Abortion

A. Fai, R. Chowdhury
Abortion

Expulsion of products
of conception from
uterus before 20
weeks of gestation or
if fetal weight < 500g
Types of abortion
< 12 w – early abortion (legally induced)

Spontaneous (miscarriage) >12 w – late abortion (medical reasons only

Induced/therapeutic >20 weeks - stillbirth

 Spontaneous abortions
Up to 60% of abortions
are spontaneous
A majority of those go unnoticed
(happening in the first 2-4 weeks

15% of the recognized pregnancies end

in spontaneous abortion

30 % are lost between implantation and

the 6th week

70 % of first trimester losses are due

to chromsomal abnormalities
 Etiology

Maternal factors Fetal factors

Infections Chromosomal abnormalities
Trauma Anembrionic pregnancy
Endocrine Faulty implantation
Progesterone def, DM, Endometrial rejection
hyperthyroidism
Drugs Placental factors
Maternal anoxia/malnutrition Placenta previa
Uterine defects Placental abruption
 Induced abortion

Clinical Spontaneous abortion

classification Septic abortion

Habitual abortion
Induced abortion
Intentional medical or surgical termination of pregnancy

Elective Therapeutic

Interruption of pregnancy Termination before fetal

before fetal viability at te viability to safe-guard the
request of the patient mother’s health

• NOT due to maternal

illness/RF Indications
• Can be performed only
<12 wks • Continuation = threat to
mother life
• Rape/incest
• Severe physical
deformities/mental
retardation
 Surgical vs medical abortion
Dilation +
curettage
Used primarly in 1 trimester abortion
st
Progressive dilation of cervix, followed
by curettage of the fetus and scrape of
the linings of the uterus
Surgical*
Suction
aspiration
Most common 1st trimester
Dilation after paralization of cervical muscle
tissue, followed by introduction of suction
catheter with knife tip in uterus. Fetus and
following “reassembling” to ensure nothing is
placenta are cut and suctioned
Dilation +
evacuation
2nd + 3rd trimester abortion
Cervical dilation with dismemberment of the
fetus and removal piece by piece, with
left behind
PGs are given to induce contractions and
deliver the fetus
 Surgical vs medical abortion
Medical
Pros Cons Medications

Non invasive Effectiveness drops after the 7th week • Antiprogestin – mifepristone
No anesthesia required Frequent follow ups • Antimetabolite – methotrexate
Oral/IV administration Possibility of more prolonged bleeding • Prostaglandins - misoprostol
Visual effect
Spontaneous abortion

Threatened abortion
Vaginal bleeding or bloody vaginal discharge in the
first half of pregnancy
Occours in ¼ of pregnancies
• 50% stop bleeding → normal pregnancy follows
• 50% progress to inevitable abortion
Clinic
Vaginal bleeding (pain or painless)
Closed cervix
US – viable IUP with HR
Tx – bed rest, spasmolytics, progesterone, magnesium
Inevitable abortion
Stage in spontaneous abortion in which its
not possible for pregnancy to continue

Clinic
Excessive vaginal bleeding with clotting
Colicky pain in suprapubic region, radiating to
the back

No POC passage, cervix is dilated

Intact gestational sac on US
Incomplete vs
complete abortion
Incomplete – retention of some POC inside the uterus .
It may be whole or part of placenta

Clinic
Continuous vaginal bleeding, passage of POC with
intrauterine residue, open cervical OS.
US – retained contents

Complete– All POC have been expelled from uterus

Clinic
Slight bleeding, cessation of pain, cervical closure.
US – empty cavity
 A retention of POC for > 4 weeks

Missed
Usually painless,
No bleeding,
Closed cervical OS,

abortion Regression of pregnancy

symptoms,
Absent fetal movements

US: collapsed gestational sac,

absent cardiac activity
If retained for long enough, the
gestation may end up as

Carneous mole – Lobulated mass of

blood clots, fetal membranes+ placenta

Macerated fetus – collapse of skull

bones and flexion of spine, degeneration
of internal organs, easily peelable skin.
US – little/no amniotic fluid

Treatment – in the majority of cases it’s

expelled spontaneously
If not within 4 wks or bleeding – Evacuation

Uterine size < 12 wks gestation –

suction/vaginal evacuation
Uterine size > 12 wks gestation –
PGs, oxytocin, combo
Septic abortion
Serious complication of abortion, often
associated with criminal abortion.
Occurs due to pathogenic organisms of bowel and vaginal flora

Clinic
Intoxicated, pyretic patient
Tachycardia, malaise, arthralgia, myalgia
Jaundice + Hematuria → Hemolysis
Suprapubic pain, abdominal rigidity
POC may be palpated

Treatment
Rest
Antibiotic, fluid threapy
Oxytocin infusion – for bleeding control
Surgical evacuation of uterus – at least 6 hours after IV infusion
Hysterectomy – last option
Habitual abortion
Recurrent abortions/ miscarriages – defined as 3 or more consecutive pregnancy losses

Etiology
Genetic factors
Endocrine factors
Anatomic causes
Infections
Immunological problems
Thank you for your attention

-Socrates