2. Definition
An abortion is the premature expulsion of products of
conception from the uterus. Vaginal bleeding during early
pregnancy (up to 24 weeks of gestation) can be due to
various types of abortions, ectopic pregnancy or the
presence of a hydatidiform mole (molar pregnancy).
4. Etiology
More the 80% of abortion occur in first 12 weeks and the
rate decreases rapidly thereafter. various maternal and fetal
factors have been implemented.
• Fetal factors
• Maternal factor
• Endocrine disorder
• Drug used and environmental factors
• Autoimmune disorder
• Uterine defects
5. Common cause
First trimester:-
• Genetic factor.
• Hormonal deficiency
• Trauma
• Acute infection.
Mid trimester:-
• Cervical incompetence
• Uterine malformation such as bicornuate septate or double uterus.
• Uterine fibroid
• low implantation of placenta
• Twins and hydramnios
6. Spontaneous abortion
I. Threatened abortion
Women have threat to abort as the process of abortion has
started but still the chances of recovery are there are
appropriate measures. Refers to a stage in the abortion that
suggests potential miscarriage may take place.
Process of abortion stared
(Pain following bleeding)
Recovery possible
(As internal OS is closed)
7. Symptoms
• Light bleeding
• Cramping/lower abdominal pain
• Closed cervix
• Uterus softer than normal
• The size of the uterus corresponds to the gestational period
Management of threatened abortion:-
• Medical treatment is usually not required.
• Advise the woman to avoid strenuous activity and sexual intercourse;
complete bed rest is, however, not necessary.
• If the bleeding stops, follow up in an antenatal clinic. Reassess if the
bleeding recurs
8. II. Inevitable abortion
Inevitable abortion is signaled by gross rupture of membranes in the
presence of cervical dilatation, under these condition abortion is
almost certain. In most of the cases after rupture of membranes
uterine contraction develops promptly result in expulsion of
pregnancy or infection develops.
Sign and symptoms
• Heavy bleeding, Dilated cervix
• Cramping/lower abdominal pain
• No expulsion of the products of
conception
• The size of the uterus corresponds
to the gestational period
9. Management
If the pregnancy is less
than 12 weeks
• Plan for evacuation of the
contents of the uterus
• Give Misoprostol 400
mcg (2 tablets of 200 mcg
each) orally. Repeat once
after 4 hours, if necessary.
• Arrange for evacuation as
soon as possible.
If the pregnancy is more than 12
weeks
• Await spontaneous expulsion of the
products of conception and then
evacuate the uterus to remove any
retained products of conception.
• If necessary, augment uterine
contractions by giving Oxytocin 20 U
in 500 ml of R/L @ 40 drops/minute;
• Administer Tab. Misoprostol, 800
mcg (4 tablets of 200 mcg each),
intravaginally. Give 2 tablets (400
mcg) again after 4 hours if the woman
has not aborted till then.
10. III. Complete abortion
When whole of products of conception are expelled in masses.
the patient present with history of passing a fleshy mass per
vagina followed by subsidence of abdominal pain and decreased
vaginal bleeding.
Sign and symptoms:-
• Light bleeding, Closed cervix
• Light cramping/abdominal pain
• History of expulsion of the
products of conception
• The size of the uterus is smaller
than that expected for the
gestational period
• Uterus softer than normal
11. Management
• Evacuation of the uterus is usually not necessary as all the
products of conception have been expelled.
• Observe for heavy bleeding.
• Ensure post-abortion follow up of the woman after
treatment
• Check for any retained products of conception and/or
bleeding
• No further management is required if the condition of the
woman is stable.
12. IV. Incomplete abortion
When the entire product of conception are
not expelled instead a part of it is retained
inside the uterine cavity.
Sign and symptoms:-
• Heavy bleeding
• Cramping/lower abdominal pain
• Dilated cervix
• History of partial expulsion of the products of conception
• The size of the uterus is smaller than that expected for the
gestational period
13. Management
• If the bleeding is light to moderate and the pregnancy is less
than 12 weeks, use your fingers or sponge forceps to remove
the products of conception protruding through the dilated
cervix.
• If the bleeding is heavy and the pregnancy is less than 12
weeks, evacuate the uterus.
• Manual vacuum aspiration (MVA) is the preferred method
of evacuation. Do not carry out evacuation by sharp
curettage.
• If evacuation is not immediately possible, give Tab.
Misoprostol 400 mcg orally (repeated once after 4 hours, if
necessary)
14. CONT...
If the pregnancy is more than 12 weeks:
• Start an Oxytocin drip, i.e. 20 U of Oxytocin in 500 ml of R/L
@ 40 drops/minute until the products of conception are
expelled.
• If necessary, give Tab. Misoprostol 200 mcg vaginally every 4
hours until the products of conception are expelled; do not
administer more than a total of 800 mcg.
• Evacuate any remaining products of conception from the
• IV fluids: RL, NS
• Blood grouping & Cross matching → BT if indicated
• Evacuation
• Antibiotics: ampicillin, metronidazole
• Analgesics
15. V. Missed abortion
Missed abortion is defined as retention
of dead products of conception in utero
for several weeks usually more than 4
weeks. A missed abortion or a silent
miscarriage, occurs when a fetus dies,
but the body does not recognize the
pregnancy loss or expel the pregnancy
tissue. As a result, the placenta may
still continue to release hormones, so
the woman may continue to experience
signs of pregnancy
16. Sign and symptoms
• Uterus is smaller in size then period of amenorrhoea
• cervix feel firm
• OS is closed
• On Doppler cardio scope fetal heart motion is not seen
• Immunological test for pregnancy become negative.
• On USG empty gestational sac with absent fetal heart motion.
17. Management
• If a missed miscarriage has occurred early in pregnancy, a
woman will usually be able to expel the pregnancy tissue
naturally.
• if the fetal tissue remains in the body for a longer time, a
D&C or Manual vacuum aspiration (MVA) procedure is
usually recommended.
• In this procedure, the cervix is opened and the contents of
pregnancy are removed. This can cut down on infections,
which may occur if the fetal tissue remains in the body.
18. IV. Septic abortion
Septic abortion is defined as abortion complicated by
infection. Sepsis may result from infection if the organisms
ascend from the lower genital tract following either a
spontaneous or an unsafe abortion. Sepsis is more likely to
occur if there are retained products of conception and
evacuation has been delayed. Sepsis is a frequent
complication of unsafe abortion involving instrumentation.
19. Signs and Symptoms
• Abdominal pain
• Fever
• Vaginal discharge (foul smelling) Sick looking, febrile or
jaundiced
• Tender uterus
• Offensive vaginal discharge or bleeding
• Cervix is usually soft and may be dilated
20. Management
• IV fluids: RL, NS
• Insert urethral catheter
• Monitor Input/output
• Blood grouping & Cross matching
• Antibiotics:
• Preferably cephalosporins, if not available ampicilin
and metronidazole
• Evacuation
21. Induced abortion
It Is defined as a process by which the pregnancy is deliberately
terminated before fetal viability.
Legal illegal
Medical termination
of pregnancy (MTP)
