Abortion

1. ABORTION

2. Abortion

Induced



Therapeutic
Criminal
Elective

3. Abortion

Spontaneous



20 -25% of pregnancies terminate
spontaneously
Usually due to embryo abnormalities
May also result from infection, unfavorable
intrauterine environment, cervical
incompetence

4. Abortion

Spontaneous




Threatened
Inevitable
Complete
Incomplete

5. Abortion

Threatened

Vaginal bleeding, mild or absent contractions,
closed cervix



20% of women bleed in early pregnancy
50% go on to abort
Any bleeding in early pregnancy is dangerous
and abnormal

6. Abortion

Inevitable





Vaginal bleeding
Moderately severe contractions
Possible amniotic sac rupture
Cervix effacement and dilation
Changes are irreversible

7. Abortion

Completed

Products of conception expelled




fetus
placenta
decidual lining
Signs, symptoms




Profuse vaginal bleeding
Passage of tissue, clots
Continuing mild contractions
Possible hypotension

8. Abortion

Incomplete


Products of conception retained
Signs, symptoms





Profuse bleeding
Passage of tissue/clots
Severe contractions
Hypotension, shock
Sepsis

9. Abortion

Missed


Fetus dies in utero before 20th week
Retained at least 2 months afterwards

10. Abortion

Missed

Signs/Symptoms



Continued amenorrhea
History of bleeding without cramping
Decrease in uterine size
 Resorption of fluid
 Calcification of products of conception

11. Abortion

History



Confirmed or suspected pregnancy
Abdominal pain, cramping
Bleeding, passage of tissue

12. Abortion

Physical Exam


Orthostatic vital signs (tilt test)
Examine for amount of vaginal bleeding,
presence of tissue

13. Abortion

Management






High concentration oxygen
IV or IV’s with LR
MAST if indicated
Do NOT pack vagina
Save any tissue passed
Transport