Abortion, inevitable

Notes
  • It is characterized by vaginal bleeding with the membranes showing or not showing gross rupturing, the cervix being dilated and abortion being almost certain.
  • The conception products and intracervical contents are still present at the time of examination
  • Once cervical dilatation occurs, threatened abortion progresses to an inevitable miscarriage.
  • Once conception products and intracervical contents have passed through the cervical os incomplete abortion occurs. This will eventually progress to a complete abortion.
Symptoms
  • Bloody vaginal discharge
  • Lower back pain
  • Abdominal cramping /pain.
  • Cervix open / dilated
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 hydatidiform 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

None

Management
  • Inf Oxytocin 20IU in 500 mL normal saline over 4hrs (to facilitate expulsion of products of conception, POCs). OR
  • Misoprostol 600µg vaginally (if gestation is > 14 wks)
  • Evacuation in case some products of conception (POCs) still remain after the above
Drug Index 2.0 is here
Our new update features a more powerful search feature and easier login. Having any issues? Contact us today. Contact Us