abortion
The team of abortions and miscarriages are synonymous and mean the expulsion of the embryo before it ends before the end of the 28th week of pregnancy. There is no clear line between abortion and early preterm birth, the division is merely descriptive convenience.
After the 28th week of delivery of the fetus is considered viable. Before the execution or delivery of the fetus 28 weeks notifiable in Great Britain if it is born alive, while that all deliveries after that date must be notified.
Causes of abortion
Despite a long list of factors etiologic in cases where the cause of abortion is particularly uncertain. The known causes:
1. Malformation of the zygote. The most common cause of the abortion issue is a particular anomaly in the fetus or the chorion, the server is enough to cause fetal death. About 70 percent of them are caused by chromosomal abnormalities, including two percent can be liable even mainly the abortion of this type are not recurrent, so that the prognosis of subsequent pregnancies is abortion good unless similar pattern has occurred and a number.
In some cases, it is found that the dose amniotic sac containing an embryo a condition once described as an egg in "decline", but now that anembryonic pregnancy.
- In any case in which the villi The studies involved genetic evidence indicates that the karyotype is 46XX, but all gynecological
chromosome material is derived from sperm. are partial molar triploid
karyotype.
2. rejection of the fetus. Many of the immunological immune mother to her fetus are currently underway. There is some disagreement about the results, but it seems that the actions of some trophoblast cell antigen feeding. These cross-reactive (TLX) antigens is due in part to other antigens. It is postulated that the mother is mounted an antibody response against antigens TLX, and also protects the trophoblast from attack by the failure of this mechanism, this also protects the trophoblast of the failure of the related antigens. Some causes of recurrent abortion may be caused by the failure mechanism, and the infusion of donor lymphocytes to stimulate the response has been proposed.
3. General Disease mother. pregnancy often continue in the spirit of the mother's illness, but any disease can cause an abortion if it is sufficiently severe, especially acute fevers. Maternal infection may result in the fetus, particularly rubella and syphilis, malaria, but also rarely, brucellosis, toxoplasmosis, cytomegalic inclusion disease and listeriosis.
In a few cases of rubella occurred on abortion, but often Most infected fetus born alive. The dose syphilis early abortion, and is a rare cause of late abortion is more likely to cause stillbirth after 28 weeks.
In diabetes the abortion rate is above average, if the disease is not adequately controlled.
In cases of hypertension and kidney disease in utero fetal death may occur sometime before the 28th week.
server malnutrition cause abortion, but must be a degree which is unlikely to be seen in Britain. Vitamin E deficiency causes the abortion of the animals because there is evidence that in women because this substance is present in adequate amounts in the diet.
4. uterine anomalies. The incidence of abortion is higher if the uterus is double or septate, but for the sake pregnancy, many complications.
The retroversion of the uterus, because it is a cause for abortion, except in rare If the uterus is incarcerated and does not receive treatment.
A leiomyoma of the uterus that is closely related to the cavity of the uterus can cause abortion, but others do not want to fibroma.
Cervical laceration extending so that the market for operating system can cause abortion in the center three or premature delivery. Rarely, the congenital weakness the cervix is usually the result of damage or obstetric surgery reckless expansion of the cervix. During pregnancy, inflammation of the membranes without support for the neck and break when after a miscarriage.
5. Hormone deficiency. It said the inadequate production of progesterone by the corpus luteum until the placenta is fully developed will lead to failure of the decidua and abortion.
The evidence of this weakness (see p. 286).
Both hyperthyroidism and hypothyroidism may be contributing causes of abortion.
6. . Drugs Cytotoxic drugs or lead poisoning can cause fetal death and abortion. oxytocin drugs have been used to induce abortion; ergot quinine, and prostaglandins are used sometimes as abortions, although the doses used may have serious side effects.
7. Trauma. Trauma can cause uterine server detachment of the embryo, which can also be caused by the insertion of an instrument or foreign bodies in the neck. Abortion after surgery, myomectomy, for example, and you can follow a condition complicated by peritonitis server.
In normal pregnancy, intercourse does not affect patients, but not wise that the cause of women with a history of abortion in a previous pregnancy.
8. Acute emotional disturbance. As fear or pain may be followed by abortion, probably due to strong uterus occurs. For this type would be accepted in a particular case of the error must follow immediately after the incident.
pathological anatomy
In the first two months of pregnancy the embryo in the decidua is so small that the separation uterine contractions can continue strong, most often the immediate cause of abortion is bleeding in the space choriodecidual. The exact cause of bleeding is often unknown, but after the embryo develops in the latter partly or wholly separated from the decidua.
Gynecology
If the innermost basal decidua remains in the uterus and the embryo in all or a portion of the decidua capsular type. Sometimes only the decidua is caosularis exploded in the embryo and surrounded by chorionic villi, is expelled, or chorion, and amino acids can be broken, then discovered the fetus escapes.
Later, when the placenta is a definite structure, the fetus is usually expelled first, followed by the placenta and membranes, but is common for the placenta to be kept small, with bleeding continues. Bacterial invasion of the selected products could occur.
An abortion is a work in miniature, the uterus contracts rhythmically the cervix dilates
and when the hole house is open enough, the embryo is expelled, partially or fully. If the embryo is completely expelled, stop contractions a few days but finally ceases, and the uterus regresses to the normal dose after birth.
In some cases, incomplete abortion is a piece of placental tissue may remain in the uterus
because it is set at its base. laminated layers of his blood clot, is attached to the base. A blood clot in a polypoid mass, and is described as a fibrinous polyp or the placenta.
variety abortion clinics
The following terms are used to describe the clinical varieties:
1. Threatened abortion 5. Septic Abortion
2. inevitable abortion 6. missed abortion (Mola fleshy).
3. complete abortion
4. Incomplete abortion
1. Threatened abortion
In threatened abortion bleeding in the space choriodecidual but not enough to kill the embryo. There are no painful contractions of the uterus and the cervix is not dilated.
The decision of whether abortion is threatened or only inevitable, it is important, but often uncertain. Abortion is not far dose occur even after several attacks to stop acute bleeding, and it is not uncommon to find cases where the bleeding lasts for a while and once the child is healthy term infants. These cases, however, still considered seriously, because at any time can cause bleeding and abortion is inevitable. If the loss of red light and a steady increase in the amount the prognosis is poor. A loss followed by light escaping from the old weathered brown blood means that the initial loss has stopped. It is not uncommon Threat dark loss of abortion, spending several days gradually decrease in quantity.
Administration
The remains partient bed rest (except toilet) until two days after the loss of red ceased. Relations is prohibited. All the pills and everything that happens must be held for review it will help diagnose and prevent a waste of time if the conservative treatment of the products of conception are considered. if the patient is agitated and anxious one mild sedative can be given, but otherwise there is no value.
Opinions differ on the degree to which these patients should be examined. much fear that women an internal review increases the risk of miscarriage, but an examination speculum smooth passage have the advantage that any cause of unexpected bleeding, such as polyps or cervical cancer, you can even find, and that any dilation of the cervix uterus is noted.
Once the first detainee bellding analysis is made by ultrasound. This indicates if the pregnancy is intact. Demonstration of an embryo by the cardiovascular pulse is essential, because even if an embryo is present, it can be concluded that if being viable without it. With a field of high-resolution scanner in real time the mechanical cardiac activity can still be recognized in 8 weeks. Demonstration of a vacuum bag after 8 weeks of gestation is a reliable proof of the absence or death of the embryo. Routine exploration of threatened abortion patients showed a common cause of bleeding during the first trimester of a twin pregnancy is for the surviving twin is good.
If abortion is completed the uterus is indistinguishable from a normal non-pregnant uterus.
When a threatened abortion moved the patient must be sure the bleeding has not interfered with the developing embryo (although Obstetrics must close into account the possibility of placental insufficiency in late pregnancy).
2. Inevitable abortion
A threatened abortion became inevitable when the bleeding increased and rhythmic uterine contractions become stronger. The neck the uterus and then begin to dilate and products of conception can sometimes be felt through the internal os. Before the 12th week, is common leave all the contents of the uterus that is extruded, and the abortion is complete. After 12 weeks of rupture of membranes and the fetus is often gone, leaving behind of the placenta, then all the complications of incomplete abortion may arise.
Diagnosis
inevitable abortion, pregnancy entoptic and some cases of hydatidiform mole, all persons present in the triad of pain, vaginal bleeding and amenorrhea. The two pregnancy and early abortion are associated entoptic with a short gestation period followed by irregular uterine bleeding. The duration of amenorrhea during pregnancy entoptic before the patient is usually pain short, and is almost always less than 10 weeks.
In the abortion bleeding is usually bright red, often accompanied by blood clots, and is more abundant, then pregnant entoptic where bleeding tends to be dark red or brown.
Vaginal bleeding during pregnancy is usually preceded by entoptic severe abdominal pain, from very low in one quadrant, but quickly spread throughout the abdomen. On abortion, severe pain and is not produced after the appearance bleeding is intermittent, such as pain.
In all cases of ectopic pregnancy, except those with complete rupture of tubes (in which the diagnosis intraperitoneal bleeding and shock with severe generalized abdominal pain is usually evident) there is a separate feel painful swelling of the uterus too, which may be a mole or hematocele ligation. If in doubt, ultrasound scan or laparoscopy may be required.
hydatidiform mole may be the job management on a scale small. The uterus is too large, and diagnosis can be confirmed by ultrasound or the finding of a high chorionic gonadotropin in urine or serum material.
Administration
This can be summarized in the management of small-scale work. The uterus is usually expels its contents alone. Any revision should be done under strict aseptic conditions. If abortion is not complete quickly, or if the interruption hemorrhage, the contents of the uterus is removed with a suction curette. Painkillers such as pethidine
100 mg can be injected, and the bleeding is heavy ergometine 0.5 mg. Unless the patient is known to be Rh positive must also be given 100ug of anti-D immunoglobulin.
3. complete abortion
A complete abortion is one in which all products conception is expelled. On examination, pain is absent and the bleeding is low and declining. The uterus is smller
then the period of amenorrhea ie and the cervix may be slightly open. If the past material has been registered with the test that are found throughout the embryo is present.
Administration
Once the pain has ceased and the bleeding is minimal further treatment is necessary, but the patient must be informed to report immediately if the pain or bleeding persists, or if you develop a temperature, which suggests that retained products of conception that have been infected. anti-D globulin is equal (as above).
4. Incomplete abortion
This means that some of the products of conception, the fetus is usually adopted, but some usually kept the placenta. The amount of bleeding is variable, but can be severe and accompanied by dangerous shock. It is possible for a woman to bleed so severely that in a few hours, the hemoglobin level drops to 5 g / 100 ml. If there is still bleeding a week after an abortion that was intended to be complete, is certainly incomplete.
Administration
Treatment aims to prevent infections, control bleeding and obtain an empty uterus involution. The main risks associated with products stored are haemorrhage and sepsis, and it is unwise to let a piece of placenta in the uterus for any length of time in the hope that it will be expelled.
If the bleeding is cut can be a shock. If a patient is transferred to the hospital before the shock is treated, it can dangerously increase during the trip. These patients require immediate first aid and emergency squad should be called to administer blood in the woman's house to the Amoul lead patients to the hospital. Blood pressure is controlled and ergometrine 0.5 mg should be administered both intravenously. Even if the uterus is not empty, if the bleeding is often reduced by ergomenrine, although its action in the uterus is smaller at the beginning and end of pregnancy. Sometimes the bleeding continues, as a large piece of the placenta is retained in the cervical canal, the elimination This under direct vision, using a sterile speculum and a sponge forceps, will reduce the uterus and uterine bleeding. The foot of the bed rises and morphine 15 mg can be injected. When blood pressure reached normal level of the patient is transferred to hospital. He received the anesthesia and the uterus is empty gloved finger suction curette or sponge forceps. The Pass is generally open and not require expansion. Ergometrine 0.5 mg was administered intramuscularly once the uterus is empty. Anti-D globulin is given unless the patient is known to be Rh positive.
In the same cases of abortion incomplete is not associated with severe bleeding, but bleeding continued intermittently for weeks and is due to fibrinous polyp (p.165). The uterus is bulky and neck cervix dilates slightly. Surgical evacuation of the uterus is essential. It is sometimes difficult to decide whether prolonged irregular bleeding after a miscarriage is caused by a polyp fibrinous or to complete the abortion followed by anestrus endometrial bleeding, which can occur before the normal cycle is restored. In both cases it requires curettage and histological examination evacuated complete diagnostic material.
5. Septic Abortion
The uterine cavity can become septic abortion, even ones as a result of a criminal attempt to procure abortion, and a unified instrument passing in the channel neck. The patient has pain suprapubic and increased temperature and pulse. There may be some bleeding or contraction of the uterus and cervical canal may remain closed. Abdominal rigidity may be and the uterus is very painful to bimanual examination.
In other infection after an incomplete abortion, and the symptoms and signs of varying severity.
The most common organisms infecting in Britain today are Staphylococcus aureus, coliforms and bactericide and Clostridium perfringens.
Previously streptococci Hemolytic two aerobic and anaerobic, were found frequently. The most dangerous infections are the gram-negative organisms that can cause endotrxic around the uterus, causing pelvic blood flow or cause septicemia.
Administration
All cases were admitted to the hospital. When the patient is seen first past is a speculum and a buffer is used to collect secretions from the cervical canal, and a blood test. These are sent to the laboratory for microscopy and culture and to determine the sensitivity of organisms to antibiotics. There is much debate about the best option. A combination that can be used is ampicillin 500 mg every 6 hours with 400 mg of metronidazole and six hours by mouth. When the report is available bacteriological treatment is discussed. It is advisable to continue treatment with antibiotics for at least five days after the temperature returns to normal. If the septic incomplete abortion treatment depends in part on the amount of bleeding. If this light, the evacuation of the uterus may be postponed for 24 hours to allow time for the action of antibiotics, but the pieces of tissue located in the channel cervical must be removed with sponge forceps; evasion. However, in many cases, the volume of bleeding is such that drainage can not be injected intramuscularly with 0.5 mg of ergometrine help control bleeding.
In case of septic abortion over 14 weeks of gestation, if the dead fetus remains an infusion of prostaglandin or may be given oxytocin in the hope of a spontaneous delivery.
Laparotomy is still a desperate adventure, In these cases, but may be appropriate If the vaginal vault was torn or perforated the uterus. This can be sure if an X-ray showed gas under the diaphragm, or if there are signs of free fluid in the peritoneal cavity after a syringe was used. Clostridial infections require special mention. dead tissue and placental blood clot are excellent means for the growth of anaerobic organisms. Some of these patients, usually according to a criminal trial is seriously ill with a pulse of 140 per minute and a temperature below normal. It is a severe anemia due to hemolysis and blood loss, and may suffer from jaundice. When infection is suspected based Clostridium clinical or biological attacks with massive doses of penicillin are given. All the dead tissue from the placenta should be removed surgically as soon as possible. If there is no transfusion blood and antibiotics, the possibility that the uterus has become gangrenous must be taken into account. After Hysterectomy shown. Hyperbaric oxygen is used if available.
In all cases of septic abortion careful monitoring takes place in the flow of urine. renal cortical tubular necrosis or sometimes can occur.
Another dangerous complication of septic abortion circulatory failure due to peripheral vasodilatation caused by endotoxin released from agencies coliform bacteria that have invaded the bloodstream.
About the Author
khurram akhtar
http://urshealth.com
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