ABORTION

ROWENA M. CUEVILLAS
Professor

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ABORTION
Legally : Expulsion of product of
conception at anytime during pregnancy
prior to reaching full term.
Accdg. To Gynecology and Obstetrics :
Abortion- means expulsion of products of
conception within12 weeks of gestation.
Premature Delivery – means expulsion of product
of conception after 28 weeks of pregnancy but
before reaching full term.

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Medico-legal conditions in which a
female is examined for signs of abortion
1- A woman-alleging abortion after a blow
in a fight.
2- A woman notifying that a medical man
gave her some abortifacient drugs.
3- A woman wishing to conceal abortion
after being charged with it.

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MEDICO-LEGAL ASPECT OF ABORTION
Criminal investigation can result from
1. physical violence
2. Use of abortifacients
3. Use of instruments
4. Physical violence can be self-inflicted,
accidental or deliberate but not necessarily
intended to result to abortion.
5. Death can result from shock, air embolism,
instrument injury, or sepsis.

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 FOR ILLEGAL ABORTION IF SUSPECTED, EXAMINATION OF
THE DECEASED SHOULD INCLUDE :
7. Physical condition of the uterus and contents such
as perforation, foul smelling products,
8. Signs of abortifacients such as soapy fluids or
foreign bodies should be look for.
9. Evidence of air embolism in pregnancies in less
than 24 weeks duration is also an indication that
death may have been related to failed illegal
abortion.
10. Examination of fetal remains consist of physical
and histological measurements of fetus and organs.

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Threatened Abortion
•occurring before the 20th week of gestation
•characterized by cramping and vaginal bleeding with no
cervical dilation.
•it may subside or an incomplete abortion may follow.
•It may be due to ectopic
pregnancy, cervical polyps,
extensive erosion of the cervix
Complete Abortion
•characterized by complete expulsion of all products
of conception
•light bleeding
•mild uterine cramping
•passage of tissue
•closed cervix

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Missed Abortion
• retention of dead products of conception in
utero for more than 8 weeks.
•the cervix is closed, and the client may report
dark brown vaginal discharge.
•pregnancy test findings are negative.
Imminent or Inevitable Abortion
•membranes rupture and the cervix dilates
•characterized by lower abdominal cramping and
vaginal bleeding.
•Profuse bleeding
Recurrent or Habitual Abortion
• characterized by spontaneous abortion of
three or more consecutive pregnancies
• Possible cause are known to be genetic
error, anatomic abnormalities of genital
tract, hormonal abnormalities, infections,
immunologic factors, or systemic disease
Septic Abortion
• abortion complicated by infection
• Foul smelling vaginal discharge
• uterine cramping
• fever
INCOMPLETE ABORTION
 Characterized by expulsion of only part of the
products of conception (usually the fetus)
 Severe uterine cramoing
 Bleeding occur wuth cervical dilation
 CLASSIFICATION OF
ABORTION
1- Natural or Spontaneous abortion :
About 10% of all pregnancies terminate
spontaneously
I. Diseases of the mother:
a) General diseases, e.g. nephritis, fevers,
syphilis, hypertension, etc.
b) Local diseases, e.g. uterine hypoplasia,
fibroids, etc.
II. Diseases of the fetus, membranes, or placenta: as
vesicular mole, hydramnios, fetal deformity, etc..

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2-Induced abortion:
A) Therapeutic (lawful) abortion: when induction
of abortion is performed by a medical man to
save the mother’s life.
 Therapeutic abortion is induced in the following
conditions:
- The mothers (decompensate HF),
(chronic R.failure), or (extensive plum T.B.).
- Diseases of pregnancy, e.g. pre-
eclampsia, eclampsia, hyper emesis
gravidarum,

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PRECAUTIONS BEFORE PERFORMANCE
OF THERAPEUTIC ABORTION:

1. consultation of two specialists and a written

opinion about the necessity
2. A written consent must be taken from the
woman and from her husband.
3. Should be done in general or maternal
hospital.
4. It must be done by specialists.
5. The cases must be recorded in the hospital
files.

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B. Criminal Abortion
 Abortion done without any therapeutic
indication but with criminal intent is
punishable by law.
1. General Violence
 Heavy exercise
 Application of pressure
 Alternate hot and cold bath
 Riding in s horse back
2. Local Violence
 May be applied in any portion of the generative
organ.
 Usually resorted to when general violence and
the use of drug fails to give the desired result.
 May be applied by the pregnant woman
herserlf, by the physician, midwife or by the
parents
 Use of douche of warm and cold water
 Injection of fluid into the uterine cavity
 Use of rubber inserted into the cervic
 Dilatation of the cervix by instrumentation
3. By the Use of Drug
I. Drugs acting directly on the uterus
1. Emmenagogues – increases the menstrual
flow.
a. Direct Emmanagogues
 These are substances which act directly on the
uterus or on the nervous system in close
relation to it.
 Examples:
 Ergot
 Apiol
 Cantharides
 Aloes
 Tamsy
 Borax
b. Indirect Emmenagogues
 These are substance which induce or
increase menstrual flow by promoting
and building the health of the person as
a whole
 Examples:
• Purgatives – castor oil
4. By Surgical Intervention
 This method of abortion by the application
or the use of instrument by doctor.
 Surgical intervention may be:
a. Dilatation and Curettage

b. Surgical abdominal route

5. Modern Methods of Inducing Route
a. Amniocentesis
b. Vacuum Suction (commonly known as
menstrual regulation)– suction apparatus
will detach and brake up the products of
conception
 1. TRAITS 1. NATURAL ABORTION 1. CRIMINAL ABORTION

1. HOW CAUSED Spontaneously induced

II. PRECIPITATE CAUSE Maternal /Foetal disease Unwanted pregnancy

III. EVIDENCE OG Absent Present

GENITAL / EXTRA-
GENITAL VIOLENCE
IV. DETECTION OF Not necessary seen May be present
FOREIGN BODY FROM
GENITALIA

V. TOXIC EFFECT OF Absent May ne present

DRUGS

VI. FOETAL INJURY Absent Rarely present

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CAUSES OF DEATH IN
CRIMINAL ABORTION
1. Early cause – haemorrhage, air
embolism, perforation of the uterus,
cervix and vagina
2. Delayed cause – peritonitis, tetanus,
septicaemia, secondary haemorrhage
3. Late cause – hepatitis, meningitis,
pneumonitis, pulmonary embolism and
systemic poisoning

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 DIAGNOSIS OF ABORTION
A- IN THE LIVING
1.The patient’s consent for examination is
necessary and a complete story about the
cases is taken.
2. Signs of pregnancy are looked for in her
breasts, abdomen, etc. Including the biological
pregnancy test.
3.Signs of general violence (e.g. bruises) may
be present on her abdomen

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4. Signs of local violence:
A) Uterus is enlarged.
B) Cervix shows a dilated soft external os,
which admits one or more fingers and recent
cervical lacerations with a bloody discharge.
C) Vagina may show irritation, bruise or
laceration according to the methods of
induction used.
D) Foreign bodies (E.g. irritant plug or cotton
stick) may be found either in the vagina, or
protruding from the cervix.

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E) Embryonic tissues, such as remnants
of the placenta or fetus may be found in
the vagina or protruding from the cervix.
5) Laboratory investigations:
6) Products of abortion:
DIAGNOSIS OF ABORTION
B- IN THE DEAD
In addition to the above mentioned signs, a
more detailed post-mortem:
1- The abdomen is opened and there may be
evidence of peritonitis.
2- The intestines may show irritation due to
the effect of drastic purgatives

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3- The uterus is slit open and examined
for its size, texture, contents,
4- The cervix examined for signs of
instrumental dilatation, laceration or FB
5- The vagina is opened and carefully
examined for bruise, laceration or FB.
COMPLICATIONS OF ABORTION

1- Neurogenic
shock
Rupture uterus may be
2- Hemorrhage: due to:
3- Air Embolism a) Diseases.
b) Difficult labor.
4- Acute Poisoning c) Trauma.
5. Infection

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