Obstetrics and gynecology. Premature termination of pregnancy (most important)

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Obstetrics and gynecology. Premature termination of pregnancy (most important)

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35. Premature termination of pregnancy

Abortion (abortus - "miscarriage") - termination of pregnancy during the first 28 weeks. Termination of pregnancy after 28 weeks (up to 38 weeks) is called preterm birth (partus praematurus).

Spontaneous abortion. It is the most common obstetric pathology, occurring more often in the 3rd month in approximately 2-8% of pregnant women. The reasons for spontaneous abortion are quite complex and ambiguous. Impaired ovarian function leading to miscarriage can occur due to induced abortions, inflammatory diseases of the female genital organs, and dysfunction of the endocrine glands. Complications arising in connection with induced abortions lead to miscarriage: trauma to the basal layer of the endometrium, isthmus and cervix. One of the reasons is isthmic-cervical insufficiency of an organic nature, malformations of the uterus, neoplasms of the genital organs with the appropriate size and localization, as well as concomitant neuroendocrine and other disorders.

Clinic and course. During an abortion, the fertilized egg gradually peels off from the walls of the uterus, which is accompanied by damage to the vessels of the decidua. This causes bleeding. Under the influence of the contractile activity of the myometrium, the exfoliated fertilized egg is expelled from the uterine cavity, less often as a whole, more often in parts. Contractions of the uterus, promoting the expulsion of the fertilized egg, are felt as cramping pain. The following stages of abortion are distinguished: threatened abortion, started abortion, ongoing abortion, incomplete abortion, complete abortion, delayed (failed) abortion.

Slight pulling pains, a feeling of heaviness in the lower abdomen in the absence of bleeding indicate a threat of abortion.

Abortion in the course is characterized by the fact that contractions intensify and become painful, bleeding increases. The cervix shortens, the cervical canal opens, the fetal egg, exfoliated from the walls of the uterus, is pushed out of it. Bleeding becomes severe and often reaches an alarming degree. Preservation of pregnancy is impossible, the fetal egg is removed as a matter of urgency.

Incomplete abortion is characterized by the fact that not all of the fetal egg is expelled from the uterus, but only the fetus and part of the membranes depart. The remaining parts of the ovum interfere with a good contraction of the uterus. The cervical canal is somewhat open, the size of the uterus is less than the gestational age. Bleeding continues and can be very heavy.

Complete abortion in early pregnancy is much less common than in later periods. With a complete abortion, no elements of the fetal egg remain in the uterus, it contracts, the cervical canal closes and the bleeding stops.

Author: Ivanov A.I.

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