Abortion in the Shadow of the Criminal Law? The Case of South ...
Inevitable abortion case presentation
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Transcript of Inevitable abortion case presentation
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ABORTION INEVITABLE ABORTION
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CLINICAL CASE
• Mrs M aged 24 yrs and 11 weeks pregnant presented to the Emergency Department with abdominal cramping and heavy vaginal bleeding and clots. Over the past 2 days, she has experienced light spotting, which has increased in severity that morning. Mrs M reported no fever , chills, burning on urination, nausea or vomiting.
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• Past obstetric H/o : G-4, P-2, A-1 she was receiving prenatal care from her
obstetrician. • Physical Examination: BP- 125/85 mm Hg Heart Rate- 83beats/min RR- 18 breaths/min O2 saturation- 100% on room air Lungs - were clear, s1 and s2 normal,
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• PELVIC EXAMINATION: O/E- Moderate active bleeding was noted in
the vaginal vault with cx os open. Product of conception are felt through OS. No cervical motion tenderness or adnexal
tenderness was observed.
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Diagnostic workup
• WBC – 10,000/uL (normal- 4,500-11,000)
• Hb - 13.7g/dl (normal 12.1-15.1)
• Hematocrit – 39.7% (normal 36%-44%)
• Blood Type- B+ve• Beta-HCG – 9400.0mlU/mL• TV USG- Appeared to be an abnormal G.Sac
near to cervical canal
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Differential Diagnosis
• Cervical Abnormalities- Malignancy, polyps or trauma
• Ectopic Pregnancy• Idiopathic bleeding in a viable pregnancy• Infection of the vagina or cervix• Molar Pregnancy• Spontaneous Abortion• Vaginal Trauma
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DISCUSSION
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INTRODUCTION / DEFINITION
• TERMINATION OR LOSS OF PREGNANCY BEFORE THE AGE OF VIABILITY (28,24,22 wks or <500g)
• WHO- 24wks or 500g• In our environment- officially still 28 wks
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• Significant public health problem, important cause of maternal mortality in the developing countries.
• Appox. 70,000 women die from complications of induced Abortions.
• Around 99% of deaths are due to unsafe procedures.
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CLASSIFICATION ABORTIONS
SPONTANEOUSINDUCED
ISOLATED RECURRENT
THREATENED INEVITABLE COMPLETE INCOMPLETE MISSED SEPTIC
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CAUSES
GENETIC FACTORS
INFECTION
ENDOCRINE AND METABOLIC FACTORS
IMMUNOLOGICAL FACTORS
ANATOMIC FACTORS
OTHERS
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INEVITABLE ABORTION
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DEFINITION & CLINICAL FEATURES
- It a clinical type where the change have progressed to a state from where continuation of pregnancy is impossible.
- Pregnancy cannot be redeemed and must be terminated
- vaginal bleeding with severe abdominal pain and dilatation of the cervix
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MANAGEMENT• To take appropriate measures to look after the
general condition.• To accelerate the process of expulsion.• To maintain strict aseptic measures.
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ACTIVE TREATMENT
Before 12 weeks
•D&E followed by CURETTAGE•Suction EVACUATION
After 12 weeks
• oxytocin drip 10 units in 5oo NS Acceleration of Uterine contraction
• Abdominal Hysterotomy
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DILATATION AND EVACUATION
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INSTRUMENTS
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PROCEDURE
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COMPLICATIONS• Injury to the uterine lining or cervix• Uterine Perforation• Moderate to Severe Bleeding ( tissue
remaining in Uterus) • Shock• Sepsis( endometritis, myometritis, pelvic
pertonitis)• Increased morbidity
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THANK YOU