Defining Abortion and Its Classifications

Defining Abortion

• An interruption or expulsion of the products of conception before the fetus can survive independently
• Considered viable after the 5th month of gestation
• Premature expulsion of the contents of the uterus
• Can be spontaneous or induced
• Expulsion or extraction of an embryo or foetus weighing 500gm or less when it is not capable of independent survival (WHO definition)

### Classifications

• Spontaneous:
  • Threatened: Abortion has started, but may still be reversible
  • Inevitable: Continutation of pregnancy is impossible
  • Complete: All products of conception are expelled
  • Incomplete: Some products of conception remain in the uterus
  • Missed: Fetal death occurs in the uterus, but the body is not expelled
  • Septic: Infection in the uterus
• Induced:
  • Septic abortion: Occurs when the abortion procedure is performed unsafely and results in an infection
  • Elective abortion: Voluntary termination of pregnancy
  • Therapeutic abortion: Performed when the mother's life is at risk, or the fetus has severe abnormalities

Etiology of Spontaneous Abortion

• Fetal factors:
  • Genetic: Chromosomal abnormalities (trisomy) are a common cause
  • Multiple gestation: Increased risk of miscarriage
• Maternal factors:
  • Endocrine/Metabolic Factors: Diabetes mellitus
  • Anatomical Abnormalities: Cervical incompetence, uterine fibroids, congenital malformations of the uterus
  • Environmental Factors: Smoking, alcohol consumption, maternal medical illnesses
• Infections: Viral (rubella, cytomegalovirus, HIV), Bacterial (chlamydia)
• Immunological Disorders: Autoimmune diseases resulting in anti-fetal antibodies
• Unexplained: The exact cuase is not known in 40-60% of cases

Types of Spontaneous Abortions and Management

Threatened Abortion

• Clinical Features:
  • Slight vaginal bleeding
  • Mild backache or dull lower abdominal pain
  • Soft uterus and cervix
  • Closed cervix
• Management:
  • Rest
  • Tocolytic drugs (Salbutamol, Nifedipine)
  • Analgesics
  • If pregnancy continues, there is an increased risk of preterm labor and intrauterine growth restriction (IUGR)

Inevitable Abortion

• Clinical Features:
  • Vaginal bleeding
  • Aggravation of colicky pain in the lower abdomen
  • Dilated cervical os (opening)
  • Products of conception may be felt through the cervix
• Management:
  • Monitoring for signs of infection
  • Medications to help expel the products of conception
  • Dilation and Curettage (D&C) if necessary

Complete Abortion

• Clinical Features:
  • Expulsion of a fleshy mass per vagina
  • Subsiding abdominal pain
  • Reduced vaginal bleeding
  • Uterus smaller than expected for the period of amenorrhea
  • Closed cervical os
  • Empty uterus on ultrasound
• Management: Counseling and family planning

Incomplete Abortion

• Clinical Features:
  • Heavy vaginal bleeding
  • Abdominal pain
  • Uterus larger than expected for the period of amenorrhea
  • Cervical os is open
  • Visible products of conception on ultrasound
• Management:
  • Dilation and Curettage (D&C) to remove remaining placental tissue

Missed Abortion

• Clinical Features:
  • Fetal death but no expulsion
  • Uterus smaller than expected
  • No fetal heart beat on ultrasound
• Management:
  • Dilation and Curettage (D&C) to remove the fetus

Septic Abortion

• Clinical Features:
  • Fever, chills, severe abdominal pain
  • Foul-smelling vaginal discharge
  • Tender uterus
• Management:
  • Antibiotics
  • Dilation and Curettage (D&C)
  • Intravenous fluids
  • Close monitoring for complications

Recurrent Miscarriage

• Definition: Three or more consecutive spontaneous abortions
• Etiology:
  • Fetal chromosomal abnormalities
  • Maternal medical conditions
  • Hormonal imbalances
  • Anatomical abnormalities
  • Infections
  • Autoimmune disorders
  • Cervical incompetence
  • Multiple gestations
  • Prior preterm birth

Management of Recurrent Miscarriage

• Diagnosis:
  • History and physical exam
  • Hysterosalpingography
• Treatment:
  • Cervical cerclage (Shirodkar suture)
  • Hormonal therapy (Progesterone)

### Induced Abortion

• Septic Abortion: Complications from an unsafe abortion procedure
• Elective Abortion: Voluntary termination of pregnancy
  • Surgical methods: Dilation and Curettage (D&C), Vacuum aspiration
  • Medical methods: Misoprostol
• Therapeutic Abortion: Performed to protect the mother's life or if the fetus has severe abnormalities

### Nursing Management

• Pre-procedure Care:
  • Thorough assessment
  • Counseling and informed consent
  • Preparation
• Post-procedure Care:
  • Monitor for bleeding and infection
  • Pain management
  • Emotional support and counseling
  • Family planning counseling

Post-Abortion Family Planning

• Definition: Using family planning methods after an abortion to prevent unintended pregnancy
• Importance:
  • Allows for a period of recovery
  • Reduces the risk of another abortion
• Contraceptive methods can ideally be started immediately after an abortion
• Special considerations:
  • Counseling about the benefits and risks of different methods
  • Understanding the return of fertility, as it can occur quickly
  • Addressing the woman's emotional needs

This quiz delves into the definitions and classifications of abortion, including the key differences between spontaneous and induced types. Explore various scenarios and terms associated with abortion terminology, such as threatened, inevitable, and elective abortions. Test your knowledge on this sensitive and important topic.