Miscarriage and abortion

Published on 09/03/2015 by admin

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Last modified 09/03/2015

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Chapter 8 Miscarriage and abortion

Caroline De Costa, Michael Flynn

Definition. Termination of pregnancy at less than 20 weeks gestation or with the fetus weighing less than 400 g (exact definitions depend on the jurisdiction). ‘Miscarriage’ is usually taken to mean spontaneous abortion. ‘Abortion’ or ‘termination of pregnancy’ (TOP) usually refers to induced abortion (by surgical or medical means).

Incidence. About 15% of all pregnancies spontaneously abort (miscarry) at 6–13 weeks gestation. Up to 80% of spontaneous abortions are diagnosed at 8–12 weeks gestation.

Aetiology of spontaneous abortion

• genetic: chromosomal abnormalities present in up to 50% of first-trimester abortions (e.g. trisomy, monosomy, triploidy)
• fetal malformations (e.g. neural tube defects)
• immunological disorders
• uterine abnormalities
• cervical incompetence
• endocrine disorders (e.g. luteal phase dysfunction, diabetes mellitus)
• infections: listeria, mycoplasma, ureaplasma
• trauma: surgery, amniocentesis, chorionic villus sampling

Presentation and management

Presentation (spontaneous abortion)

• a period of amenorrhoea, followed by vaginal bleeding and cramping lower abdominal pain
• human chorionic gonadotrophin (hCG) positive

Examination

• general examination: colour, blood pressure, pulse
• abdominal examination
• vaginal examination

• bleeding through the cervical os
• bulky uterus

• cervical os may be open, with products of conception at the os or in the vagina

Investigations

• full blood count, blood group
• ultrasound scan of the pelvis

Management

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