MISSED ABORTION (SILENT MISCARRIAGE)

 Definition: - when the fetus is dead and retained inside the uterus for a variable period is called as missed abortion or silent miscarriage.

Clinical Features: - Persistent brownish vaginal discharge 

    Subsides of pregnancy symptoms

    Retrogression of breast changes 

    Cessation of uterine growth

    Fetal Heart sound are not audible 

Treatment:-

Uterus less than 12 weeks:-

   Dilation and evacuation (D & E ) 

   Dilation and curettage 

   Suction & evacuation 

Slow dilation of cervix by laminarsn tent 

Uterus Mare than 12 weeks:-Induction is done by following methods oxytocin 

                           (10-20 unit of oxytocin in 500 ml NS) Prostaglandin (PG) 

                            PGE, analogue ( misoprostol) 200 mg tab 

                                               4 Hourly in post vaginal fornix for 5 times 

15 methy PGF2 (carbo prost) romethamine                    250 ml. inj.  3 hourly for 10 times

SEPTIC ABORTION 

Definition:- Type of abortion with evidence of infection of product of conception a uterus. 

Abortion is commonly in complete but may be threatened Inventible   threatened or induced. 

Etiology/risk factor:-

Rise of temperature above 100 4 F

Offensive vaginal discharge 

Lower abdominal pain tenderness 

Micro – Organism: - Anaerobic – Streptococcus & tetanus 

  Aerobic – Staphylococcus e. coli

In complete evacuation 

Injury to genital organs 

Clinical features:-

pyrexia  chills a rigor 

Abdominal pain 

pulse rate 100-120 b/m

purulent vaginal discharge 

tender uterus 

bright red color of vaginal mucosa lining 

Investigation:-

Blood investigation 

HB, TLC,DLC, ABO, RH grouping 

cervical or high vaginal swab culture 

Urine analysis including culture 

USG of pelvic abdominal

Serum electrolyte 

Type grade :-

  Grade I :-  Infection is localized to uterus (80% Associated with spontaneous abortion 

  Grade II :- Infection speed to pelvic structure 

 Grade III :- Generalized peritonitis endrotoxic shock (5%) Jaundice/ renal failure this is almost always caused by criminal abortion 

Prevention: - encourage family to follow family planning measures to unwanted pregnancy use aseptic technique during procedure.

Management:-

General: - Hospitalization 

Control sepsis 

Remove source of infection 

Grade-I:-

Antibiotics –

gram + aerobes - penicillin 

        Amphicillin 

areoles – gentamycin 

ceftaxone 

Anaerobes - Metronidozole 500 mg IV

Clindamy-cin 600 mg IV 

Analgesics a sedatives 

Blood trans fusion 

Evacuation

Grade-II:- Antibiotics – same as I 

Analgesics 

Blood Transfusion 

Surgery 

Evacuation 

Grade-III:-  Antibiotic – same –as

IV therapy 

Supportive therapy 

Generalized peritonitis 

Gastric suction 

Surgery: - Indication - Injury to uterus or bowel

Foreign bodies in abdomen

Peritonitis c pay collection 

Septic shock 

Big uterus 

 Laparotomy is done to correct any abnormal condition in uterus abdominal and pelvic .