Abortions is considered an important topic for the NEET PG exam. The medical aspects of abortion, including the different types of abortions, the risks and benefits of each, and the best practices for post-abortion care, are critical components of a medical professional's education.
Understanding these factors is essential for providing safe and effective medical care to women who may choose to have an abortion. In this blog, we have covered important details on this high-yield OBGYN topic of abortions. Keep reading.
Spontaneous abortion: Anything delivering before < 28 weeks or less than 500 gms
Any baby delivery ≥ 28 weeks: viable baby
Important Information Term pregnancy: 37-42 weeks
MTP: Medical termination of pregnancy
Causes of spontaneous abortion
1st trimester abortion (12 weeks)
Mostly because of chromosomal causes
Trisomy 16,13, 21 (16 M/C association)
Monosomy 45 XO
2nd trimester abortion: Mostly due to Anatomical causes
Vascular thrombosis: ≥ 1 arterial, venous, or small vessel thrombosis
≥1 fetal death (at or beyond the 10th week of gestation)
≥1 premature birth before the 34th week of gestation because of eclampsia, severe preeclampsia, or placental insufficiency
≥3 consecutive (pre) embryonic losses (before the 10th week of gestation)
Lupus anticoagulant positivity on ≥ 2 occasions at least 12 weeks apart
Anticardiolipin antibody (IgG and / or IgM) in medium or high titer ( i.e >40,or above the 99th percentile ) , on two or more occasions at least 12 weeks apart
Anti–beta 2 glycoprotein-I antibody (IgG and / or IgM) in medium or high titer ( ie , above the 99th percentile ) on two or more occasions at least 12 weeks apart
Definite APS is present if at least one of the clinical criteria and one of the laboratory criteria are met
Only indication of unification of a Bicornuate uterus: Recurrent abortions
Septal resection is also done in bicornuate uterus
Abortion occurs at 20-24 weeks and there is painless dilatation of the cervix. It can be diagnosed pre pregnancy by passing Hegar's Dilator (8 size should not go in easily)
It is also diagnosed with Antenatal scan at 10-13 Weeks: cervix length < 2.5 cm (short) Leading to abortion or pre - term labor
Mx of cervical incompetence: Cerclage by 12 weeks and beyond; M / C used method is McDonald's method.
Shorter cervix or Mutilated cervix: Shirodkar stitch or any Abdominal cerclage. Shirodkar stitch: Dissect bladder anteriorly away and stitch put high up on cervix. Removal of Cerclage is done at ≥ 37 weeks or when a patient comes with labor.
On per vaginal examination if OS is closed: Threatened abortion
On PV if OS is opened and products are bulging: Inevitable abortion
If OS opened, H/O passage of products and still few products of pregnancy felt through PV: Incomplete abortion. If OS closed, the uterus is of Normal size and H/O passage of products: Complete abortion. If there are no symptoms of Miscarriage, and dead fetus / Embryo retained in uterus (baby was alive before now dead): Missed Abortion
On USG only gestational sac is seen, and on repeated USG after a few weeks gestational sac increases in size but no yolk sac or fetus formation. (Normal sequence of events: Gestational sac - yolk sac formation – fetal node formation-cardiac Activity)
Aka Anembryonic Gestation
Act passed in 1971 and implemented in 1972, revised in 1975
Amendment in 2021: Can now be done up till 24 weeks
Can only be done in government Approved center
Trained for 6 months
Done 25 abortions under supervision of a gynecologist.
1st trimester abortions up to 9 weeks: We can do medical abortion by
Methotrexate or Mifepristone(200-600mg) ?24 to 72 hrs. later Misoprostol to expel the fetus (800mg Vaginally)
Success rate of Mifepristone / Misoprostol
First 7 weeks: 99 %
First 9 weeks: 95 %
Suction / evacuation is done ideally: 8-10 weeks
Dilation / curettage is done ideally: 8-12 weeks
If pregnancy > 12 weeks: DOC is prostaglandins
Misoprostol (PGE1): Tablet can be used as vaginal, oral, rectal
Dinoprostone (PGE2): Gel form and given in vagina
Carboprost (PGF2 α): Injection form and given IM
Laminaria tent (dry seaweed): Act by hygroscopic action
Hysterotomy: If there is abortion failure after prostaglandins administration and to remove the dead / macerated fetus, different from LSCS as the lower segment is not formed.
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