Spontaneous abortion, also known as miscarriage, refers to the premature expulsion of the embryo or fetus from the uterus before the 20th week of pregnancy. A miscarriage may be complete, where the entire contents of the uterus are expelled, or incomplete, where some remains. Miscarriages are commonly caused by genetic factors, hormonal imbalances like low progesterone levels, infections, immunological issues, maternal age, and other stresses. Treatment for a miscarriage depends on whether the fetus and placenta have been fully expelled. Remaining tissue can be removed through vacuum aspiration, dilation and curettage, or use of medical abortifacients like misoprostol to stimulate uterine contractions.

1. SPONTANEOUS
ABORTION
BY: MRS. PRECILLA C. STEPHEN

2. DEFINTION
It refers to the premature expulsion of the products of conceptions (embryo or
foetus) from the uterus, usually before the 20th week of pregnancy.
An abortion may be spontaneous (naturally occurring also called
miscarriage) or induced (intentionally performed).
The expelled embryo or foetus is called abortus.

3. CLASSIFCATION OF ABORTION
ABORTION
SPONTANEOUS INDUCED

4. Sporadic &
Recurrent
Threatened Inevitable Complete Incomplete Missed Septic

5. Induced
Legal Illegal
Illegal
Septic
(common)

6. Etiology Of Spontaneous Abortion
1. Genetic Factors
2. Endocrine Hormones (Low Progesterone Levels ): During the first 3 to 4 months of pregnancy,
the corpus luteum in the ovary continues to secrete progesterone and estrogens, which maintain
the lining of uterus during pregnancy. From the third month through the remainder of the
pregnancy, the placenta itself provides the high levels of progesterone and estrogens required.
The chorion secretes human chorionic gonadotropin into the blood. In turn, hCG stimulates the
corpus luteum to continue production of progesterone and estrogens – an activity required to
prevent menstruation and for the continued attachment of the embryo and foetus to the lining of
the uterus. By the 8th day after fertilization. hCG can be detected in the blood and urine of a
pregnant woman. Peak secretion of hCG occurs at about the 9th week of pregnancy
Low level of progesterone that causes miscarriage is probably due to its inadequate production from
the corpus luteum.

7. 3. Infections and diseases – neonatal herpes, cytomegalovirus, bacterial
infections such as chlamydia, mycoplasma, streptococcus, parasitic infections –
toxoplasmosis. Undiagnosed diabetes may also cause a miscarriage
4. Immunological causes:
Autoimmune diseases: The presence of certain complex antibodies like lupus
anticoagulant and the anticardiolipin can cause miscarriage.
Erythroblastosis foetalis
5. Age of the mother
6. Other factors: environmental chemicals, toxins, chronic illness and stress.

8. MANAGEMENT
Usually, the foetus and placenta are completely expelled from the uterus during a miscarriage. But if
they are not expelled, or only a part of them is expelled, following modern management techniques
may be used by a specialist.
1. Vacuum Aspiration: The remaining tissue in the uterus can be removed by a mechanical pump.
2. Dilation and curettage (D & C): In this procedure, the cervix is dilated and a curette is used to
scrape the lining of the uterus to remove the remaining tissue.
3. Medical Management: Certain drugs such as a form of prostaglandin E (misoprostol) is given
which stimulates uterine contractions that aid in expulsion of remaining tissue and endometrium.
Miscarriage may be followed by bleeding for several weeks, changing from bright red to pink in
colour. Suction procedure may also cause abdominal cramps. In case of excessive bleeding even
after a few weeks, unpleasant odour of discharge, or fever, consult doctor.