Abortion of pregnancy

1. Dr. Samar Thabet

2. Bleeding in early pregnancy may be
associated with:
1) Miscarriage.
2) Ectopic pregnancy.
3) Gestational trophoblastic disease.
4) Rarely gynaecological lower tract pathology
(e.g. Chlamydia, cervicalcancer, or a polyp).

3. Miscarriage
Defined as expulsion of pregnancy, embryo, or
fetus at a stage of pregnancy when it is incapable
of independent survival:
A. Includes all pregnancy losses before 24wks
B. The vast majority are before 12wks.

4. Miscarriage
Miscarriage is common occurring in at least
15–20% of pregnancies
Possibly up to 40% of all conceptions.

8. Management
Expectant management
• Appropriate in those women who are not bleeding
heavily.
• It is highly effective for women with an incomplete
miscarriage.
• In women with an intact sac, resolution may take
several weeks and may be less effective.

9. Management
Expectant management
• A repeat TVS should be offered at 2wks to ensure
complete miscarriage — can be repeated after
another 2wks if a woman wishes to continue with
conservative management.
• Patients should be offered surgical evacuation at a
later date if expectant management is unsuccessful.

10. Management
Medical management
• Prostaglandin analogues (usually misoprostol) are
used, administered orally or vaginally, usually
with antiprogesterone priming (mifepristone)
24 - 48h prior.
• Women should be warned that passage of
pregnancy tissue may be associated with pain and
heavy bleeding facilities for emergency admission
should be available

11. Management
Surgical management:
• An ERPC should be performed in patients who
have excessive or persistent bleeding or request
surgical management.
• Suction curettage should be used.

12. Complications of SMM:-
1) Infection.
2) Haemorrhage.
3) Uterine perforation (and rarely intraperitoneal
injury).
4) Retained products of conception.
5) Intrauterine adhesions.
6) Cervical tears.
7) Intra-abdominal trauma.

13. Anti-D prophylaxis:-
• Anti-D should be given to all non-sensitized Rh
–ve patients in the following circumstances:
1) < 12wks (250IU IM):
• uterine evacuation (medical and surgical)
• ectopic pregnancies.
2) > 12wks: all women with bleeding (250IU IM
before 20wks and 500IU IM after 20wks).