Abortion is the termination of pregnancy before fetal viability, defined as pregnancy loss before 20 weeks of gestation or when the fetal weight is less than 500 grams.
Types of Abortion
- Threatened Abortion
- Inevitable Abortion
- Incomplete Abortion
- Complete Abortion
- Missed Abortion
- Septic Abortion
- Recurrent Abortion
1. Threatened Abortion
Definition:
- Vaginal bleeding before 20 weeks without cervical dilatation.
Clinical Features:
- Mild bleeding per vagina.
- No passage of products of conception (POC).
- Cervix is closed.
- Uterus size corresponds to gestational age.
Management:
- Bed rest.
- Avoid intercourse.
- Progesterone supplementation (if luteal phase defect suspected).
- Monitor by serial ultrasound.
2. Inevitable Abortion
Definition:
- Cervical dilatation with bleeding, making pregnancy loss inevitable.
Clinical Features:
- More severe bleeding than threatened abortion.
- Painful uterine contractions.
- Cervix is open.
- No passage of POC initially, but expulsion is inevitable.
Management:
- Expectant management if early pregnancy.
- Medical evacuation (Misoprostol).
- Surgical evacuation (D&C or MVA) if bleeding persists.
3. Incomplete Abortion
Definition:
- Partial expulsion of POC, with retained tissue inside the uterus.
Clinical Features:
- Profuse vaginal bleeding.
- Painful uterine contractions.
- Cervix is open.
- Some POC visible at cervical os or on ultrasound.
Management:
- Medical: Misoprostol.
- Surgical: Manual Vacuum Aspiration (MVA) or Dilation & Curettage (D&C) if heavy bleeding.
4. Complete Abortion
Definition:
- All POC are expelled, uterus contracts, and bleeding stops.
Clinical Features:
- Minimal bleeding post-expulsion.
- Pain subsides.
- Cervix is closed.
- Ultrasound shows empty uterus.
Management:
- No active treatment needed if uterus is empty.
- Follow-up ultrasound if necessary.
5. Missed Abortion
Definition:
- Embryo or fetus dies in utero but is not expelled.
Clinical Features:
- No vaginal bleeding initially.
- Pregnancy symptoms disappear.
- No fetal heart activity on ultrasound.
Management:
- Expectant: Wait for spontaneous expulsion.
- Medical: Misoprostol.
- Surgical: D&C or MVA if prolonged retention (>4 weeks).
6. Septic Abortion
Definition:
- Infected abortion due to retained POC or unsafe abortion practices.
Clinical Features:
- Fever, foul-smelling vaginal discharge.
- Lower abdominal pain.
- Signs of sepsis (tachycardia, hypotension, shock in severe cases).
Management:
- IV antibiotics (Broad-spectrum, e.g., Ceftriaxone + Metronidazole).
- Surgical evacuation of infected retained products.
- Supportive care (IV fluids, monitoring for septic shock).
7. Recurrent Abortion
Definition:
- Three or more consecutive pregnancy losses before 20 weeks.
Causes:
- Genetic: Chromosomal abnormalities.
- Anatomical: Uterine anomalies (septate uterus, fibroids).
- Hormonal: Luteal phase defect, diabetes, hypothyroidism.
- Immunological: Antiphospholipid syndrome (APS).
- Infections: TORCH infections (Toxoplasmosis, Rubella, CMV, Herpes).
Management:
- Investigate cause (Genetic tests, hysteroscopy, endocrine evaluation).
- Correct underlying condition (Progesterone for luteal defect, Aspirin & Heparin for APS).
- Close monitoring in future pregnancies.
Investigations for Abortion
- Ultrasound: To check for viability, POC retention.
- Serum β-hCG: To assess pregnancy progression.
- Complete Blood Count (CBC): To check for anemia or infection.
- Blood Group & Rh Typing: For Rh incompatibility screening.
- Coagulation Profile (if septic abortion suspected).
Management Summary
|
Type |
Cervical Os |
Bleeding |
Fetal Viability |
Management |
|
Threatened |
Closed |
Mild |
Present |
Conservative |
|
Inevitable |
Open |
Moderate |
Not viable |
Evacuation |
|
Incomplete |
Open |
Heavy |
Not viable |
Evacuation |
|
Complete |
Closed |
Minimal |
Not viable |
Observation |
|
Missed |
Closed |
None |
Not viable |
Medical/Surgical |
|
Septic |
Open/Closed |
Variable |
Not viable |
IV Antibiotics + Evacuation |
|
Recurrent |
Variable |
Variable |
Variable |
Investigate & Treat |
Complications of Abortion
Immediate:
- Hemorrhage
- Sepsis
- Uterine perforation
- Cervical trauma
Late:
- Asherman’s syndrome (Intrauterine adhesions).
- Infertility due to repeated uterine damage.
- Psychological distress.
Prevention of Abortion
- Prenatal care & early ultrasound screening.
- Managing maternal health conditions (Diabetes, Thyroid disorders).
- Folic acid supplementation before conception.
- Genetic counseling in recurrent abortion cases.
