Spontaneous and Induced Abortions - NEET PG OBGYN

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.

Overview

• Spontaneous abortion: Anything delivering before < 28 weeks or less than 500 gms
• Any baby delivery ≥ 28 weeks: viable baby 

• 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 
• 2^nd trimester abortion: Mostly due to Anatomical causes  
  • Incompetent OS
  • Bicornuate uterus 
  • Septate Uterus
  • Unicornuate uterus 
• Causes leading to abortion in any trimester 
  • Diabetes
  • TORCH
  • Hypothyroidism
  • Syphilis 
  • SLE
  • APLA syndrome 

Also Read: Vaginal Yeast Infections: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

Recurrent Pregnancy Losses 

• ≥ 3 losses at any time of pregnancy
• M / C cause chromosomal 
• Other causes 
  • Anatomical 
  • DM / APLA / SLE / Hypothyroidism 
• It can never be due to TORCH group infection because once they cause pregnancy loss then the women become immune to the infection
• Important Information
  • APLA (Antiphospholipid antibody syndrome) 
    • Ab against phospholipid membranes: causing thrombosis in blood vessels, thrombosis in babies blood vessels causing death of baby

Also Read : Genital Warts: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

Thrombophilias 

• Inherited 
  • Antithrombin deficiency 
  • Factor V Leiden mutation 
  • Protein S and C deficiency 
  • Prothrombin gene mutation 
• Acquired 
  • APLA
  • Major surgery / Immobilization 
  • Malignancy
  • Pregnancy
• Diagnosis of APLA 

• Definite APS is present if at least one of the clinical criteria and one of the laboratory criteria are met 

ANATOMICAL DEFECTS

• Only indication of unification of a Bicornuate uterus: Recurrent abortions
• Septal resection is also done in bicornuate uterus 

Cervical incompetence

• 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. 

Also Read:

Endometriosis and Adenomyosis - NEET PG OBGYN

Postpartum Hemorrhage: Causes, Types and Management

Drugs in Pregnancy - NEET PG Obstetrics

Presentation of Abortion

• Bleeding (most commonly), pain
• Bulging of membranes 
• 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
• Blighted Ovum
  • 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 

MTP

• 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 
• Done by 
  • Gynecologist 
  • Doctor 
    • Trained for 6 months
    • Done 25 abortions under supervision of a gynecologist. 

Methods 

• 1^st 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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