Abortion is the expenditure of conception before the fetus can live outside the uterus especially when the fetal weight less than 500 grams or gestational age of fewer than 20 weeks. In other words, abortion is the end of a pregnancy by the certain consequences on or before the 22 weeks of pregnancy. Also, pregnancy has not been able to live outside the womb.
Spontaneous abortion is a natural abortion without outside intervention (artificial) to end the pregnancy. The general terminology of the problem is a miscarriage. Artificial abortion is an abortion that occurs due to certain interventions aimed at ending the pregnancy process. The terminology for this condition is abortion or provocate abortion.
Types of Abortion
- Abortion imminens
It is often also referred to as gifted miscarriage. This type will occur if bleeding found in a young pregnancy, although the pregnancy test still shows positive results. In this case, the discharge of the fetus can still be prevented by providing hormonal and antispasmodic therapy and having bedrest.
If after a few weeks, it turns out that bleeding found and in two pregnancy tests have a negative result, curettage should be done. This case indicates a fetal miscarriage has occurred.
- History of late menstruation with HCG (positive) results with a gestational age less than 20 weeks
- Not too much vaginal bleeding, brownish and mixed with mucus
- Lower abdominal cramps, sometimes also not accompanied by cramps
- Abortion incisions
Infectious abortion occurs when bleeding found in pregnancy accompanied by the opening of the uterine os, touched membranes. The treatment is the same as incomplete abortion.
- Increased bleeding, fresh red color with the opening of the cervix
- Stomach mild pain or spasm (such as contractions during labor)
- Incomplitus abortion (miscarriage remaining)
It is the removal of part of the conception results in pregnancy for before 20 weeks with remaining left in the uterus. The sign of this type of patient is if vaginal bleeding occurs with a fetal discharge without placental removal. The other symptoms are amenorrhea, abdominal pain due to contractions, bleeding that comes out can be a lot or little.
On examination, it is found that the ostium opened and sometimes still feels tissue. Moreover, the size of the uterus is smaller than the gestational age. If there are indications of shock, treat it first by giving blood and fluid transfusion, then remove the tissue as soon as possible by a digital method (using two fingers) or curettage, then give uterotonic drugs and antibiotics. Patients are included in this type of abortion if they experience successive miscarriages for more than three times.
- Active bleeding
- Severe abdominal pain such as contractions during labor
- Issuance of part of the results of conception
- The mouth of the uterus is opened with some of the remaining conception left behind
- Sometimes patients come in shock due to bleeding
- Complaint abortion
In this type, all the results of conception (fetus) have been released. In this type of abortion will be found vaginal bleeding accompanied by the release of all the results of conception (fetus and decidua) so that the uterus is empty.
- Little bleeding
- Abdominal pain or mild cramps
- The mouth of the uterus is closed
- Expenditures on all results of conception
- Delayed Abortion (missed abortion)
It is the fruit of pregnancy that is held in the womb for 8 weeks or more. Fetal death is sometimes accompanied by a little vaginal bleeding resulting in an imminent abortion picture. Furthermore, the uterus does not enlarge and even shrink because of absorption of amniotic water and maceration of the fetus. This abortion usually ends no later than 6 weeks after the fetus dies, if the fetus dies in a very young pregnancy, the fetus will be expelled sooner, but conversely, if fetal death occurs in a further pregnancy, fetal retention will last a long time.
- Breasts shrink
- Without pain
- Accompanied by bleeding or not
- Habitual Abortion
Spontaneous abortion occurs three times in a row or more. In general, sufferers are not difficult to become pregnant, but the pregnancy ends before 28 weeks. Etiology of this abortion is genetic abnormalities (chromosomes), hormonal abnormalities (immunological), and anatomical abnormalities. Immunologic causes are the failure of reaction to lymphocyte trophoblast cross-reactive antigens. Patients with weak or none reactions will experience abortion. This Trophoblast Lymphocyte Cross-Reactive (TLX) system is a way to protect pregnancy. This disorder can be treated by transfusion of leukocytes or heparin.
In the diagnosis of the cause, it is necessary to do a careful examination, such as find complete medical records, the examination of the blood type of the husband and wife; presence or absence of blood compatibility: VDRL examination, glucose tolerance test, chromosome examination, and mycoplasma examination.
- Infectionosus and Septic Abortion
This type is an abortion accompanied by an infection in the genitalia. While septic abortion is severe abortus infection accompanied by the spread of germs or toxins into the bloodstream or peritoneum.
Infection in the uterus or surrounding area can occur in any abortion but is usually found in incomplete abortion and often in artificial abortion done without regard to asepsis and antisepsis. Generally, abortus infectionosus is limited to the decidua. In septic abortion, bacterial virulence is high, and the infection spreads to the myometrium, tuba, parametrium, and peritoneum. If the infection spreads further, generalized peritonitis or sepsis occurs, with the possibility of being followed by shock.
The diagnosis of abortus infections is determined by the presence of abortion accompanied by symptoms. Also, if it is found the indications of infection of genital organs, such as heat, tachycardia, odorous vaginal bleeding, enlarged musculature of the uterus, tenderness, and leukocytosis. If there is sepsis, the patient appears to be seriously ill. Moreover, if sometimes it is found the case of shivering, high fever and decreased blood pressure. To find out the cause of the germs, it is necessary to carry out blood and sap on the cervix.
Complications of Abortion
Here are several hazardous complications in abortion. They are:
Bleeding can be overcome by emptying the uterus from the remnants of conception and if necessary giving blood transfusions. Death due to bleeding can occur if help is not given in time.
Uterine perforation in scrapings can occur mainly in the uterus in a hyperretrophlex position. If this happens, the sufferer needs to be observed. If there is a danger sign, a laparotomy is needed immediately, and depends on the extent and shape of the perforation, wound perforation or needing a hysterectomy. Uterine perforation in abortion done by lay people causes serious problems because the uterine injury is usually extensive; there may also be an injury to the bladder or intestine. With the presence or certainty of perforation, a laparotomy must be done immediately to determine the extent of the injury, to then take the necessary measures to overcome the complication.
Shocked to abortion can occur due to bleeding (hemorrhagic shock) and due to severe infection (endoseptic shock).