Complete and Incomplete Abortion
Definition: is when all the contents are expelled. It is called complete abortion.
Clinical features: There is history of expulsion of a fleshy mass per vaginam followed by:
- Subsidence of abdominal pain.
- Vaginal bleeding becomes trace or absent.
- Internal examination reveals: (a) uterus is smaller than the period of amenorrhoea and a little firmer. (b) Cervical os is closed. (c) Bleeding is trace.
- Examination of the expelled fleshy mass is found intact.
- There is no treatment other than rest is usually needed. All of the tissues that came out should be saved for examination by a doctor to make sure that the abortion is complete. The laboratory examination of the saved tissue may determine the cause of abortion.
- The effect of blood loss, if any, should be assessed and treated. If there is doubt about complete expulsion of the products, uterine curettage should be done.
- Rh- negative women: should be protected by anti-D gamma globulin-50 microgram or 100 microgram intramuscularly in cases of early abortion or late abortion respectively with in 72 hours. However, anti-D may not be required in a case with complete miscarriage before 12 weeks gestation where no instrumentation has been done.
Definition: when the entire products of conception are not expelled, instead a part of it is left inside the uterine cavity, it is called incomplete abortion.
Is name given to abortion where the uterus retains part or the entire placenta. Bleeding may occur because part of the placenta may adhere to the uterine wall and the uterus does not contract to seal the large blood vessels that feed the placenta.
History of expulsion of a fleshy mass per vaginam followed by:
(1) Continuation of pain in lower abdomen, colicky in nature, although in diminished magnitude.
(2) Persistence of vaginal bleeding of varying magnitude.
(3) Internal examination reveals- (a) uterus smaller than the period of amenorrhoea. (b) patulous cervical os often admitting the tip of the finger and (c) varying amount of bleeding.
(4) on examination the expelled mass is found incomplete.
The products left behind may lead to – (1) profuse bleeding (2) Sepsis (3) placental polyp and (4) rarely choriocarcinoma.
In recent cases – the same principles are followed as that of inevitable abortion. It is emphasized, that the patient may be in a state of shock due to blood loss. She should be resuscitated before any active treatment is undertaken.
- Early abortion: dilatation and evacuation under general anaesthesia is to be done.
- Late abortion: the uterus is explored under general anaesthesia by finger and the products left behind is either removed by ovum forceps or by blunt curette. Dilatation and curettage operation is to be done to remove the bits of tissues left behind. The removed materials are subjected to a histological examination.