Threatened abortion

Threatened abortion

threatenedabortion

Definition: It is a clinical entity was the process of abortion has started but has not progressed to a state from which recovery is impossible.

Threatened abortion is the earliest stage of most spontaneous abortions. There is bleeding from the genital tract, but the cervix is closed and there is no discharge of products of conception.

The clinical features of a threatened abortion are:

  • uterus is normal size for dates
  • vaginal bleeding – the bleeding may be slight as faint brown discharge or a profuse red discharge with clotting
  • no products have been passed – do not confuse clots with products
  • cervix is closed, but note, the external os of a multigravida admits a finger tip
  • there is generally no pain although there may be a dull ache or discomfort due to congestion of the pelvic organs
  • pregnancy test is positive
  • fetal heart sounds and movements are observed

Investigations:

Routine investigations include: 1)blood- for haemoglobin estimation, ABO and Rh grouping. Blood transfusion may be required urgently if abortion becomes inevitable and anti-D gamma globulin has to be given in Rh negative non immunized women. 2) urine test for immunological test of pregnancy. This is done to confirm the fetal death in cases of continued bleeding. However, the test remains positive for a variable period even after the fetal death.

Special investigation:

The ultrasonographic (transvaginal) findings may be: 1) a well formed gestational ring with central echoes from the embryo indicating healthy fetus. 2) observation of fetal cardiac motion. With this there is 98% chance of continuation of pregnancy. 3) a blighted ovum is evidenced by loss of definition of the gestational sac, smaller mean gestational sac diameter, absent fetal echoes and absent fetal cardiac movements.

Management:

Bed rest: the patient should be in bed for few days until bleeding stops. Prolonged restriction of activity has got no value. However, with history of previous early pregnancy  wastage, the period of rest should be extended about two weeks beyond the period at which the previous wastage occurred.

  • Sedation
  • there is The no evidence that progestogens or gonadotrophins are of any help in the treatment of threatened abortion. 
  • Rhesus prophylaxis if appropriate.

General measures

  • the patient advised to preserve the vulval pads and anything expelled out per vaginam, for inspection.
  • To report if bleeding and / or pain becomes aggravated.
  • Routine note of pulse, temperature and vaginal bleeding.

Advices on discharge:

  • The patient should limit her activity for at least 2 weeks and avoid heavy work, strenuous exercise and excitement.
  • Coitus is contraindicated during this period.
  • She should be re-examined after one month to note the growth of the uterus and advice to consult the physician if bleeding recurs.

Prognosis:  The prognosis is very unpredictable whatever method of treatment is employed either in the hospital or at home. Is best assessed with an ultrasound scan. Approximately 75% of pregnancies continue.