26 years old G1, P0 comes to the OG department with complains of moderate amount of vaginal bleed which she noticed while she was bathing. On examinations, there are no uterine contractions or pain or abdominal cramps. Blood pressure-120/76 mmHg, Pulse rate- 84/min, temperature- 37.6 C, Respiratory rate-16/ min. On speculum examination, small clot was noted at the level of vault. There was no bleeding or abnormal mass. Cervix was closed. Bimanual examination is uneventful. Diagnosis is
Answer: a) threatened abortionABORTION (miscarriage)Expulsion of the fetus before viability (< 500gms/20weeks)Abortion< 12 weeks: first trimester abortion.75% abortions occur < 16th week & about 75% of these occur before the 8th week of pregnancy.Types of AbortionDefinitionThreatened abortionThe process of abortion has started, but has not progressed to a state from which recovery is impossible.Inevitable abortionProcess of abortion has progressed to a state from where continuation of pregnancy is impossible.Complete abortionProducts of conception are expelled en masse.Incomplete abortionProducts of conception are not expelled but a part is left inside the uterine cavity.Missed abortionFetus is dead and retained inside the uterus for a variable periodCAUSES OF ABORTION:First trimesterSecond trimester* Genetic factors (50%)* Endocrine disorders* Immunological disorders* Infections* Anatomic abnormalities- Cervical incompetence- Mullerian fusion defects- Uterine synechiae- Uterine fibroid* Maternal medical illness.ETIOLOGY OF SPONTANEOUS ABORTIONS (15%):GENETIC FACTORS:(50% of abortions are due to chromosomal abnormalities in the conceptus)Autosomal trisomy is the commonest (50%) cytogenetic abnormality.M/C/ cause of autosomal trisomy: meiotic non-dysjunction during gamete formation.Trisomy for all the chromosomes except Chr.1 has been reportedThe most common trisomy is trisomy 16, followed by trisomy 22.Turner syndrome is the single most frequent specific chromosomal abnormality.Autosomal monosomy is rare and incompatible with life.Triploidy is often associated with hydropic or molar placental degeneration.ENDOCRINE AND METABOLIC FACTORS (10-15%)Luteal Phase Defect (LPD)Hypo & Hyper ThyroidismUncontrolled DiabetesANATOMICAL ABNORMALITIES: (10-15%, mostly related to llnd trimester abortions)Cervical incompetence- Commonest cause for llnd trimester & recurrent abortionsCongenital uterine malformations & Uterine fibroidsIntra-uterine adhesions, Asherman SyndromeINFECTIONS (5%)Viral-rubella, cytomegalo virus, variola, vaccinia, HIVParasitic-Toxo plasma, MalariaBacterial- Ureaplasma, Chlamydia, BrucellaIMMUNOLOGICAL DISORDERS (5-10%)Recurrent (habitual) abortionThree or more spontaneous abortions in a sequence.Causes:Parental chromosomal abnormalitiesAntiphospholipid antibody syndromeSubset of uterine abnormalities.Other suspected but not proven causes are alloimmunity, endocrinopathies, and environmental toxinsTYPES OF ABORTIONSAbortionBleedingPainOn examinationManagementThreatenedSlight, bright red Stops spontaneouslyUsually painless; occasional back pain +OS: closed Uterus & cervix: softSedation & pain relief. ObservationInevitableMoreSevereOS: dilatedCorrection of shock & termination of pregnancyCompleteTrace/absentSubsidesOS: closed Uterus: smallerSupportive management D&C if neededIncompletePresentContinuation of pain, colicky typeOS: patulous. Uterus: smallerCorrection of shock & terminationMissedBrownish vaginal discharge OS: closed Uterus: smaller
Threatened abortion
Missed abortion
Inevitable abortion
Incomplete abortion
Miscellaneous (Gynae)