Types of abortion:
There are two main groups and seven subgroups in abortions.
Spontaneous abortions: threatened, inevitable, incomplete,
missed, recurrent
Induced abortions: therapeutic, elective.
Legally induced abortion is a relatively safe procedure,
especially when performed during first 2 months of pregnancy.
In it the risk of death is 0.7/100,000 procedures.
This risk doubles with each 2 weeks of delay after 8 weeks
of gestation.
Threatened abortion:
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When any bloody vaginal discharge or bleeding appears
during the first half of the pregnancy the possibility of threatened abortion
can be presumed.
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In it bleeding usually begins first followed by
cramping abdominal pain a few hours to several days later.
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Threatened abortion is commonly seen in one out of four
or five women with vaginal spotting or bleeding in early pregnancy.
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Half of these women will abort.
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The unaborted women will have increased risk of
suboptimal pregnancy outcomes such as preterm delivery, low birth weight and
perinatal death.
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The risk of malformed infant does not increase usually.
Differential diagnosis:
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Patient should be carefully examined to rule out the
possibility of dilated cervix., which will make the abortion inevitable.
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To rule out ectopic pregnancy or torsion of unsuspected
ovarian cyst.
Treatment:
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Bed rest at home.
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Analgesia to relieve the pain.
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If bleeding becomes serious and persistent
reexamination and hematological evaluation should be done.
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If blood loss is more and causing anemia or hypovolemia
etc. evacuation of the pregnancy is indicated generally.
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Sometimes slight bleeding may persist for weeks. In
that case vaginal sonography, estimation of serial serum quantitative hCG
levels, serum progesterone levels in alone or in various combinations help in
ascertaining a live intrauterine pregnancy.
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Rh-ve pregnancy with a threatened abortion should
receive anti-D immunoglobulin. Because more than 10% of such women have
significant fetomaternal hemorrhage.