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ABORTIONS-Ist TRIMESTER

ABORTIONS-Ist TRIMESTER. Dr Sathisha Nayak Dept. of OBG MMMC. WE BEGIN. CASE SCENARIO-1. 23YR,PRIMI,8WEEKS,OPD C/O-BLEEDING P/V - 1 DAY PAIN ABDOMEN-6 HOURS O/E- STABLE,NO PALLOR P/A-SOFT,P/S-BLEED+ FROM OS P/V- OS CLOSED,NO TENDERNESS. CASE SCENARIO-1.

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ABORTIONS-Ist TRIMESTER

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  1. ABORTIONS-Ist TRIMESTER Dr Sathisha Nayak Dept. of OBG MMMC

  2. WE BEGIN..

  3. CASE SCENARIO-1 • 23YR,PRIMI,8WEEKS,OPD • C/O-BLEEDING P/V - 1 DAY PAIN ABDOMEN-6 HOURS O/E- STABLE,NO PALLOR P/A-SOFT,P/S-BLEED+ FROM OS P/V- OS CLOSED,NO TENDERNESS

  4. CASE SCENARIO-1 • NORMAL OR ABNORMAL..? • GIVE 4 POSSIBILITIES/CAUSES • CAN WE SEND HER HOME? • WHAT INVESTIGATIONS NEEDED? • WHAT IF U DON’T TREAT HER?

  5. CASE SCENARIO-2 • 30YRS,G3P2,10WEEKS,ER • BROUGHT COLLAPSED IN ER • H/O –SEVER BLEEDING P/V-1 DAY • --PAIN ABDOMEN -12 HRS • O/E- NO PULSE,NO BP,RESTLESS PALLOR+++.P/A-SOFT P/V-BLEEDING+++,PRODUCTS+

  6. CASE SCENARIO-2 • WHAT IS YOUR FIRST STEP..? • WHATS WRONG WITH THIS PATIENT? • HOW WOULD YOU EVALUATE HER? • WHATS MANAGEMENT AND WHEN • WILL U DO IT?

  7. CASE SCENARIO-3 • 35 YRS,12 WEEKS,OPD • ANTENATAL CLINIC • NO COMPLAINTS • EXAMINATION-P/A SOFT,OS CLOSED • P/V-UTERS 8 WEEKS • USG SCAN- IRREGULAR GEST.SAC NO FETAL CARDIAC ACT.

  8. CASE SCENARIO-3 • DO U THINK THIS IS OK? • WHAT IS THE CONDITION? • WHAT WILL YOU DO.?

  9. CASE SCENARIO-4 • 18YRS GIRL,7WEEKS,ER • C/ HIGH FEVER -3 DAYS • PAIN ABDOMEN - 3 DAYS SHE HAS NOT PASSED URINE 24H • O/E-40* C,P/A TENDER P/S-FOUL SMELLING DISCH.

  10. CASE SCENARIO-4 • CAN U IDENTIFY THE CONDITION..? • WHAT WOULD HAVE CAUSED THIS? • HOW CAN WE AVOID & MANAGE?

  11. OBJECTIVES • DEFINE ABORTION • LIST TYPE OF ABORTIONS • IDENTIFY TYPE OS ABORTION • LIST 4 COOMON CAUSES • KNOW 4 COMMON SYMPTOMS &SIGNS • LIST 4 COMPLICATIONS • EVALUATION • MANAGEMENT OUTLINE

  12. ABORTION • COMMON OBG COMPLICATION • 15% OF ALL PREGNANCYS • ONE OF COMMON AVOIDABLE CAUSE OF MAT MORTALITY

  13. DEFINITION ‘ EXPULTION OF PRODUCT OF CONCEPTION BEFORE PERIOD OF VIABILITY’

  14. ABORTION TYPES -SPONTANEOUS- THREATENED INEVITABLE INCOMPLETE COMPLETE MISSED SEPTIC - INDUCED -MTP

  15. ABORTION-CAUSES • CHROMOSOMAL ABNORMALIY-50% • GENETIC DEFECTS - 20% • UNKNOWN ?-ENDOCRINAL-THYROID,?LFD -IMMUNOLOGICAL- -MATERNAL SYS DISEASE-SLE

  16. ABORTION-CLINICAL FEATURES -SYMPTOMS :-PAIN ABDOMEN BLEEDING P/V PASSING PRODUCTS P/V FOUL DISCHARG/FEVER -SIGNS : BLEEDING P/V NO P/A TENDERNESS CERVIX OPEN +/- PRODUCTS IN CX CANAL

  17. ABORTION-CLINICAL FEATURES -BLEEDING P/V+OS CLOSE = T.A -BLEEDING P/V+OS OPEN =INEVITABLE -BLEED.PV+OS OPEN+PRODUCTS HALF WAY IN CX OR VAGINA= INCOMPLETE -BLEED PV+PRODUCT OUT=COMPLETE -BLEED PV+/-,OS CLOSED,FETUS DEAD == MISSED ABOTION

  18. ABORTION-COMPLICATIONS • HAEMORRHAGE • HYPOVOLEMIC SHOCK • SEPSIS- SEPTIC ABORTION • MATERNAL DEATH • SEVERE ANAEMIA

  19. ABORTION-EVALUATION • DETAILED HISTORY • CLINICAL EXAM-GE+P/A+PV • INVESTIGATIONS -BL.GROUP,HB% -ULTRASOUND SCAN PELVIS

  20. ABORTION-MANAGMENT STABILISE PATIENT-BLOOD/IVFLUID SPECIFIC MANAGEMENT • T.A : REST/OBSERVATION • INEVITABLE : EVACUATION OF UT. • INCOMPLETE :EVACUATION OF UT. • COMPLETE : CHECK FOR RPOC • MISSED : D & EVACUATION OF UT. • SEPTIC :ANTIBIOTICS,EVACUATION SURGICAL DRAINAGE

  21. THANK YOU

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