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Treatment of induced abortion
Last reviewed: 08.07.2025
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When an abortion has begun, cramping pains and bloody discharge are more pronounced than with a threatened one. The fertilized egg is separated in a small area, so the size of the uterus corresponds to the gestational age. The cervix is preserved, its canal is closed or slightly open. With isthmic-cervical insufficiency, the cervical canal is somewhat widened, so the pain is less pronounced or absent. Leakage of amniotic fluid is possible.
Differential diagnosis is carried out with threatened abortion, incomplete abortion, isthmic-cervical insufficiency. In case of abortion, the treatment is basically the same as in case of threatened abortion. In case of bloody discharge in a larger volume than in case of threatened miscarriage, differential diagnosis is carried out:
- bleeding from the second horn of the uterus is possible in case of developmental defects;
- menstrual-like bleeding may occur on the days of expected menstruation;
- the death of one embryo from twins and natural elimination of the dead embryo is possible;
- chorionic detachment with formation of retrochorial hematoma or detachment along the edge of the chorion/placenta;
- chorion previa/placenta previa.
In any of these situations, the tactics will be determined by the general condition of the pregnant woman, the presence of a living embryo and the extent of detachment and bleeding. It is necessary to urgently determine the blood type, Rh factor, do a general blood test, hemostasiogram and ultrasound. If the patient's condition is compensated, after the ultrasound and determination of the presence of a living embryo and the extent of detachment and its nature (retrochorial or along the edge without hematoma formation), carefully conduct an examination in mirrors, remove blood clots, examine the cervix. It is inappropriate to do a vaginal examination, since there is ultrasound data, and it is necessary to remove blood from the vagina to assess the amount of blood loss and due to the fact that there may be an infection, since blood is a good nutrient medium for microorganisms.
To stop bleeding, the drug transamin (tranexamic acid, transamcha) gives good results, which promotes the "sticking" of the chorion or placenta and does not affect the hemostasiogram. It is advisable to administer transamin intravenously, drip 5.0 ml in 200.0 ml of physiological solution 1-2 times a day, or intramuscularly 2.0 ml 2-3 times a day. After stopping the bleeding, continue taking it in tablet form for another 4-5 days.
It is advisable to prescribe the drug Dicynone (Etamsylate) 2.0 ml intramuscularly 2-3 times a day, then in tablets 250 mg 3 times a day until the bleeding stops completely. In the absence of transamine, fresh frozen plasma can be administered. Along with hemostatic agents, antispasmodics, Magne-V6, and antianemic agents are prescribed. After the bleeding has stopped, Wobenzym is prescribed for faster resorption of the hematoma, 3 tablets 3 times a day 40 minutes before meals until the hematoma is completely resorbed. If amniotic fluid is leaking, it is inadvisable to continue the pregnancy. Instrumental emptying of the uterus is performed (vacuum excochleation, curettage).