Explain Abortion neet pg lvl
Reading File
Finding Sources
Finding Sources
Reading File
Reading File
Reading File
Reading File
Reading File
Reading File
Finding Sources
Reading File
Reading File
Reading File
Finding Sources
I now have comprehensive content from multiple authoritative sources. Let me compile the full NEET PG level answer.
Abortion - NEET PG Complete Notes
1. DEFINITION
| Authority | Definition |
|---|---|
| WHO / Clinical | Expulsion or extraction of an embryo/fetus weighing <500 g or before 20 weeks of gestation |
| Medical (India) | Expulsion of products of conception before 28 weeks (viability) |
| Legal (India) | Expulsion of products of conception from the uterus at any period prior to full term; law makes no distinction between abortion, miscarriage, and premature labor |
NEET trick: Medical definition uses 28 weeks; WHO/international uses 20 weeks / <500 g.
Terminology by gestational age (legal):
- Ovum - product of conception between 7-10 days
- Embryo - after 10 days until end of 9th week
- Fetus - after 9th week until birth
2. INCIDENCE
- 10-15% of clinically recognized pregnancies end in spontaneous abortion
- Using sensitive β-hCG assays, an additional ~20% of early pregnancies abort spontaneously (total ~30-40%)
- ~75% of spontaneous abortions occur before 8 weeks
- ~50% of abortions have chromosomal abnormalities (Robbins)
3. CLASSIFICATION
A. Forensic / Legal Classification
| Type | Description |
|---|---|
| Natural | Spontaneous or accidental, before 28 weeks |
| Artificial/Induced - Justifiable | MTP Act permitted termination |
| Artificial/Induced - Criminal | Unlawful termination without proper indication |
B. Clinical Types (Most Important for NEET PG)
| Type | Cervical Os | Bleeding | Tissue Passed | Key Feature |
|---|---|---|---|---|
| Threatened | Closed | Mild-moderate | None | Pain mild; viable fetus on USG; manage conservatively |
| Inevitable | Open/Dilated | Heavy | None | Severe pain; cannot be saved |
| Incomplete | Open | Continuous | Partial (placenta retained) | Most common complication = retention of placenta; needs evacuation |
| Complete | Closing | Reducing | All POC passed | USG shows empty uterus; manage conservatively |
| Missed | Closed | Brown discharge | None (retained dead fetus >4 weeks) | Uterus smaller than dates; POC converted to carneous/blood mole |
| Septic | Variable | Variable | Variable | Fever + signs of infection + any stage of abortion |
| Recurrent (Habitual) | - | - | - | 3 or more consecutive spontaneous abortions |
NEET mnemonics:
- Threatened = Closed os (the fetus is still "threatened" but not yet gone)
- Inevitable = Open os (cannot be reversed)
- Missed abortion = fetus dies, retained >4 weeks, uterus smaller than dates, brown discharge
4. ETIOLOGY OF SPONTANEOUS ABORTION
Fetal Causes (Most Common Overall)
- Chromosomal abnormalities - present in ~50% of early abortions (aneuploidy, polyploidy, translocations)
- More subtle genetic defects not detectable on routine karyotype
Maternal Causes
| Category | Examples |
|---|---|
| Endocrine | Luteal phase defect, poorly controlled diabetes, thyroid disorders |
| Uterine anomalies | Submucosal leiomyomas, polyps, uterine malformations (prevent/disrupt implantation) |
| Immunological | Antiphospholipid antibody syndrome, coagulopathies |
| Infections | Toxoplasma, Mycoplasma, Listeria, TORCH viruses, syphilis, HIV |
| Systemic disease | Hypertension, autoimmune disorders |
| Environmental | Anesthetic agents, heavy metals (lead), tobacco, X-rays |
| Other | Advanced maternal age, prior poor obstetric history |
Key fact: Ascending infections from the cervicovaginal vault are a common cause of second-trimester losses. (Robbins)
5. MECHANISM OF ABORTION
The process mirrors normal labor:
- Expulsion of whole ovum in one piece - early weeks; decidua vera + basalis separates and expels ovum entirely
- Expulsion by inversion of decidua vera/parietalis - most common typical mechanism; retroplacental clot forms, ovum pushed into uterine cavity
- Incomplete expulsion - ovum expelled but placenta and membranes retained (= incomplete abortion)
- Missed abortion - ovum detaches sufficiently to kill embryo, but retained in uterus
6. INVESTIGATIONS
- β-hCG (quantitative serum) - confirm pregnancy, monitor viability; doubling every 48h = normal
- USG (transvaginal) - gold standard for fetal viability, gestational age, retained POC, rule out ectopic
- IUP visible on TVS at β-hCG ~1500 mIU/mL (discriminatory zone)
- CBC - assess blood loss/anemia
- Blood group + Rh factor - for anti-D immunoglobulin (Rh -ve mothers)
- Urinalysis - UTI associated with increased fetal wastage
7. MANAGEMENT
| Type | Management |
|---|---|
| Threatened | Bed rest (not proven), avoid intercourse + tampons; follow-up β-hCG + USG; cannot prevent if inevitable |
| Inevitable | Uterine evacuation (D&C or medical) |
| Incomplete | Uterine evacuation - D&C or misoprostol 600 mcg PO; ergometrine for uterine contraction to expel retained placenta |
| Complete | Conservative; confirm on USG |
| Missed | Uterine evacuation; watch for DIC (especially if retained >5 weeks) |
| Septic | IV broad-spectrum antibiotics (ampicillin-sulbactam 3g IV, OR clindamycin 600mg + gentamicin 1-2 mg/kg IV) + uterine evacuation + fluid resuscitation |
8. MTP ACT, 1971 (AMENDED 2002 AND 2021)
This is a high-yield topic for NEET PG Forensic Medicine. The MTP (Amendment) Act came into force on 25 March 2021.
Indications (Section 3(2)(b)):
| Ground | Description | Gestation Limit |
|---|---|---|
| Therapeutic | Risk to life or grave injury to physical/mental health of pregnant woman | Up to 20 weeks |
| Eugenic | Substantial risk the child would be born with serious physical/mental abnormality | No upper time limit |
| Social | Failure of contraceptive device/method (anguish = grave injury to mental health) | Up to 20 weeks |
| Humanitarian | Pregnancy alleged to result from rape (anguish = grave injury to mental health) | Up to 20 weeks |
2021 Amendment key change: Upper limit extended from 20 weeks to 24 weeks for certain categories (rape survivors, minors, women with disabilities, etc.) with 2 doctors' opinion. Beyond 24 weeks only with Medical Board approval.
Who Can Perform MTP?
A Registered Medical Practitioner (RMP) who has:
- PG degree/diploma in Obstetrics & Gynecology, OR
- Assisted in 25 cases of MTP, OR
- 6 months experience as house surgeon in OBG in a recognized hospital
For MTP up to 9 weeks using medical methods only (Amendment Rules 2021):
- 3 months experience in OBG at any hospital, OR
- Independently performed 10 cases of MTP by medical methods under supervision
Gestational Limits Summary (2021 Amendment):
| Period | Requirements |
|---|---|
| Up to 20 weeks | Opinion of 1 RMP |
| 20-24 weeks | Opinion of 2 RMPs (special categories: rape survivors, minors, women with disabilities, fetal anomaly) |
| >24 weeks | State-level Medical Board approval (for substantial fetal anomaly) |
| Emergency | Single doctor, even without training, even in unrecognized hospital |
Consent:
- Adult (≥18 yrs) woman: her own consent only (husband's consent NOT required)
- Minor (<18 yrs) or mentally ill: guardian's consent required
Venue:
- Government hospital, OR
- Hospital recognized by government for this purpose
- NGOs need a license from government/district-level committee
Penalty for Illegal Abortion:
- Rigorous imprisonment not less than 2 years, may extend to 7 years
MTP Act vs IPC/BNS:
- Doctor acting under MTP Act provisions is protected from criminal liability under BNS sections on abortion, if acted in good faith with proper care and skill
9. MTP ACT vs PCPNDT ACT (High-yield Comparison)
| Feature | MTP Act | PCPNDT Act |
|---|---|---|
| Objective | Legal termination of pregnancy up to 20 weeks on therapeutic/eugenic/humanitarian/social grounds | Check female feticide; improve sex ratio |
| Underlying reason | Unwanted/unintended pregnancy | Son preference, dowry, low valuation of girls |
| Expected outcome | Reduce unsafe abortions | Improve sex ratio |
10. CRIMINAL ABORTION (Forensic)
- Unlawful termination of pregnancy without proper indication
- Methods used:
- General methods - drugs (oxytocics, quinine, castor oil), violence
- Local methods - insertion of instruments, paste, chemicals into uterus
- Signs: laceration/perforation of uterus, peritonitis, sepsis, hemorrhage
- Cause of death in criminal abortion: Hemorrhage, sepsis, air embolism, vagal inhibition (reflex cardiac arrest from instrumentation)
11. SPECIAL TOPICS
Carneous (Blood) Mole
- Formed in missed abortion when fetus dies and is retained
- Products of conception converted to an ovoid, fleshy mass due to recurrent or slow hemorrhage into chorionic spaces
- Associated with >8 weeks gestation
Recurrent (Habitual) Abortion
- 3 or more consecutive spontaneous abortions
- Investigations: karyotype (both partners), uterine anatomy (HSG, hysteroscopy), antiphospholipid antibodies, thyroid function, luteal phase assessment
- Most common identified cause: antiphospholipid syndrome (treat with low-dose aspirin + heparin)
Rh-Negative Mother
- All Rh-negative women with threatened/inevitable/incomplete/complete/missed abortion should receive Anti-D immunoglobulin (300 mcg within 72 hours)
12. QUICK NEET PG RECALL BOX
| Point | Fact |
|---|---|
| Most common cause of spontaneous abortion | Chromosomal abnormality (50%) |
| Most abortions occur before | 8 weeks (75%) |
| Threatened abortion - cervical os | Closed |
| Inevitable abortion - cervical os | Open |
| Habitual abortion = | 3 or more consecutive |
| MTP Act passed | 1971, amended 2002 & 2021 |
| MTP up to 20 weeks needs | 1 RMP opinion |
| MTP 20-24 weeks needs | 2 RMP opinions |
| MTP >24 weeks needs | Medical Board |
| Eugenic abortion time limit | No upper limit |
| Consent for adult woman | Her own (husband's NOT required) |
| Penalty for illegal abortion | 2-7 years rigorous imprisonment |
| Missed abortion mole | Carneous/blood mole |
| Septic abortion antibiotics | Ampicillin-sulbactam OR Clindamycin + Gentamicin |
| Anti-D needed in | All Rh-negative women with any type of abortion |
Sources: The Essentials of Forensic Medicine and Toxicology (36th ed., 2026) - MTP Act; Tintinalli's Emergency Medicine - clinical types/management; Robbins & Cotran Pathologic Basis of Disease - etiology/pathology; Berek & Novak's Gynecology - epidemiology/management; P.C. Dikshit Textbook of Forensic Medicine - legal aspects/classification.
This is a shared conversation. Sign in to Orris to start your own chat.