1. Definition of Abortion
Abortion is the termination of pregnancy before 20 weeks of gestation or fetal weight <500 g.
- Missed Abortion: Fetal death without expulsion.
- Incomplete Abortion: Partial expulsion of products of conception.
- Septic Abortion: Infection of retained pregnancy tissue.
2. Missed Abortion (Silent Miscarriage)
Definition:
A missed abortion occurs when the fetus dies but remains retained in the uterus without symptoms of expulsion.
Causes:
- Chromosomal abnormalities (Most Common).
- Maternal factors: Antiphospholipid Syndrome (APS), Diabetes, Thyroid Disorders.
Clinical Features:
- Asymptomatic or mild spotting.
- No fetal heart activity on ultrasound.
- Closed cervix.
Diagnosis:
- Ultrasound: No fetal heartbeat, No fetal growth.
- β-hCG levels: No normal doubling pattern.
Management:
- Expectant (If <10 weeks): Wait for spontaneous expulsion.
- Medical: Misoprostol 800 mcg vaginally to induce expulsion.
- Surgical: D&C (Dilatation & Curettage) if incomplete expulsion or excessive bleeding.
Monitor for Infection & Heavy Bleeding.
3. Incomplete Abortion
Definition:
Partial expulsion of the fetus & placenta, with retained products in the uterus.
Causes:
- Chromosomal abnormalities.
- Uterine abnormalities (Fibroids, Septate Uterus).
Clinical Features:
- Heavy vaginal bleeding.
- Lower abdominal pain.
- Open cervix with retained products.
Diagnosis:
- ltrasound: Retained pregnancy tissue.
- β-hCG Levels: Declining but not fully normalized.
Management:
- Medical: Misoprostol 600 mcg orally or 800 mcg vaginally.
- Surgical: D&C or Manual Vacuum Aspiration (MVA) if bleeding persists.
Monitor for signs of infection.
4. Septic Abortion (Infected Miscarriage – Medical Emergency)
Definition:
Septic abortion is infection of retained pregnancy tissue leading to severe maternal illness.
Causes & Risk Factors:
- Unsafe abortion (Unsterile instruments, Self-induced abortion).
- Retained products of conception.
- Ascending genital infections (Chlamydia, Gonorrhea, E. coli).
Clinical Features:
- Fever >38°C, Chills.
- Foul-smelling vaginal discharge.
- Pelvic pain, Uterine tenderness.
- Signs of sepsis (Hypotension, Tachycardia).
Diagnosis:
- CBC: Leukocytosis, Elevated WBC count.
- Blood Culture: If sepsis suspected.
- Ultrasound: Retained infected products.
Management:
- Immediate IV Antibiotics (Clindamycin + Gentamicin).
- Surgical Evacuation (D&C or MVA).
- IV Fluids, Blood transfusion (If needed).
Complications:
- Septic shock, DIC (Disseminated Intravascular Coagulation), Multi-organ failure.
5. Summary Table: Missed, Incomplete & Septic Abortion
|
Type |
Key Features |
Management |
|
Missed Abortion |
Fetal death, No expulsion, No symptoms |
Misoprostol or D&C |
|
Incomplete Abortion |
Heavy bleeding, Open cervix, Retained products |
Misoprostol, D&C |
|
Septic Abortion |
Fever, Foul-smelling discharge, Sepsis signs |
IV Antibiotics + D&C |
6. Key Takeaways
- Missed abortion = Retained dead fetus, needs medical or surgical evacuation.
- Incomplete abortion = Partial fetal expulsion, requires Misoprostol or D&C.
- Septic abortion = Infection due to retained tissue, requires IV antibiotics & urgent evacuation.
- Unsafe abortion is a major cause of maternal mortality worldwide.
