Obstetrics and Gynecology/Abortion

< Obstetrics and Gynecology

The term abortion is used by the lay person to refer to an elective termination of pregnancy. Medical staff working in the field of obstetrics use this term to describe miscarriage before 24 weeks gestation and is also referred to as spontaneous abortion. There are different types of spontaneous abortion and the importance of diagnosis cannot be underestimated as each is managed in a different way. The physician dealing with a woman who has presented with spontaneous abortion must choose his/her words carefully when discussing the diagnosis with the patient. This is already a very stressful time for such patients and the term "abortion" used inappropriately may cause this stress and anxiety to be unduly exasperated. Therefore, the term "miscarriage" will be used in place of the word "abortion" for the rest of this article.

The risk Factors for spontaneous Abortion are:


Threatened Miscarriage


Threatened miscarriage is defined as vaginal bleeding before 20 weeks gestation in the presence of a viable fetus. One in five pregnancies will present in this manner and these pregnancies are 2.6 times more likely to result in complete miscarriage.

Clinical Features

History:

Examination:

Investigation:

Management

Unfortunately, there is no medical treatment indicated. Management involves bed rest if bleeding recurs and anti-D if indicated. Prognosis can be assessed with further ultrasound scans.


Inevitable Miscarriage

In inevitable miscarriage, the cervix has begun to open and some products of conception have passed, therefore, the pregnancy cannot be saved and miscarriage is inevitable.

Clinical Features

History:

Examination:


Management

Medical

Surgical


Complete Miscarriage

This is defined as the return to normal uterine size after the passage of all products of conception and normally occurs before 8 weeks gestation.

Incomplete Miscarriage

This is most common between 8 and 14 weeks gestation. All the products of conception have not been passed and the patient requires evacuation of the retained products of conception.


Clinical Features

History:

Examination:


Management

Medical

Surgical Abortion

Missed Miscarriage

A missed (or silent) miscarriage is the spontaneous abortion of a pregnancy in the absence of vaginal bleeding. In essence, the fetus is dead in utero.

Clinical Features

History:

Examination

Investigations

Management

Evacuate uterus

Septic Miscarriage

This is a uterine infection of the retained non-viable products of conception following an incomplete miscarriage. An attempt at an illegal termination of pregnancy (back-street abortion) should be suspected.

Clinical Features

History

Examination

Investigations

Management

IV antibiotics, fluids and curretage.


Patient help

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References

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