Abortion

Overview

Abortion is the termination of pregnancy before fetal viability (typically < 20–24 weeks gestation, depending on jurisdiction). It may be:

• Spontaneous abortion (miscarriage): Natural pregnancy loss.

• Induced abortion: Deliberate medical or surgical termination.

• Types of spontaneous abortion: threatened, inevitable, incomplete, complete, missed, septic.

Symptoms often include vaginal bleeding, abdominal pain, passage of tissue, or absence of fetal heart activity.

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Treatment Options

1. Threatened Abortion

• Supportive care only (if cervix closed and fetus viable).

• Rest, reassurance, avoid heavy exertion.

• Progesterone supplementation may be considered in recurrent miscarriage:

  • Micronized progesterone: 200–400 mg vaginally daily.

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2. Incomplete Abortion

• Medical evacuation:

  • Misoprostol: 600–800 mcg PO or vaginally as a single dose.

• Surgical evacuation:

  • Manual vacuum aspiration (MVA) or dilation and curettage (D&C) if bleeding persists.

• Supportive: IV fluids, analgesia, monitor for anemia.

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3. Missed Abortion

• Expectant management: spontaneous expulsion in weeks.

• Medical management:

  • Mifepristone 200 mg PO single dose, followed by misoprostol 800 mcg vaginally/PO after 24–48 hours.

• Surgical evacuation if retained tissue or heavy bleeding.

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4. Septic Abortion (Emergency)

• Hospitalization and stabilization (IV fluids, oxygen, monitoring).

• Broad-spectrum antibiotics:

  • Ampicillin 2 g IV q6h + gentamicin 5 mg/kg IV daily ± metronidazole 500 mg IV q8h.

• Surgical evacuation after antibiotics started.

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5. Induced Abortion (Elective Termination)

• Medical abortion (up to 9–10 weeks gestation):

  • Mifepristone 200 mg PO once, then misoprostol 800 mcg vaginally/buccally 24–48h later.

• Surgical abortion:

  • Vacuum aspiration (≤14 weeks).

  • Dilation and evacuation (D&E) (>14 weeks).

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Supportive & Monitoring Measures

• Analgesics: ibuprofen 400 mg PO q8h PRN or paracetamol 500–1000 mg q6h.

• Rh immunoglobulin (Rho(D) Ig 50–300 mcg IM) for Rh-negative women to prevent alloimmunization.

• Iron supplementation (ferrous sulfate 325 mg PO TID) for blood loss.

• Counseling and psychological support.

• Contraceptive counseling post-abortion (IUD, OCPs, implant, injection).

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Key Notes

• Always rule out ectopic pregnancy when managing early pregnancy bleeding.

• Spontaneous abortion is common (10–20% of pregnancies).

• Septic abortion is life-threatening and requires immediate antibiotics and evacuation.

• Legal regulations for induced abortion vary by country; always follow local guidelines.