Abortion

Interruption of pregnancy or expulsion of the product of conception before the fetus is viable is called abortion. The fetus is generally considered to be viable anytime after the fifth to six month gestation.

Spontaneous Abortion
An abortion that occurs naturally without any medical intervention when there is a physical problem with a pregnancy is called a spontaneous abortion or a miscarriage. Most of these occur because an abnormality in the fetus makes survival impossible. Types of spontaneous Abortion Threatened A threatened miscarriage is a condition that suggests a miscarriage might take place before the 20th week of pregnancy.

Causes
Some pregnant women have some vaginal bleeding, with or without abdominal cramps, during the first three months of pregnancy. When the symptoms indicate a miscarriage is possible, the condition is called a "threatened abortion." (This refers to a naturally occurring event, not medical abortions or surgical abortions.) Miscarriage occurs in about half of pregnancies with first trimester bleeding. Symptoms of a threatened miscarriage include:
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Abdominal cramps with or without vaginal bleeding Vaginal bleeding during the first 20 weeks of pregnancy (last menstrual period was less than 20 weeks ago)

Note: During an actual miscarriage, low back pain or abdominal pain (dull to sharp, constant to intermittent) typically occurs, and tissue or clot-like material may pass from the vagina.

Exams and Tests

Abdominal or vaginal ultrasound may be done to check the baby's development, heart beat, and amount of bleeding. A pelvic exam will be done to check the cervix. The following blood tests may be performed:

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Beta HCG (quantitative) test over a period of days or weeks to confirm whether the pregnancy is continuing Complete blood count (CBC) to determine amount of blood loss Pregnancy test to confirm pregnancy Progesterone level White blood count (WBC) with differential to rule out infection

Treatment
Bed rest and conservative treatment, the abortion may be prevented. Inevitable abortion
Means the process of expulsion of products of conception has become irreversible. The expulsion of products of conception has not occurred but it is bound to happen and nothing can be done to stop this process.

 Amenorrhoea  Bleeding per vagina,  Pain:Pain is a characteristic feature of inevitable abortion. It is characterized by lower abdominal  
cramps(due to painful uterine contractions). The intensity of pain depends upon the duration of pregnancy and parity of the patient. Size of the uterus:In an inevitable abortion,as all the products of conception are still in the uterine cavity, the size of the uterus corresponds to the duration of the gestation. Dilatation of Cervix :This is a pathogenic sign of inevitable abortion. Once the internal Os of the Cervix starts dilating, it means that the abortion is inevitable The sac of membranes or the foetus may be felt through the dilated cervix.

GENERAL TREATMENT

If the blood loss is not heavy, and the patient is in the satisfactory state, she does not need any treatment other than evacuation of the uterus. In case of excessive bleeding and shock, the following treatment should be instituted: 1. Raise foot end of the bed and keep the patient warm. 2. Oxygen inhalation may be given. 3. Intramuscular or intravenous injection of Pethidine 100 mg, or Diazepam 10 mg should be given. 4. A blood sample should be collected and sent for hemoglobin,grouping and cross matching. 5. Intravenous drip should be started with 5% dextrose in water or 5% dextrose in saline.Blood transfusion should be as soon as cross matched blood is available. 6. If the bleeding is continuous and heavy, an intravenous injection of Oxytocin 5-10 units or Ergometrine 0.5mg should be given. 5-10 units of Oxytocin may be added to the intravenous drip.

EVACUATION OF THE UTERUS : Arrangements should be made to evacuate the uterus as soon as possible.The method of evacuation depends upon the duration of pregnancy.

Incomplete abortion
Termination of pregnancy in which the products of conception are not entirely expelled or removed. It often causes hemorrhage that may require surgical evacuation by curettage, oxytocics, and blood replacement. Infection is also a frequent complication of incomplete abortion.

Complete abortion
Termination of pregnancy in which the conceptus is expelled or removed in its entirety. Because no products of conception remain in the uterus, surgical evacuation is not necessary.

Habitual abortion
Habitual or recurrent abortion is defined as a successive, repeated, spontaneous abortions of unknown cause. Symptoms of Habitual Abortion Pains of the same character as labour pajns and bleeding are the two main symptoms of possible abortion. Bleeding may lead to the detachment of the ovum from the uterus. It now acts as a foreign body in the uterus which stimulates uterine contraction. This generates a lot of pain and the foetus is thrown out of the body. In later weeks when the foetus is well developed, if it dies in the uterus, it leads to maceration of the body. The abdomen is filled with blood and the skin color appears red. Sometime after a few more days, the foetus gets dehydrated and the fluid surrounding the foetus gets dried' away. Cause There are various causes for habitual abortions, and some are treatable. Some couples never have a cause identified, often after extensive investigations.

Management  If bleeding occurs in a patient with a history of habitual abortion, conservatives measures such as bed rest and administration of progesterone to support the endometrium, are attempted to save pregnancy.  Supportive counseling is crucial in this stressful condition.  Bed rest, sexual abstinence, a light diet, and no straining on defecation may be recommended to prevent spontaneous abortion.  If infection is suspected, antibiotics may be prescribed.