Miscarriage or abortion
An abortion is the expulsion of the products of
conception before the 24th week of pregnancy.
The word abortion is often considered by women
to be a procured termination of pregnancy, legal or
criminal. Hence, the softer term miscarriage is better
used for the spontaneous event. A simple classification
is helpful in understanding the various
terms used (Fig. 8.1).
Causes of spontaneous miscarriage
These are maternal, fetal and possibly paternal or
• Acute febrile illness.
• Septicaemia with infection of the fetus.
• Severe hypertension or renal disease.
• A ...view middle of the document...
Most of these cases end in spontaneous miscarriage;
rarely the pregnancy continues.
Incidence of spontaneous miscarriage
The frequency depends on the definition:
• in clinically diagnosed pregnancies 15–20% will
miscarry in early pregnancy;
• non-development of the blastocyst within 14
days occurs in up to 50% of conceptions.
Clinical features and management of
• Scanty uterine bleeding preceded by symptoms
• Pain is usually absent; there may be backache or
slight uterine contractions.
• The breasts may be active.
• The uterus is enlarged corresponding with dates
• The cervix is closed.
• There is no pelvic tenderness.
• Delayed miscarriage when the uterus is smaller
than expected. Check with ultrasound.
• Ectopic pregnancy when pain generally precedes
• Dysfunctional uterine bleeding—where no signs
Ultrasound can show a sac (five weeks), an embryo
and the fetal heart beat (six weeks). Human
chorionic gonadotrophin (hCG) can be measured
in blood or urine.
Treatment is usually rest until fresh bleeding has
After bleeding has ceased, the woman should
avoid exertion and intercourse till after the 12th
week of pregnancy. Progesterone therapy is ineffective,
but still used.
Bleeding and pain are characteristic, bleeding is
heavier than in threatened miscarriage. There may
be crampy, low abdominal pains and an escape of
• Uterus enlarged.
• The internal os of the cervix is dilated. Prod-
Delayed Complete Incomplete Septic
Recurrent Illegal Legal
Figure 8.1 A simple classification of
the terms used.
Bleeding in pregnancy Chapter 8
ucts of conception may be felt in the cervical
canal. Once this has occurred, miscarriage is
Before 12 weeks’ gestation, evacuate the uterus
under general anaesthesia in an operating
After 12 weeks, allow...