U/S IMAGES OF ABORTIONBY

DR SAMINA KAKARHO IN RADIOLOGY DEPT BMCH

TYPES OF ABORTION

Spontaneous AbortionCauses

Genital Tract Infections Bacterial vaginosis Vaginal mycoplasma infection

Medical Disorders Diabetes Thyroid disease Hypertensive disorders Renal disease

Spontaneous AbortionCauses

Endocrine Abnormalities Poor development of the corpus luteum Inadequate secretory endometrium Low serum progesterone levels

Uterine Abnormalities Structural abnormalities implicated in 15% of early pregnancy

losses e.g. Double uterus Unicornuate, bicornuate, septate or subseptate

uterus Failure of uterus to develop to adult size, remaining infantile

Spontaneous AbortionCauses

Retroversion of the Uterus Does not itself cause abortion As uterus fails to enlarge into abdomen, vaginal and abdominal

manipulation to correct the retroversion causes abortion Cervical Weakness

Caused by laceration of cervix or undue stretching of internal os as a result of previous medical abortion or childbirth

Membranes bulge through cervical canal and rupture Characterised by recurrent late pregnancy losses

Spontaneous AbortionCauses

Environmental Factors Environment teratogens such as lead and radiation Ingested teratogenetic substances such as drugs

(namely cocaine) and alcohol Smoking

Maternal Age Women in late 30’s and older at higher risk,

irrespective of previous obstetric history

Spontaneous AbortionCauses

Stress and Anxiety Severe emotional upset may disrupt hypothalmic and pituitary

functions Paternal Factors

Poor sperm quality Source of chromosomal abnormalities

Immunologocial Factors Maternal lymphocytes with natural killer cell activity may affect

trophoblast development Autoimmune diseases such as antiphospholipid syndrome

Spontaneous AbortionThreatened Miscarriage

Signs and Symptoms Pain: Variable, possibly slight lower

abdominal pain or backache

Bleeding: Scant, during first 3 months Cervical Os: Closed, no dilation Uterus: If palpable, soft and not tender

Normal ultrasonic image of 7 wks pregnancy

Threatened abortion image

Spontaneous AbortionInevitable Miscarriage

Signs and Symptoms Pain: Severe, rhythmical Bleeding: Heavy, clots Cervical Os: Open with dilation Uterus: If palpable, smaller than expected

Inevitable abortion image

Spontaneous AbortionIncomplete Miscarriage

Signs and Symptoms Pain: Severe Bleeding: Heavy, profuse Cervical Os: Open with dilation Uterus: Tender and painful Other: Tissue present in cervix

Shock

Incomplete abortion image

Spontaneous AbortionComplete Miscarriage

Signs and Symptoms Pain: Diminishing or absent Bleeding: Minimal or absent Cervical Os: Closed Uterus: If palpable, firm and contracted

Complete abortion image

Spontaneous AbortionMissed Miscarriage

Signs and Symptoms Pain: Absent Bleeding: Some spotting possible, brown loss Cervical Os: Closed Uterus: If palpable, smaller than expected

Confirmation of cardiac activity of fetus by magnifying image

No cardiac activity seen on magnifying cardiac area

Spontaneous AbortionSeptic Miscarriage

Signs and Symptoms Pain: Severe or variable Bleeding: Variable, may be offensive Cervical Os: Open Uterus: Bulky, tender and painful on

examination