Abortion, threatened

Notes
  • Threatened abortion is vaginal bleeding in a woman with closed cervix that occurs in the first 20 wks of pregnancy. It is occasionally accompanied by abdominal cramps.
  • It is the most common complication in pregnancy.
  • Threatened abortion may lead to spontaneous abortion (miscarriage)
  • Once the cervix begins to open, pregnancy loss is practically inevitable.
  • After threatened abortion, the risk of antepartum hemorrhage, pre-labour rupture of the membranes, preterm delivery, and intrauterine growth restriction are increased.
  • Statistics: prevalence of threatened abortion is - about 20-30% of pregnancies; proportion of threatened abortions that will result in miscarriages – about 50%; proportion of miscarriages during the first-trimester that are due to abnormalities in the developing fetus - 90%

##Risk factors include

  • Alcohol abuse
  • Chromosomal abnormalities
  • Comorbid maternal diseases such as diabetes mellitus, hypothyroidism, severe hypertension and UTIs
  • Drug abuse
  • Incompetent cervix
  • Uterine fibroids
  • Inflammation of the villi
  • History of previous miscarriage
  • Malnutrition
  • Maternal old age
  • Multiparity
  • Obesity
  • Physical and emotional trauma
  • Smoking
  • Stress and fatigue
Symptoms
  • Bloody discharge
  • Lower back pain
Diagnosis
  • Pregnancy test
  • Ultrasound (transvaginal pelvic ultrasonography being more accurate than transabdominal ultrasound) to answer the following questions - is the embryo still there? Is the embryo still alive? Is there a possibility of ectopic pregnancy? Is there a “Blighted ovum”? Is there a hydatidform mole? Is there any other defect?
  • Complete Blood Count
  • Blood typing and Rh testing
  • Serum hCG
  • Serum progesterone (rarely done)
  • Test for malaria in malaria - endemic area.
  • Urinalysis and microscopy
  • Test for syphilis
Differential
  • Benign hydatidiform mole
  • Blighted ovum
  • Cervical cancer
  • Cervical ectopic pregnancy
  • Dysfunctional uterine bleeding
  • Incompetent cervix
  • Tubal ectopic pregnancy
  • UTIs
  • Adnexal Tumors
  • Thrombocytopenia
Prevention
  • It is not possible to prevent threatened abortion all together but incidences can be reduced by mitigating the risk factors such as treatment of UTIs, proper antenatal care and management of the underlying disease.
Management
  • Bed rest.
  • Abstinence from sexual intercourse for at least two weeks and the bleeding ceases
  • Progestogen (but it is still controversial)
  • Treatment of comorbid maternal diseases
  • Anti-D in case of Rh positive cases.
  • Heparin with low doses of aspirin (in case of the presence of antiphospholipid antibodies that is common in lupus)

##Pain Management by

  • Tabs hyoscine butyl bromide 20mg TID x 5/7 OR
  • Tabs paracetamol 1gm TID x 5/7

##Sedation to reduce anxiety and ensure bed rest;

  • Tabs phenobarbitone 30mg TID x 5/7 OR
  • Tabs diazepam 5mg TID x 5/7
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