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Summaries and exam orianted note / hand written notes/ image like

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Exam-oriented handwritten-style medical notes titled "ABORTION - Complete Notes" from Ayurvediya Prasuti Tantra. Cream/yellow notebook paper background with blue and black ink handwriting style. Include these sections clearly: SECTION 1 - DEFINITION & TYPES (top): Box: "Termination of pregnancy before viability = before 20 weeks / birth weight < 500g. Expelled product = ABORTUS" Two columns: SPONTANEOUS (Miscarriage): Threatened → Inevitable → Incomplete → Complete + Missed + Septic INDUCED: Therapeutic (health/fetal disease) | Elective (MTP - legal / Criminal - illegal) Timeline bar: Early abortion = before 12th week | Late abortion = 12th-20th week SECTION 2 - ETIOLOGY (colorful mind map style): Center circle: "CAUSES OF ABORTION" Branches: 1-Genetic (Trisomy, Polyploidy, Monosomy, Structural rearrangement) | 2-Endocrine (Luteal phase defect, Progesterone deficiency, Thyroid, DM) | 3-Anatomical (Cervical incompetence, Congenital uterine malformation, Fibroid, IU adhesions) | 4-Infections (Bacterial: Chlamydia, Brucella / Viral: Rubella, CMV, Variola, HIV / Parasite: Toxoplasma, Malaria) | 5-Immunological (ANA, Lupus anticoagulant, Anticardiolipin) | 6-Others (ABO incompatibility, IUCD, Smoking, Thrombophilia) | 7-Unexplained 40-60% SECTION 3 - COMPARISON TABLE (middle, colored headers): Columns: Type | OS | Bleeding | Pain | USG | Management Rows: Threatened | CLOSED | Slight bright red | Mild | Confirms viable (Prog >25ng/ml) | Rest + Phenobarbitone 30mg + limit activity 2wks Inevitable | OPEN | Profuse bright red | Severe cramps | - | IV fluids + Methergin 0.2mg + <12wks DandC / >12wks Oxytocin drip Incomplete | OPEN | Present | Prominent | Retained POC | <12wks DandC/suction + >12wks DandC GA + anti-D 50mcg if Rh-ve Complete | Closing | Subsiding | Subsiding | Empty uterus | No treatment needed Missed | CLOSED | Brown discharge | Absent | No FHS, no growth | <12wks suction evacuation / >12wks vaginal PG + Syntocinon Septic | Open/Closed | Offensive purulent | Fever+chills | Free fluid | Hospitalize + Broad spectrum antibiotics + Evacuation SECTION 4 - RECURRENT ABORTION (bottom left box): "≥3 spontaneous abortions before 20 weeks" 1st trimester causes: Chromosomal abnormalities, DM, Thyroid autoantibodies, Luteal phase defect, PCOS, Genital infection, Immunological (ANA/Lupus/Anticardiolipin), Unexplained SECTION 5 - SEPTIC ABORTION highlights (bottom right box, red border): Grading: Grade I - uterus only | Grade II - 15% myometrium/parametrium/tubes/ovaries | Grade III - 5% peritonitis/endotoxic shock Mgmt: Hospitalize + Ampicillin 500mg IM 6hrly + Gentamicin 80mg IV BD + Metronidazole 500mg IV 8hrly + Anti-gasgangrene 8000u + Anti-tetanus 3000u + Urine output target 30ml/hr Clean, colorful, high quality, very readable, exam revision style with stars and arrows highlighting key facts

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Summaries and exam orianted note / hand written notes/ image like

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Handwritten-style exam notes on cream notebook paper with blue ink. Title at top in large bold: "ABORTION - Garbha Vyapada" underlined twice. Content organized in sections: TOP SECTION - two boxes side by side: Box 1 (blue border): "DEFINITION: Termination of pregnancy before VIABILITY = before 20 weeks OR birth weight less than 500g. Expelled product = ABORTUS" Box 2 (orange border): "TYPES: 1) SPONTANEOUS (Miscarriage) - beyond patient control. Stages: Threatened → Inevitable → Incomplete → Complete + Missed + Septic. 2) INDUCED: Therapeutic (health/fetal disease) OR Elective (MTP=legal / Criminal=illegal). Methods: Medications + Surgery" MIDDLE LEFT - timeline arrow drawing: "BASED ON AMENORRHOEA PERIOD" Arrow with two markers: [Early abortion = before 12th week] ------ [Late abortion = 12th to 20th week] MIDDLE CENTER - spider diagram: Central oval: "ETIOLOGY OF ABORTION" with 7 branches radiating outward: Branch 1: "GENETIC: Autosomal trisomy, Polyploidy, Monosomy, Structural rearrangement" Branch 2: "ENDOCRINE: Luteal phase defect, Low progesterone, Thyroid abnormality, DM" Branch 3: "ANATOMICAL: Cervical incompetence, Uterine anomaly, Fibroid, IU adhesions" Branch 4: "INFECTIONS: Bacterial-Chlamydia,Brucella / Viral-Rubella,CMV,HIV / Parasite-Toxoplasma,Malaria" Branch 5: "IMMUNOLOGICAL: ANA, Lupus anticoag, Anticardiolipin, Paternal HLA" Branch 6: "OTHERS: ABO incompatibility, Smoking, IUCD, Thrombophilia, X-ray" Branch 7: "UNEXPLAINED: 40-60% cases" BOTTOM - neat comparison table with colored row headers: Table title: "TYPES OF ABORTION - Quick Comparison" Row 1 header (blue): Type | OS status | Bleeding | Pain | Key feature Row 2 (green): Threatened | CLOSED | Slight, bright red | Mild discomfort | Can be reversed! Row 3 (yellow): Inevitable | OPEN | Profuse bright | Severe cramps | Cannot be reversed Row 4 (orange): Incomplete | OPEN | Prominent | Present | Retained POC Row 5 (teal): Complete | Closing | Subsiding | Subsiding | All POC expelled Row 6 (purple): Missed | CLOSED | Brown discharge | Absent | Dead fetus retained weeks/months Row 7 (red): Septic | Open or Closed | Offensive/purulent | Fever + chills | 10% admissions; 20-30% maternal mortality Handwritten feel, clean, colorful, exam-ready, notebook style

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📝 ABORTION (Garbha Vyapada)

Ayurvediya Prasuti Tantra - Exam Notes

🔷 DEFINITION

Termination of pregnancy spontaneously or induced, before the period of viability = before 20 weeks of gestation OR birth weight < 500g Expelled embryo/fetus = ABORTUS

🔷 TYPES

A) Based on Cause:

TypeDetails
SpontaneousBeyond patient control = Miscarriage. Stages: Threatened → Inevitable → Incomplete → Complete + Missed + Septic
Induced - TherapeuticTo preserve health of mother or due to fetal disease
Induced - ElectiveMTP = Legal | Criminal = Illegal

B) Based on Period of Amenorrhoea:

|-------- 12 weeks --------|-------- 20 weeks --------|
   EARLY ABORTION                 LATE ABORTION

🔷 ETIOLOGY (7 Categories)

#CategoryCauses
1GeneticAutosomal trisomy, Polyploidy, Monosomy, Structural chromosomal rearrangement
2Endocrine/MetabolicLuteal phase defect, Deficient progesterone, Thyroid abnormalities, Diabetes mellitus
3AnatomicalCervical incompetence, Congenital malformation of uterus, Uterine fibroid, Intra-uterine adhesions
4InfectionsBacterial: Chlamydia, Brucella | Viral: Rubella, CMV, Variola, HIV | Parasite: Toxoplasma, Malaria
5ImmunologicalAnti-nuclear antibody, Lupus anticoagulant, Anti-cardiolipin antibody, Paternal HLA
6OthersABO incompatibility (husband A + wife O), Inherited thrombophilia, Smoking/alcohol/X-ray, IUCD in situ, Maternal illness
7Unexplained40-60% of cases - exact cause not diagnosed ⭐

🔷 COMPARISON TABLE - All Types ⭐⭐ (Most Important for Exam)

FeatureThreatenedInevitableIncompleteCompleteMissedSeptic
OSCLOSEDOPENOPENGradually closesCLOSEDOpen/Closed
BleedingSlight, bright redProfuse, bright redPresentSubsidingBrownish dischargeOffensive/purulent
PainMild discomfortSevere crampsProminentSubsidingABSENTFever + chills
UterusSoft, size = periodSoft, enlarged-FirmerSmaller than periodTender
Key DxSerum Prog >25ng/ml; USGUterine contractionsRetained POC on USGEmpty uterus on USGNo FHS; no growth on USGFever; offensive discharge
Reversal?YES - can reverseNONOComplete--

🔷 MANAGEMENT - Each Type

✅ THREATENED ABORTION

  1. Rest
  2. Drugs - Striptics, Phenobarbitone 30 mg for pain relief
  3. Limit activity for 2 weeks, avoid coitus
  4. Re-examine after 1 month to assess fetal growth

✅ INEVITABLE ABORTION

  1. Correct blood loss - IV fluids + BT
  2. Methergin 0.2 mg - to control bleeding (when cervix dilated + uterus < 12 wks)
  3. Before 12 wks - D&C or suction evacuation under GA/analgesia
  4. After 12 wks - Mini labour established by Oxytocin drip

✅ INCOMPLETE ABORTION

  • Before 12 wks - D&E or suction evacuation under GA/analgesia
  • After 12 wks - D&C under general anaesthesia
  • In Rh negative patient - Anti-D gamma globulin 50 mcg IM after D&C ⭐

✅ COMPLETE ABORTION

  • If uterine cavity is empty → No treatment required

✅ MISSED ABORTION

  • Correct clotting abnormalities first (fresh blood transfusion)
  • < 12 wks - Suction evacuation under sedation + paracervical block/GA (after arranging 1 unit blood)
  • > 12 wks - Vaginal prostaglandins + Syntocinon drip
    • Syntocinon: 10 units in glucose saline; add 10 units every 100 ml till pain starts; max 100 units; discontinue ≥6 hrs/day
    • Vaginal PGE₂ 20 mg 3-hourly x 4 doses OR Cerviprime 5 mg gel
    • 15-methyl PGF₂α (Carboprost) 250 mg 3-hourly IM, max 10 injections (give loperamide 2 tabs TDS to prevent diarrhoea) ⭐

🔷 BLIGHTED OVUM (Anembryonic Gestation)

  • Fertilised ovum implants → embryo does NOT develop
  • Cause of ~50% of first trimester miscarriages
  • Due to chromosomal abnormalities
  • Differs from missed abortion by absence of recognizable fetal parts

🔷 RECURRENT ABORTION

≥ 3 spontaneous abortions before 20 weeks ⭐

First Trimester Causes:

  1. Parental chromosomal abnormalities
  2. Diabetic patient
  3. Thyroid autoantibodies
  4. Luteal phase defect (low progesterone)
  5. PCOS (overproduction of LH)
  6. Active genital tract infection
  7. Immunological (ANA, Lupus, Anticardiolipin antibodies)
  8. Unexplained

🔷 SEPTIC ABORTION ⭐⭐

Any abortion where uterine contents become infected Mostly follows illegal induced / criminal abortion 10% of abortions requiring admission are septic 20-30% of maternal mortality due to septic abortion

Grading:

GradeExtent%
IInfection confined to uterus onlyMajority
IISpreads to myometrium, parametrium, tubes, ovaries, pelvic peritoneum15%
IIIGeneralised peritonitis OR endotoxic shock (via fallopian tubes or uterine/gut perforation)5%

Organisms:

  • Anaerobes: Bacteroides, Streptococci, Clostridium welchii, Tetanus bacilli
  • Aerobes: E. coli, Klebsiella, Staphylococcus, Pseudomonas, Proteus, Haemolytic streptococci

Clinical Features:

  • Temperature with chills and rigors
  • Pain abdomen + offensive/purulent discharge or vaginal bleeding
  • Febrile, tachycardia, increased RR (septicaemia features)
  • Anaemia (haemorrhage + sepsis)
  • Tenderness: lower abdomen (pelvic peritonitis) or whole abdomen with guarding/rigidity (generalised peritonitis)

Pelvic Examination:

  • Tender uterus, offensive/purulent discharge through cervix (os open or closed)
  • Products of conception felt if os open; foreign bodies may also be felt
  • Cellulitis, tender parametrium, tender adnexa, infected tubo-ovarian masses
  • Pelvic abscess: cystic/fluctuating mass in posterior/lateral fornix

Investigations:

  • Hb, TLC, DLC, ABO/Rh typing, blood urea, serum electrolytes, LFTs, coagulation profile
  • Blood + cervical swab + urine for culture and sensitivity
  • X-ray chest + abdomen (sitting + lying) - gas under diaphragm = gut perforation
  • USG - free fluid, products in uterus, collection in Pouch of Douglas

Management (9 Steps):

  1. Hospitalization
  2. Broad spectrum antibiotics: Ampicillin 500 mg IM 6-hourly + Gentamicin 80 mg IV BD + Metronidazole 500 mg IV 8-hourly
  3. Monitor pulse, BP, CVP (normal 0-5 cm H₂O), intake-output chart
  4. Urine output target: ≥ 30 ml/hour (adequate tissue perfusion) ⭐
  5. Anti-gasgangrene serum 8000 units + Anti-tetanus serum 3000 units (illegal abortion cases) ⭐
  6. Analgesics + sedatives
  7. Severe/toxic: upgrade to 3rd generation cephalosporins + IV drip
  8. Blood transfusion if severely anaemic
  9. Evacuate uterus after starting antibiotics (Grade I); use gentle curettage only - sharp curettage avoided to prevent perforation/spread ⭐

⭐ EXAM HIGH-YIELD QUICK POINTS

PointFact
Viability cutoff20 weeks / 500g
Unexplained abortion40-60%
Serum progesterone in threatened> 25 ng/ml = viable
Anti-D dose in Rh-ve incomplete abortion50 mcg IM
Blighted ovum = % of 1st trimester abortions~50%
Recurrent abortion definition≥ 3 spontaneous abortions before 20 wks
Septic abortion - maternal mortality contribution20-30%
Septic abortion - Grade III incidence~5%
Urine output target in septic30 ml/hour
Anti-gasgangrene dose8000 units
Anti-tetanus dose3000 units
Carboprost dose250 mg 3-hourly IM, max 10 injections
Syntocinon max concentration100 units
Missed abortion hypofibrinogenaemiaIf fetus retained > 3-4 weeks
These notes cover everything from your 9 images in a format ready for revision. Each section maps to a likely exam question. The comparison table and the high-yield points box at the bottom are the most exam-relevant parts to memorize.
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