1. Dr. Madhavi Karki

2. DEFINITION However for international acceptance it is brought down to 20 th weeks or fetus weighing 500gm.

3. CLASSIFICATION/VARIETIES

5. Etiology A. Ovular or fetal factors-

6. B. Maternal illness-

8. Definition : It is a clinical entity where the process of abortion has started but has not progressed to a state from which recovery is impossible THREATENED ABORTION

9. EXAMINATION

10. Investigations

11. TREATMENT ADVICE ON DISCHARGE : The patient should limit her activities for 2 weeks

12. INEVITABLE ABORTION DEFINITION : IT IS A TYPE OF ABORTION WHERE THE CHANGES HAVE PROGRESSED TO A STATE FROM WHERE CONTINUATION OF PREGNANCY IS IMPOSSIBLE.

13. TREATMENT

14. COMPLETE ABORTION DEFINITION : WHEN THE PRODUCTS OF CONCEPTION ARE EXPELLED EN MASSE, IT IS CALLED COMPLETE ABORTION

15. MANAGEMENT

16. Incomplete Abortion DEFINITION : WHEN THE ENTIRE PRODUCTS OF CONCETION ARE NOT EXPELLED INSTEAD A PART OF IT IS LEFT INSIDE THE UTERINE CAVITY Treatment : ~ inevitable abortion. The removed materials are sent for histopatholgical examination.

17. MISSED ABORTION DEFINITION : WHEN THE FETUS IS DEAD AND RETAINED INSIDE THE UTERINE CAVITY FOR A VARIABLE PERIOD OF TIME.

18. MANAGEMENT

19. SEPTIC ABORTION DEFINITION : Any abortion associated with evidences of infection of the uterus and its contents is called as septic abortion.

21. INVESTIGATIONS

22. MANAGEMENT

23. RECURRENT ABORTION DEFINITION : RECURRENT ABORTIONS IS DEFINED AS A SEQUENCE OF THREE OR MORE CONSEQUETIVE SPONTANEOUS MISCARRIAGES. IT CAN BE PRIMARY OR SECONDARY

24. INVESTIGATIONS HISTORY : (1)THE NATURE OF THE PREVIOUS ABORTION PROCESS (2)HISTOLOGY OF THE PLACENTA OR KARYOTYPING OF THE CONCEPTUS, IF AVAILABLE (3) ANY CHRONIC ILLNESS

25. Treatment INTERCONCEPTIONAL PERIOD

26. DURING PREGNANCY :

27. CIRCLAGE OPERATION TWO TYPES : SHIRODKAR’S AND Mc DONALD’S

28. (a)COMPETENT CERVIX (b) INCOMPETENT CERVIX WITH HERNIATION OF MEMBRANES (c)COMPETENCY RESTORED AFTER ENCIRCLAGE OPERATION

29. STEPS OF SHIRODKAR’S OPERATION STEP 1 : THE PATIENT IS PUT UNDER GENERAL ANESTHESIA AND PLACED IN LITHOTOMY POSITION WITH A GOOD EXPOSURE OF THE CERVIX BY A POSTERIOR VAGINAL SPECULUM. THE LIPS OF THE CERVIX ARE PULLED DOWN BY ALLIS TISSUE FORCEPS. STEP 2 : A TRANSVERSE INCISION IS GIVEN ANTERIORLY BELOW THE BASE OF THE BLADDER ON THE VAGINAL WALL AND THE BLADDER IS PUSHED UP TO EXPOSE THE LEVEL OF THE INTERNAL OS. A VERTICAL INCISION IS GIVEN POSTERIORLY ON THE CERVICOVAGINAL JUNCTION.

30. STEP III – THE NON ABSORBABLE SUTURE MATERIAL – NO.4 IS PASSED SUBMUCOUSLY WITH THE HELP IF ANEURYSMAL NEEDLE SO AS TO BRING THE SUTURE ENDS THROUGH THE THE POSTERIOR INCISION. STEP IV – THE ENDS OF THE SUTURE ARE TIED UP POSTERIORLY BY A REEF KNOT. THE BULGING MEMBRANES, IF PRESENT MUST BE REDUCED BEFOREHAND INTO THE UTERINE CAVITY. THE ANTERIOR AND POSTERIOR INCISIONS ARE REPAIRED BY INTERRUPTED STICHES USING CHROMIC CATGUT.

31. Mc DONALD’S OPERATION THE NON ABSORBABLE SUTURE MATERIAL IS PLACED AS PURSE STRING SUTURES AS HIGH AS POSSIBLE AT THE JUNCTION OF THE RUGOSE VAGINAL EPITHELIUM AND THE SMOOTH VAGINAL PART OF THE CERVIX BELOW THE LEVEL OF THE BLADDER. THE SUTURE STARTS AT THE ANTERIOR WALL OF THE CERVIX. TAKING SUCESSIVE DEEP BITES IT IS CARRIED AROUND THE LATERALAND POSTERIOR WALLS BACK INTO THE ANTERIOR WALL AGAIN WHERE THE TWO ENDS OF THE SUTURE ARE TIED.