WHAT IS AN INEVITABLE ABORTION ?
- Inevitable abortion means the process of expulsion of products of conception has become irreversible. The expulsion of products of conception has not occurred but it is bound to happen and nothing can be done to stop this process.
WHAT ARE THE CLINICAL FEATURES OF INEVITABLE ABORTION ?
Inevitable abortion is usually preceded by threatened abortion.Following are the clinical features of inevitable abortion:
- AMENORRHOEA, there is history of amenorrhoea, usually of 2-3 months. Other symptoms of early pregnancy are also present in most of the patients.
b)Breast enlargement and discomfort.
c)Frequency of micturition.
2.Bleeding per vagina, The bleeding per vagina in the beginning is bright red and scanty in amount, later the loss becomes heavy, with passage of clots.In case of severe bleeding,the blood loss may exsanguate the patient and result in hemorrhagic shock. Sometimes when the blood is retained in the vagina in the form of clots, the vagina becomes ballooned up.
3.Pain:Pain is a characteristic feature of inevitable abortion. It is characterized by lower abdominal cramps(due to painful uterine contractions). The intensity of pain depends upon the duration of pregnancy and parity of the patient.
In a late second trimester abortion, this pain may simulate labour pains. But in a case of early abortion the patient may either complain of continuous and severe lower abdominal pain,or there may be only a dull ache.
4.Size of the uterus:In an inevitable abortion,as all the products of conception are still in the uterine cavity, the size of the uterus corresponds to the duration of the gestation.
5.Dilatation of Cervix :This is a pathogenic sign of inevitable abortion. Once the internal Os of the Cervix starts dilating, it means that the abortion is inevitable The sac of membranes or the foetus may be felt through the dilated cervix.
GENERAL TREATMENT :
If the blood loss is not heavy, and the patient is in the satisfactory state, she does not need any treatment other than evacuation of the uterus.
In case of excessive bleeding and shock, the following treatment should be instituted:
- Raise foot end of the bed and keep the patient warm.
- Oxygen inhalation may be given.
- Intramuscular or intravenous injection of Pethidine 100 mg, or Diazepam 10 mg should be given.
- A blood sample should be collected and sent for hemoglobin,grouping and cross matching.
- Intravenous drip should be started with 5% dextrose in water or 5% dextrose in saline.Blood transfusion should be as soon as cross matched blood is available.
- If the bleeding is continuous and heavy, an intravenous injection of Oxytocin 5-10 units or Ergometrine 0.5mg should be given. 5-10 units of Oxytocin may be added to the intravenous drip.
EVACUATION OF THE UTERUS :
Arrangements should be made to evacuate the uterus as soon as possible.
The method of evacuation depends upon the duration of pregnancy.
RISKS OF EVACUATION :
The following are the risks of instrumental evacuation of uterus:
- Perforation of the uterus.
- Cervical tears.
- Excessive haemorrhage.
- Hazards of emergency anesthesia.