ABORTION

Abortion

Induced

Therapeutic Criminal Elective

Abortion

Spontaneous

20 -25% of pregnancies terminate spontaneously Usually due to embryo abnormalities May also result from infection, unfavorable intrauterine environment, cervical incompetence

Abortion

Spontaneous

Threatened Inevitable Complete Incomplete

Abortion

Threatened

Vaginal bleeding, mild or absent contractions, closed cervix

20% of women bleed in early pregnancy 50% go on to abort

Any bleeding in early pregnancy is dangerous and abnormal

Abortion

Inevitable

Vaginal bleeding Moderately severe contractions Possible amniotic sac rupture Cervix effacement and dilation Changes are irreversible

Abortion

Completed

Products of conception expelled

fetus placenta decidual lining Profuse vaginal bleeding Passage of tissue, clots Continuing mild contractions Possible hypotension

Signs, symptoms

Abortion

Incomplete

Products of conception retained Signs, symptoms

Profuse bleeding Passage of tissue/clots Severe contractions Hypotension, shock Sepsis

Abortion

Missed

Fetus dies in utero before 20th week Retained at least 2 months afterwards

Abortion

Missed

Signs/Symptoms

Continued amenorrhea History of bleeding without cramping Decrease in uterine size

Resorption of fluid Calcification of products of conception

Abortion

History

Confirmed or suspected pregnancy Abdominal pain, cramping Bleeding, passage of tissue

Abortion

Physical Exam

Orthostatic vital signs (tilt test) Examine for amount of vaginal bleeding, presence of tissue

Abortion

Management

High concentration oxygen IV or IVs with LR MAST if indicated Do NOT pack vagina Save any tissue passed Transport