1. Definition of Abortion
Abortion is the termination of pregnancy before 20 weeks of gestation or fetal weight <500 g.
- Spontaneous Abortion (Miscarriage): Naturally occurring pregnancy loss.
- Induced Abortion: Medical or surgical termination of pregnancy.
2. Types of Spontaneous Abortion (Miscarriage)
|
Type |
Definition |
Clinical Features |
Management |
|
Threatened Abortion |
Pregnancy at risk, but not lost |
Mild bleeding, Closed
cervix, No fetal loss |
Bed rest, Progesterone support |
|
Inevitable Abortion |
Pregnancy loss is unavoidable |
Heavy bleeding, Open
cervix, No fetal expulsion yet |
Expectant or surgical management |
|
Incomplete Abortion |
Partial fetal/placental expulsion |
Bleeding, Retained
products, Open cervix |
Evacuation (D&C,
Misoprostol) |
|
Complete Abortion |
Entire pregnancy expelled |
Bleeding stops, Closed
cervix |
No further treatment needed |
|
Missed Abortion |
Fetal death, but retained in uterus |
No fetal heartbeat, No
symptoms |
Misoprostol or Surgical D&C |
|
Septic Abortion |
Infected abortion |
Fever, Foul-smelling
discharge, Sepsis |
IV antibiotics + Uterine evacuation |
Ultrasound is the gold standard for diagnosis (Absence of fetal heartbeat confirms nonviability).
3. Causes & Risk Factors for Spontaneous Abortion
Fetal Causes (Chromosomal Abnormalities – Most Common):
- Trisomy (e.g., Down Syndrome).
- Monosomy X (Turner Syndrome).
Maternal Causes:
- Uterine Abnormalities: Fibroids, Septate Uterus, Incompetent Cervix.
- Infections: TORCH Infections (Toxoplasmosis, Rubella, CMV, HSV).
- Endocrine Disorders: Uncontrolled Diabetes, Hypothyroidism.
- Autoimmune Conditions: Antiphospholipid Syndrome, SLE.
- Lifestyle Factors: Smoking, Alcohol, High caffeine intake.
4. Management of Spontaneous Abortion
A. Expectant Management (If No Infection or Heavy Bleeding)
- Monitor for complete passage of products.
- Follow-up ultrasound to confirm complete evacuation.
B. Medical Management (If Retained Products Present)
- Misoprostol 800 mcg vaginally to induce expulsion.
- Monitor for heavy bleeding.
C. Surgical Management (If Heavy Bleeding, Infection, or Failure of Medical Treatment)
- Dilatation & Curettage (D&C) or Manual Vacuum Aspiration (MVA).
- Antibiotics if infection is suspected (Septic Abortion).
5. Induced Abortion (Medical & Surgical Termination)
- Legal termination of pregnancy before fetal viability (≤20–24 weeks, varies by country).
A. Medical Abortion (Up to 9 Weeks Gestation)
- Mifepristone (200 mg Oral) + Misoprostol (800 mcg Vaginal/Buccal after 24-48 hrs).
- Success Rate: ~95%.
- Contraindications: Ectopic pregnancy, Severe anemia, Hemorrhagic disorders.
B. Surgical Abortion
|
Method |
Gestational Age |
Procedure |
|
Manual Vacuum Aspiration
(MVA) |
Up to 12 weeks |
Gentle suction to remove pregnancy |
|
Dilatation & Evacuation
(D&E) |
12–24 weeks |
Dilate cervix, remove pregnancy with forceps |
|
Induction Abortion |
>16 weeks |
Misoprostol or Oxytocin to induce labor |
- Prophylactic Antibiotics (Doxycycline 200 mg) given to prevent infection.
6. Complications of Abortion
Immediate Risks:
- Heavy Bleeding (Hemorrhage).
- Uterine Perforation (Surgical Abortion).
- Infection (Septic Abortion).
Long-Term Risks:
- Asherman’s Syndrome (Intrauterine Adhesions).
- Future Pregnancy Complications (Preterm Birth, Infertility).
7. Post-Abortion Care & Contraception
- Monitor for signs of infection (Fever, Foul-smelling discharge).
- Psychological Support (If needed).
- Contraception Counseling:
- IUDs or Implants can be placed immediately.
- OCPs (Oral Contraceptive Pills) started after abortion.
8. Summary Table: Spontaneous & Induced Abortion
|
Feature |
Spontaneous Abortion |
Induced Abortion |
|
Definition |
Natural pregnancy loss before 20 weeks |
Intentional termination of pregnancy |
|
Most Common Cause |
Chromosomal Abnormalities |
Elective, Maternal health issues |
|
Diagnosis |
Ultrasound, Serial β-hCG |
History, Ultrasound |
|
Management |
Expectant, Medical, or Surgical |
Medical (Mifepristone + Misoprostol) or Surgical
(MVA, D&E) |
|
Complications |
Infection, Hemorrhage, Infertility |
Hemorrhage, Uterine perforation, Asherman’s Syndrome |
9. Key Takeaways
- Spontaneous abortion is most commonly due to chromosomal abnormalities.
- Medical abortion (Mifepristone + Misoprostol) is effective for early pregnancy termination.
- Septic abortion is a life-threatening emergency requiring IV antibiotics & evacuation.
- Long-term risks include Asherman’s Syndrome & future pregnancy complications.
- Post-abortion contraception is essential to prevent unintended pregnancies.
