Abortion

Abortion and Its Treatment 

Abortion is the separation of products of conception from the uterus prior to the potential for fetal 

survival outside the uterus.

A potential viable fetus is generally considered to weigh at least 500 grams and or have a gestational age of greater than 20 weeks.

Spontaneous Abortion

This refers to expulsion of all or part of the products of conception from the uterus prior to the 20^th completed week of gestation.

Incomplete abortion tends to occur more often after 10^th gestational week, when the placenta and the fetus tend to be expelled separately.

Induced Abortion

Refers to the evacuation of uterine contents / products of conception by either medical or surgical methodology.

Missed Abortion

Occurs with the retention of embryonic or fetal parts for eight weeks or more following the embryonic or fetal demise.

System Effected

Reproductive

Genetics

Fetal chromosomal abnormalities greatly increases the incidence of spontaneous abortion.

Predominant Age

Young less than 15 years and over 35 years of age. Incident of inducted abortion tends to decrease with age.

Predominant Sex

Female only

Signs and Symptoms

1. There are several signs
2. Vaginal bleeding
3. Uterine cramping
4. Cervical dilation
5. Ruptured membranes
6. Passage of non-viable products of conception
7. Fever
8. Shock
9. Soft, sun involuted uterus

Causes

1. The most cause of most spontaneous abortions is unknown
2. Defective germ plasm
3. Improper implantation of fertilized ovum
4. Trauma
5. Poisons (Drugs)
6. Defective spermatozoa

Risk Factor

1. Fetal chromosomal abnormalities
2. Uterine Abnormalities
3. Maternal alcohol ingestion
4. Infection with certain viruses or bacteria

Diagnosis

Ectopic Pregnancy

A potential life –threatening complication, difficult to distinguish from threatened abortion. Ultrasound can quickly distinguish ectopic Vs. intra-uterine pregnancy

Cervical polys, neoplasias , can cause vaginal bleeding.

Hydatidiform mole pregnancy usually ends in abortion prior to the 20^th weeks of Pregnancy.

Treatment

Explore all causes of first trimester vaginal bleeding

Serial quantitative BHCG determination

Bed Rest and insert nothing per vagina.

If Bleeding is severe hospitalization and close observation are advisable.

Medications

Betareceptor agonists

Progesterone if deficiency is confirmed

Analgesics if needed

Rh negative mother – Give Rho D immune globulin

Precautions

Do not give methylergonovien IV.