Pregnancy Uterus Fetus Embryo: Morbidity Selectively Reduce Multiple Pregnancy

Abortion is the termination of a pregnancy by the removal or expulsion from
the uterus of a fetus or embryo, resulting in or caused by its death.
 The termination of pregnancy before fetus is viable.

 Fetus is viable is defined as fetus of 20 weeks AOG, weighing <350 grams.
 May be elective (planned, medical termination of pregnancy) or reproductive
problem.
Types of Abortion:
complete abortion - one in which all the products of conception are expelled from the
uterus and identified.
habitual abortion - spontaneous abortion occurring in three or more successive
pregnancies, at about the same level of development.
incomplete abortion - with retention of parts of the products of conception.
induced abortion - brought on intentionally by medication or instrumentation.
The manner selected depends chiefly upon the gestational age of the embryo or fetus,
which increases in size as it ages. Specific procedures may also be selected due to legality,
regional availability, and doctor-patient preference. Reasons for procuring induced abortions are
typically characterized as either therapeutic or elective. An abortion is medically referred to
as therapeutic when it is performed to:
 save the life of the pregnant woman.

 preserve the woman's physical or mental health;
 terminate pregnancy that would result in a child born with a congenital disorder that
would be fatal or associated with significant morbidity; or
 selectively reduce the number of fetuses to lessen health risks associated with multiple
pregnancy.
inevitable abortion - a condition in which vaginal bleeding has been profuse and the
cervix has become dilated, and abortion will invariably occur.
infected abortion -associated with infection of the genital tract.
missed abortion - retention in the uterus of an abortus that has been dead for at least
eight weeks.
septic abortion - associated with serious infection of the uterus leading to generalized
infection.
spontaneous abortion - occurring naturally.
Spontaneous abortion (also known as miscarriage) is the expulsion of an embryo or fetus
due to accidental trauma or natural causes before approximately the 22nd week of gestation; the
definition by gestational age varies by country. Most miscarriages are due to incorrect replication
of chromosomes; they can also be caused by environmental factors. A pregnancy that ends
before 37 weeks of gestation resulting in a live-born infant is known as a "premature birth". When
a fetus diesin utero after about 22 weeks, or during delivery, it is usually termed "stillborn".
Premature births and stillbirths are generally not considered to be miscarriages although usage of
these terms can sometimes overlap.
therapeutic abortion - induced for medical considerations. Medical abortions are non-
surgical abortions that use pharmaceutical drugs, and are only effective in the first trimester of
pregnancy.
threatened abortion - a condition in which vaginal bleeding is less than in inevitable
abortion and the cervix is not dilated, and abortion may or may not occur.
Surgical abortion
In the first 12 weeks, suction-aspiration or vacuum abortion is the most common method.
Manual Vacuum aspiration (MVA) abortion consists of removing
the fetus or embryo, placenta and membranes by suction using a manual syringe,
while electric vacuum aspiration (EVA) abortion uses an electric pump. These techniques are
comparable, and differ in the mechanism used to apply suction, how early in pregnancy they can
be used, and whether cervical dilation is necessary. MVA, also known as "mini-suction" and
"menstrual extraction", can be used in very early pregnancy, and does not require cervical
dilation. Surgical techniques are sometimes referred to as 'Suction (or surgical) Termination Of
Pregnancy' (STOP). From the 15th week until approximately the 26th,dilation and
evacuation (D&E) is used. D&E consists of opening the cervix of the uterus and emptying it using
surgical instruments and suction.
Dilation and curettage (D&C)

The second most common method of abortion is a standard gynecological procedure
performed for a variety of reasons, including examination of the uterine lining for possible
malignancy, investigation of abnormal bleeding, and abortion. Curettage refers to cleaning the
walls of the uterus with a curette. The World Health Organization recommends this procedure,
also called sharp curettage, only when MVA is unavailable.] The term D and C, or
sometimes suction curette, is used as a euphemism for the first trimester abortion procedure,
whichever the method used
Signs of Abortion (Assessment findings)

1. Vaginal Bleeding – observe carefully for accurate determination of amount saving
all perineal pads.
2. Contractions, pelvic cramping, backache
3. Passage of tissues/fetus
4. Cervical dilatation
5. Lowered hemoglobin if blood loss is significant.(less than 10.5mg/dL)
6. Signs related to blood loss- pallor, tachycardia, tachypnea, cold clammy skin,
restless, oliguria, hypotension, air hunger.
Complications of Abortion
1. Hemorrhage
2. Infection
3. Infertility
4. Uterine perforation from curettage
5. PID (Pelvic Inflammatory disease).
6. Retained products of conception, may lead to H-mole
7. Anemia
Exams and Tests
Abdominal or vaginal ultrasound may be done to check the baby's development, heart
beat, and amount of bleeding. A pelvic exam will be done to check the cervix.
The following blood tests may be performed:
* Complete blood count (CBC) to determine amount of blood loss

* Serum HCG to ccheck pregnancy
* White blood count (WBC) with differential to rule out infection
* Ultrasound

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Abortion is the termination of a pregnancy by the removal or expulsion from

the uterus of a fetus or embryo, resulting in or caused by its death.

 The termination of pregnancy before fetus is viable.

 save the life of the pregnant woman.

Dilation and curettage (D&C)

Signs of Abortion (Assessment findings)

Exams and Tests

The following blood tests may be performed:

* Complete blood count (CBC) to determine amount of blood loss

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