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Abortion
Last reviewed: 04.07.2025
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Abortion is the termination of pregnancy before 28 weeks. Spontaneous abortion occurs in 20-40% of pregnant women, usually in the first trimester.
Stopping bleeding in early pregnancy. Check the following:
- Is the patient in shock? There may be blood loss or fetal parts may be lodged in the cervical canal (remove them with sponge forceps).
- Could this be an ectopic pregnancy?
- Is the pain and bleeding worse than with a period?
- Are parts of the fetus visible? (Blood clots may be mistaken for them.)
- Is the cervical orifice open? The external opening of the cervical canal of a woman who has given birth many times usually allows the tip of a finger to pass through.
- Is the size of the uterus appropriate for the expected gestational age?
- Is the bleeding coming from the uterus or from a damaged cervix?
- What is the patient's blood type? If RhD negative, 250 IU of anti-O immunoglobulin should be administered.
If the symptoms are not very pronounced and the cervical canal is closed, then it is a threatened abortion. The patient needs rest, but this is probably of no help. In 75% of patients, abortion begins. If the symptoms are pronounced and the cervical canal is open, they speak of an abortion in progress or, if most of the fetal parts have already passed, of an incomplete abortion. In case of profuse bleeding, ergometrine is prescribed at a dose of 0.5 mg intramuscularly. It is necessary to remove the remaining parts of the fetus (ERPC).
Failed abortion. The fetus died but was not delivered. Usually there is bleeding, the uterus is not the same size as the gestational age (smaller). The diagnosis is confirmed by ultrasound. It is necessary to remove the remaining parts of the fetus or perform a "prostaglandin" removal (see the previous section). At less than 8 weeks, the abortion may be complete and removal of the remaining parts of the fetus may not be necessary.
It is not always easy to diagnose bleeding in early pregnancy. Ultrasound examination is informative, but pregnancy tests remain positive for several days after the death of the fetus.
Mid-trimester abortion. Causes are usually mechanical, such as cervical incompetence (rapid, painless delivery of a live fetus), uterine anomalies, chronic maternal diseases (eg, diabetes, SLE).
After an abortion.
Abortion is always a psychological trauma. Give the patients time to recover. They will want to know why it happened and whether it will happen again.
Abortions in the earliest stages of pregnancy occur due to abnormal development of the fetus; in 10% of cases - due to diseases in the mother, such as hyperthermia. Most subsequent pregnancies, although they are considered risky, end successfully. In case of three pregnancies that ended in abortions, it is necessary to seek genetic, immunological and anatomical examination (of the mother).
An incompetent cervix can be strengthened with a Shirodkar suture at 16 weeks of pregnancy. The suture is removed before delivery. The best time for a second pregnancy is the one that the parents wish.
Septic abortion. Usually a consequence of a criminal abortion, manifests itself as acute salpingitis, treatment is similar. Before curettage of the uterus, broad-spectrum antibiotics must be administered intravenously.
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