Ques. 1 What are the causes of Abortion? What are the types of Abortion ? What are the Complications of Abortion?
Ans. This is the termination of pregnancy before 28th weeks where product of conception is expelled either completely or incompletely manifested by vaginal haemorrhage is called as Abortion.
Ques. 2 Elaborate the case of unwanted pregnancy.
Ans. Particular attention can be given to uterine size and position, gynaecologic disorders, psychiatric disorders, asthma, allergies, bleeding disorders, and cardio-vascular or renal disease. The importance of accurate gestational dating cannot be overstated. Routine laboratory tests to be performed should include pregnancy tests, urine analysis, haematocrit, Rh typing, V.D.R.L., culture for gonococci etc.) Evaluation of the patient requesting abortion : (Unwanted Pregnancy) – Patients give valid reasons for requesting elective abortion. Some of these reasons are externally imposed by parents, spouse, or peers. Every effort should be made to ascertain that the patient is requesting abortion for authentic personal reasons. In addition, one should be certain that patient has freedom of choice among other methods of solving the problem of unwanted pregnancy, such as adoption or single parent-hood. Social agency help should be made available. A complete medical and social history and physical examination are required.
Ques. 3 What are the causes of abortion?
Ans. Cause of abortion – The causes can be classified as follows, but in many cases we don’t know any cause –
(A) Abnormalities of the foetus, e.g.,
- Poisons, viz. lead, quinine etc. 4. Radiological effect.
(B) Maternal causes –
- General maternal disease –
- essential hypertension,
- acute infection, e.g., pneumonia, typhoid, appendicitis, malaria, cholera, pyelonephritis;
- small pox,
- scarlet fever,
- erysipelas may lead to abortion,
- chronic wasting disease,
- toxoplasmosis, rubella etc.
- chronic nephritis,
Local abnormality of the mother, e.g., (i) displacement of the uterus (retroverted uterus), (ii) fibromyoma, (iii) cervical incompetence, (iv) surgical operations, (v) abnormalities of the placenta and membranes, viz. placenta praevia. (vi) Local abnormality of the genitalia,
- Dietetic deficiency, e.g., deficiency of Vit. E., Folic Acid etc.
- Drugs – e.g., deficiency of Vit. E., Folic Acid etc.
- Drugs – e.g., Lead, quinine, cytotoxic druge, phosphorus, mercury, ergot, drastic purgative etc. Maternal hypothyroidism is an important cause of abortion.
- Psychological causes, e.g., anxietly, fear, mental shock etc.
- Trauma /injury direct – an accidental fall, violent physical exercise, blow or kick on abdomen; indirect – passing of a sound or stick or operation on gravid uterus or on its appendage may lead to abortion.
Ques. 4 Which are the types of Abortion?
Ans. Types of Abortion –
(I) Spontaneous abortion –
- Incomplete abortion.
- Complete abortion.
- Septic abortion.
- Missed abortion.
- Cervical abortion.
- Theatened abortion.
- Inevitable abortion.
(II) Habitual or recurrent abortion.
(III) Therapeutic abortion.
(IV) Criminal abortion.
Clinical Features of Abortions (General) –
Haemorrhage – Usually slight at onset but becomes profuse when the abortion proceeds. Pain – It is of intermittent type and is due to uterine contractions, sometimes it is continuous. After discharge of the ovum, the pain ceases.
Dilatation of the Internal Os – For several days a haemorrhagic discharge occurs. Uterus undergoes a process of involution similar puerperal involution.
The incidence or abortion is 10% to 15% of all pregnancies.
In the dilating canal the finger will often feel a soft somewhat, swelling, which may be a clot of blood, or the lower pole of ovum detached from the uterine wall and lying free in lower part of the uterine cavity. After dilatation, ovum is expelled out of it either complete or in pieces. The uterus rapidly retracts and cervix closes down, so that in a few hours no trace of dilatation may be detected.
Complications of Abortion – (I) Immediate –
- Endotoxic shock – Bacteraemia caused by E. coli and other gram negative organisms sometimes results in severe shock.
- Acute renal failure – It stems from combined effect of infection, shock and circulating decomposed products of conception.
- Injury to uterus and other viscera (accidental perforation of uterus during the process of dilatation and/or curettage is not uncommon).
- Coagulation defect.
- Post-abortal anuria etc.
- Infection (sepsis), the commonest organism is E. coli serogenes; next in frequently is anaerobic streptococci and less commonly haemolytic streptococci, staphylococci.
(II) Remote – 1. Chorion-epthelioma. 2. Chronic ill health due to anaemia and chronic pelvic inflammation. 3. Formation of placental polyp.
Ques. 5 Which Homoeopathic remedies are useful in case of Abortion?
Ans. Homoeopathic Remedies for Treatment of Abortion –
- CIMICIFUGA – Habitual abortion in women of rheumatic tendencies; pains fly across the abdomen from side to side, esp. from right to left; comfusions with the labor-pains.
- IPECAC – Continual nausea, without a moment’s relief. Cutting pains about umbilicus; profuse and continuous discharge of bright-red blood, with pressure downward.
- SABINA – Threatened abortion, more esp. about the 3rd months with profuse flow of black, partly fluid and partly clotted blood; severe pains extending from back to pubis. Women who habitually miscarry.
- AMBRA – Threatening abortion, with tendency to convulsions, in excitable women.
- ARNICA – Abortion in consequence of a shock, injury, after a fall, blow or concussion, esp. if labor pains set in, with discharge of blood or serous mucous. Sore feeling all through the patient, as if from a bruise.
- SECALE COR – Threatened abortion in later months; esp. after miscarriage. Copious flow of black, liquid blood. Want of action in uterus. Passage haemorrhage in thin, crawny, cachectic women.
- CANTHARIS – Threatened abortion from congestion or ulceration of the cervix uteri. Retention of placenta.
- CAULOPHYLLUM – Threatened abortion, with severe pains in back and loins, but uterine contractions feeble; slight flow. Also for habitual abortion. Want of action in the uterus.
- PULSATILLA – Labor-like pains alternating with haemorrhage. The discharges is arrested for little while, then returns with redoubled violence. Suffocative spells; Chilly patient.
- SEPIA – Abortion from 5th to 7th months; feeling of heaviness in abdomen and sense of weight in anus like a heavy ball, piles; induration of os and cervix; constipation.