Spontaneous Abortion

Characteristic features

• Intrauterine pregnancy at less than 20 weeks
• Low or falling levels of HCG.
• Bleeding, midline cramping pain Open cervical os.
• Complete or partial expulsion of products of conception.

Management

• Look for foreign bodies or vaginal wound consistent with induced abortion; remove foreign bodies, clean the wound; update tetanus immunization.
• Treat pain: Tab- Panadol (paracetamol) or antispasmodics, 1 tab PO x SOS.
• Inj- RhoGAM (Rho (D) immune globulin) is given to Rh (-ive) mothers to avoid sensitization to Rh (+ ive ) fetal blood.

Depending on the stage of pregnancy

• Before 10 weeks of pregnancy: abortion is likely to be complete. Monitor, only intervene in the event of heavy bleeding (aspiration).
• Between 10 and 12/14 weeks of pregnancy: uterine evacuation is often necessary. Instrumental method: manual vacuum aspiration is the method of choice (easier to perform, less traumatic and less painful than curettage).

Medical method

The use of misoprostol as a single dose (400 micrograms sublingually or 600 micrograms PO) may avoid instrumental procedure. There is, however, a risk of failure that increases as the pregnancy progresses. Treatment success (that i, an empty uterus) must be verified in the days after the drug is taken. If the medical method fails, the use of an instrumental method is unavoidable.

• After 12/14 weeks of pregnancy: labor should be allowed to progress, do not rupture the membranes. The placenta is usually evacuated with the fetus. If evacuation is incomplete or in the event of hemorrhage, perform manual removal immediately after the expulsion, before the uterus retracts or the cervix closes. If manual removal is delayed, curettage must be performed which carries a high risk of uterine perforation.
• In the event of post - abortion infection (pelvic pain, uterine tenderness, foul - smelling vaginal discharge): treat with antibiotics.