion refers to the expulsion of the foetus and other products of conception before the 28th week of pregnancy.

It may occur
— spontaneously (threatened, inevitable, incomplete, complete or missed)
or
— induced (therapeutic, criminal).

Both spontaneous and induced abortion may become complicated by infection
— (sepsis) and/
— profuse bleeding

Question 2

Spontaneous Abortion*

1. What are the types of spontaneous abortion?
2. What is threatened abortion?
3. What is inevitable abortion?
4. What is incomplete abortion?
5. What is missed abortion?

Answer 2

Types of spontaneous Abortion
—threatened
— inevitable,
— incomplete
— complete
— missed

Here are the definitions:

1. Threatened Abortion:

A threatened abortion is a condition where vaginal bleeding occurs during the first 20 weeks of pregnancy, but the cervix remains closed and the fetus is still viable. Symptoms include:

• Scanty to moderate painless vaginal bleeding
• Mild pelvic discomfort
• Uterine size compatible with gestational age
• No cervical effacement or dilatation

2. Inevitable Abortion:

An inevitable abortion is a condition where vaginal bleeding and cervical dilatation occur, indicating that the abortion process has begun and cannot be stopped.

Symptoms include:

• Lower abdominal pain
• Heavy vaginal bleeding
• No fetus or products of conception passed per vagina
• Painless loss of liquor per vagina

3. Incomplete Abortion:

An incomplete abortion occurs when parts of the products of conception are expelled, but others remain inside the uterus.

Symptoms include:

• Heavy vaginal bleeding
• Severe abdominal pain
• Fever
• Cervical dilatation with partial expulsion of products of conception

4. Missed Abortion:

A missed abortion, also known as a missed miscarriage, occurs when the fetus dies but remains inside the uterus.

Symptoms include:

• Absence of fetal movements
• Decreased pregnancy symptoms
• Vaginal bleeding or spotting
• Cervix closed, with no expulsion of products of conception

5. Complete Abortion:

A complete abortion occurs when all products of conception are expelled from the uterus.

Symptoms include:

• Cessation of vaginal bleeding
• Cervical closure
• Uterine size returns to normal
• Complete expulsion of products of conception

Question 3

1. What infections can cause spontaneous abortion?
2. How do fetal abnormalities contribute to spontaneous abortion?
3. What is the role of an incompetent cervix in spontaneous abortion?
4. How do chronic illnesses increase the risk of spontaneous abortion?
5. What is the impact of trauma on spontaneous abortion?

Answer 3

Causes
1. Spontaneous Abortions:Infections e.g.
— malaria,
— UTI,
— bacterial vaginosis etc.
Other causes:
y Foetal abnormalities
y Incompetent cervix
y Chronic illness e.g. diabetes, thyroid disorders, sickle cell dis-
ease etc.
y Trauma

2. How do fetal abnormalities contribute to spontaneous abortion?*

Fetal abnormalities, also known as congenital anomalies, can contribute to spontaneous abortion in several ways:

• Chromosomal abnormalities (e.g., Down syndrome, Turner syndrome)
• Structural anomalies (e.g., heart defects, neural tube defects)
• Genetic mutations
• Incompatible with life conditions (e.g., severe birth defects)

These abnormalities can disrupt normal fetal development, leading to:

• Miscarriage
• Fetal death
• Premature separation of the placenta

3. What is the role of an incompetent cervix in spontaneous abortion?*

An incompetent cervix, also known as cervical insufficiency, is a condition where the cervix dilates prematurely, leading to spontaneous abortion. This can occur due to:

• Weakened cervical tissue
• Previous cervical trauma or surgery
• Congenital cervical abnormalities
• Hormonal imbalances

An incompetent cervix can cause:

• Preterm cervical dilation
• Premature rupture of membranes
• Fetal expulsion

4. How do chronic illnesses increase the risk of spontaneous abortion?

Chronic illnesses can increase the risk of spontaneous abortion by:

• Affecting the mother’s overall health
• Disrupting hormonal balances
• Causing inflammation and oxidative stress
• Increasing blood pressure and cardiovascular stress

Examples of chronic illnesses that may increase the risk of spontaneous abortion include:

• Diabetes
• Thyroid disorders
• Sickle cell disease
• Hypertension
• Autoimmune disorders (e.g., lupus)

5. What is the impact of trauma on spontaneous abortion?

Trauma, physical or emotional, can increase the risk of spontaneous abortion by:

• Causing direct injury to the uterus or cervix
• Triggering stress responses, releasing hormones that may disrupt pregnancy
• Increasing blood pressure and cardiovascular stress
• Disrupting placental function

Types of trauma that may contribute to spontaneous abortion include:

• Physical abuse
• Accidents (e.g., car accidents, falls)
• Emotional stress (e.g., anxiety, depression)
• Surgical trauma (e.g., previous uterine surgery)

Question 4

1. What are the symptoms of threatened abortion?
2. What are the signs of threatened abortion?
3. What investigations are necessary for threatened abortion?
4. What is the treatment objective for threatened abortion?
5. What non-pharmacological treatments are recommended for threatened abortion?

Answer 4

THREATENED ABORTION
Symptoms
y Scanty to moderate painless vaginal bleeding y Mild pelvic discomfort

Signs
y The uterine size is compatible with the gestational age
y There is no cervical effacement or dilatation

Investigations
y FBC and sickling
y Ultrasoundscan(toconfirmviablefoetusinuterowithclosedcervix) y Other investigations for potential underlying causes e.g. malaria
Treatment Treatment objectives

y There is no cervical effacement or dilatation
Investigations
y FBC and sickling
y Ultrasoundscan(toconfirmviablefoetusinuterowithclosedcervix) y Other investigations for potential underlying causes e.g. malaria
Treatment Treatment objectives
y To maintain a viable pregnancy to term if possible
Non-pharmacological treatment
y Bed rest at home or hospital
y To abstain from sexual intercourse
y To report back if bleeding or pain increases
Pharmacological treatment
y No specific treatment required
y Treat any underlying illnesses e.g. malaria

Question 5

1. What are the symptoms of inevitable abortion?
2. What are the signs of inevitable abortion?
3. What investigations are necessary for inevitable abortion?
4. How does inevitable abortion differ from threatened abortion?
5. What is the primary concern in managing inevitable abortion?

Answer 5

INEVITABLE ABORTION
Symptoms
y Lower abdominal pain
y Heavy vaginal bleeding
y No foetus or products of conception passed per vagina y Painless loss of liquor per vaginam
Signs
y The cervix is dilated with the membranes bulging
y There may be loss of liquor
y The uterine size is compatible with the gestational age
y There may be signs of shock pallor, collapsed peripheral vessels,
rising pulse with reducing volume, falling BP and cold clammy skin
Investigations
y FBC and sickling
y Blood grouping and cross matching
y Ultrasound scan (shows the foetus dead or alive)
y Cervix may be dilated with membranes bulging through it
y In instances associated with loss of liquor there may be
oligohydraminios
y Ultrasound is necessary only if the diagnosis is in doubt

Treatment
Treatment objectives
y To resuscitate patient and/or prevent shock
y To relieve pain
y To allow the patient to abort (assist uterine contractions if weak) y To evacuate the retained products of conception from the uterus.

y To determine cause of abortion if recurrent
y To prevent infection with antibiotic prophylaxis
y To prevent risk of Rhesus incompatibility in future pregnancies

Non-pharmacological treatment
y Evacuationofth euterusisdonebyeitherofthefollowingtechniques after the expulsion of the foetus or before the expulsion of the foetus if it is less than 12-14 weeks size
y Manual Vacuum Aspiration (MVA) with or without paracervical Or block anaesthesia
y Uterine curettage under paracervical block or general anaes- thesia (Gestations 12 weeks or less
y Uterine evacuation under anaesthesia especially when the uterine size is larger than 12 weeks size
Pharmacological treatment
A. If patient is in shock

or bleeding is severe
y IV fluids and blood transfusion as necessary
B� To relieve severe pain
y Morphine, IV, 2.5-5 mg 4 hourly as required And
Or
Evidence Rating: [C]
y Metoclopramide, IV, 5-10 mg 8 hourly as required for vomiting
y Pethidine, IM, 75-100 mg stat. Then
50-100 mg 6-8 hourly if required
And
y Promethazine, IV/IM, 25 mg as required (max. 25 mg 6 hourly) as required to reduce the chances of vomiting and to potentiate the analgesic effect of Pethidine
C� Evacuate uterus
If uterine size > 12-14 weeks Evidence Rating [A]
y Oxytocin, IV, 10-20 units per litre of Normal saline Or
Uterine size <12 weeks Evidence Rating: [C]
y Misoprostol, oral/SL, 600 microgram stat.
D. To Prevent Infection
y Amoxicillin, oral, 500 mg 8 hourly for 5-7days And
y Metronidazole, oral, 400 mg 8 hourly for 5-7days

E. To prevent Rhesus Isommunization in Rhesus negative women
y Anti D Rh Immune Globulin, IM, 300 microgram (1,500 Units), stat. within 72 hours of abortion

Question 6

1. What is therapeutic abortion?
2. What is criminal abortion?
3. What are the risks associated with unsafe abortions?
4. How do medications interfere with pregnancy in induced abortion?
5. What are the potential complications of induced abortion?

Answer 6

Here are the answers:

1. What is therapeutic abortion?

Therapeutic abortion, also known as medical abortion, is a type of induced abortion performed for medical reasons, including:

• Fetal anomalies or abnormalities
• Pregnancy-related health risks
• Life-threatening conditions (e.g., ectopic pregnancy)
• Severe psychological or social indications

Therapeutic abortion aims to protect the woman’s physical and mental health.

1. What is criminal abortion?

Criminal abortion refers to an illegally performed abortion, often by an unqualified practitioner or under unsafe conditions. This can include:

• Backstreet or clandestine abortions
• Self-induced abortions using harmful methods
• Abortions performed without medical supervision

Criminal abortion poses significant health risks due to unsterile conditions and lack of proper care.

1. What are the risks associated with unsafe abortions?

Unsafe abortions carry numerous risks, including:

• Infection and sepsis
• Hemorrhage and blood loss
• Uterine perforation
• Cervical damage
• Infertility and reproductive complications
• Psychological trauma
• Death

1. How do medications interfere with pregnancy in induced abortion?

Medications used in induced abortion work by:

• Blocking progesterone (e.g., mifepristone)
• Stimulating uterine contractions (e.g., misoprostol)
• Softening and dilating the cervix (e.g., laminaria)

These medications disrupt pregnancy by:

• Terminating fetal development
• Inducing uterine contractions to expel the fetus
• Preparing the cervix for abortion

1. What are the potential complications of induced abortion?

Potential complications of induced abortion include:

• Infection and sepsis
• Hemorrhage and blood loss
• Uterine perforation
• Cervical damage
• Asherman syndrome (uterine scarring)
• Infertility and reproductive complications
• Psychological trauma
• Failed abortion (continued pregnancy)
• Cardiac complications (rare)

It’s crucial to access safe and legal abortion services to minimize risks.

Would you like more information on abortion or related topics?

Question 7

Complications*

1. What is sepsis in the context of abortion?
2. What are the symptoms of profuse bleeding after abortion?
3. How can infection be prevented after abortion?
4. What are the potential long-term effects of complicated abortion?
5. How can abortion complications be managed?

Answer 7

Here are the answers:

1. What is sepsis in the context of abortion?

Sepsis, in the context of abortion, refers to a life-threatening condition caused by bacterial infection, leading to:

• Systemic inflammation
• Organ dysfunction
• Septic shock

Post-abortion sepsis can arise from:

• Incomplete abortion
• Infected abortion
• Poor sanitation
• Delayed or inadequate treatment

1. What are the symptoms of profuse bleeding after abortion?

Symptoms of profuse bleeding after abortion include:

• Heavy vaginal bleeding (soaking more than 2 pads/hour)
• Prolonged bleeding (>7-10 days)
• Clots (> golf ball size)
• Severe abdominal pain
• Dizziness or fainting
• Pale or cold skin
• Rapid heartbeat

1. How can infection be prevented after abortion?

Infection after abortion can be prevented by:

• Proper sanitation and hygiene
• Sterile equipment and facilities
• Antibiotic prophylaxis
• Post-abortion follow-up care
• Avoiding vaginal intercourse or insertion of objects
• Practicing safe and hygienic menstrual management

1. What are the potential long-term effects of complicated abortion?

Potential long-term effects of complicated abortion include:

• Infertility or reduced fertility
• Chronic pelvic pain
• Adhesions or scar tissue
• Increased risk of future pregnancy complications
• Emotional trauma or PTSD
• Reproductive organ damage
• Chronic infections (e.g., PID)

1. How can abortion complications be managed?

Abortion complications can be managed by:

• Prompt medical attention
• Antibiotic treatment for infection
• Fluid replacement and transfusions for bleeding
• Surgical intervention (e.g., D&C) for incomplete abortion
• Pain management
• Emotional support and counseling
• Follow-up care and monitoring

It’s crucial to seek immediate medical attention if complications arise.

Would you like more information on abortion complications or related topics?

Question 8

True/False Questions*

1. Abortion only occurs before the 20th week of pregnancy.
2. Spontaneous abortion is always caused by fetal anomalies.
3. Induced abortion is never medically necessary.
4. Infection is a potential complication of both spontaneous and induced abortion.
5. Missed abortion requires immediate medical attention.

Answer 8

True/False Questions*

1. Abortion only occurs before the 20th week of pregnancy. (False)
2. Spontaneous abortion is always caused by fetal anomalies. (False)
3. Induced abortion is never medically necessary. (False)
4. Infection is a potential complication of both spontaneous and induced abortion. (True)
5. Missed abortion requires immediate medical attention. (True)

Question 9

Fill-in-the-Blank Questions*

1. Abortion typically occurs before the _______ week of pregnancy.
2. Spontaneous abortion may be caused by _______ or _______ factors.
3. Induced abortion can be classified as _______ or _______.
4. Complications of abortion may include _______ and/or _______.
5. Sepsis after abortion requires prompt _______ treatment.