Any interruption of pregnancy beyond the age of viability with or without expulsion of the product of conception.

Threatened Abortion

Clinical entity in which the process of abortion has started but has not progressed to a state from which recovery is not impossible.

Symptoms

  • Amenorrhea with sign symptoms of pregnancy.
  • Per vaginal bleeding (slight, bright red, stops spontaneously).
  • Slight or no pain.

Signs

  • Internal os closed.
  • Uterine size corresponds to the period of amenorrhea.
  • Uterus & cervix feel soft.

Investigations

  • CBC
  • Blood grouping & Rh typing
  • Urine for pregnancy test
  • USG of the uterus for pregnancy profile (well-formed gestational sac with central echoes).
  • RBS, thyroid profile

Treatment

  • Observation.
  • Rest, analgesics.
  • Empirical use of micronized progesterone.
  • Advice:
    • Avoid heavy work for 2 weeks.
    • Avoid coitus up to 12 weeks of gestation.
    • Follow up USG after 3-4 weeks.

Inevitable Abortion

Type of abortion in which the changes have progressed to a level from which continuation of pregnancy is impossible.

Symptoms

  • Amenorrhea with sign symptoms of pregnancy.
  • Excessive vaginal bleeding.
  • Colicky abdominal pain.

Signs

  • Internal os open/dilated.
  • Uterine size corresponds to the period of amenorrhea.

Investigations

  • CBC, Blood grouping & Rh typing.
  • USG of the uterus for pregnancy profile (shows the process of abortion).

Treatment

Before 12 weeks:

  • If os permits introduction of ovum forceps, then E&C (Evacuation & Curettage) under G/A or deep sedation.
  • If not, DE&C or S&E (Suction & Evacuation) or MVA.

After 12 weeks:

  • Oxytocin drip (10 units in 500 mL at 40-60 drops/min), after good contraction cervix will dilate and product will be expelled.
  • If placenta retained, evacuation by ovum forceps under G/A or deep sedation.

Complete Abortion

Products of conception are expelled completely.

Treatment

  • Nothing needed.
  • Counselling.

Incomplete Abortion

Entire products of conception are not expelled.

Treatment

Before 12 weeks - MVA
After 12 weeks - E&C

Missed Abortion

The fetus is dead before the age of viability and retained inside the uterus.

Treatment

Before 12 weeks (Medical):

  • Mifepristone orally + misoprostol sublingually (after 48 hours).
  • Intravaginal misoprostol.
  • Follow up USG -> if expulsion not complete, then curettage.

Before 12 weeks (Surgical):

  • DE&C or MVA.

After 12 weeks:

  • Mifepristone orally + misoprostol sublingually (after 48 hours) OR
  • Intravaginal misoprostol OR
  • Oxytocin drip (10 units in 500 mL at 20-30 drops/min).

After expulsion of the fetus, the placenta is evacuated by ovum forceps and curettage done.