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➢ Early Abortion：pregnancy loss before 12 gestational weeks
➢ Late Abortion: pregnancy loss during 12～28 gestational weeks
➢ Spontaneous Abortion ➢ Artificial Abortion
Etiology
➢ Genetic defect ➢ Maternal factors:
systematic disease; genital organ anomalies; endocrine anomalies; irritation; bad habit
➢ Immune anomalies ➢ Environmental factors
inevitable abortion
incomplete abortion
complete abortion
Diagnosis
History
Physical Examination
Laboratory Assessment:
➢ ultrasound ➢ pregnancy test ➢ hormone level: serum progesterone
The occurrence of 2 spontaneous abortions is defined as recurrent abortion
➢ Early abortion：chromosomal abnormalities， immunologic factors，luteal-phase insufficiency, hypothyroidism
Inevitable Abortion ➢ bleeding heavier, abdominal pain more
severe, or fluid passed ➢ cervical os open，pregnancy tissue visible ➢ abortion is inevitable
➢ Late abortion：congenital uterine anomalies，cervical incompetence，uterine fibroids, etc.
Management
➢ obtain information on etiology for prior losses before conception
Antibiotic treatment + Prompt evacuation ➢ without severe bleeding: management of
infection , performance of suction and curettage ➢ with severe bleeding：management of infection while applying forceps, with secondary suction and curettage
➢ no need for special management
Missed Abortion
Concept: in utero death of the embryo or fetus with retained products of conception
Clinical Manifestation: ➢ uterine enlargement ceasing or fetal movement
Incomplete Abortion ➢ heavy vaginal bleeding ➢ pregnancy tissue protruding
from the cervical os ➢ uterus small for the presumed
gestational week
Complete Abortion ➢ vaginal bleeding decreasing,
HCG→ whether to continue pregnancy
Inevitable Abortion
➢ once diagnosed，remove the pregnancy tissue as quickly as possible
➢ suction curettage
Incomplete Abortion
Ectopic Pregnancy
Concept
Ectopic Pregnancy: implantation of the fertilized ovum in tissue other than the endometrium
Extrauterine Pregnancy
➢ including：tubal pregnancy (95％), ovarian pregnancy, cornual pregnancy, cervical pregnancy, abdominal pregnancy, etc.
transfusion preparation; emptying the uterus：
➢ before 12 weeks: suction curettage ➢ after 12 weeks：induction of labor
Habitual Abortion
The occurrence of 3 or more consecutive spontaneous abortions
History
Pelvic Examination
Bleeding
Threatened Light Abortion
Abdominal Pain
None/light
Tissue Expulsion
None
Cervical Os Uterus
Closed
Normal
Inevitable Mild to hea源自文库y Intensified None Abortion
Normal or slightly large
Management
Threatened Abortion
➢ bed rest, sedation ➢ anti abortion：progesterone，HCG；
Vit E；thyroxine supplement ➢ monitoring：ultrasound；serum
During 8～12 weeks：with firm
attachment to the basal decidua ➢ Partial expulsion of the products of
conception→ non-ideal uterine contraction, severe bleeding
Management
blood routine examination, coagulation function test
correcting coagulation defects： heparin, fibrinogen, etc.
sensitizing the uterus： diethylstilbestrol
disappearing ➢ cervical os closed, uterus small for the
presumed gestational age ➢ no fetal heartbeat ; embryonic demise
suggested by ultrasound findings
of lymphocytes
Septic Abortion
Prolonged bleeding during abortion or retained products of conception lead to intrauterine infection, which might progress into pelvic inflammatory disease, peritonitis or even sepsis if not treated
➢ perform suction curettage promptly ➢ if with heavy bleeding：blood
transfusion；preventive antibiotic use
Complete Abortion
➢ no retained products of conception confirmed by ultrasound；no infection
➢ Early abortion：vaginal bleeding preceding abdominal pain
➢ Late abortion：abdominal pain preceding vaginal bleeding
Types of Abortion
Threatened Abortion Inevitable Abortion Incomplete Abortion Complete Abortion
Abortion and Ectopic Pregnancy
Liang-Qing Yao
Obstetrics and Gynecology Hospital of Fudan University
Abortion
Concept
A pregnancy loss before 28 weeks of gestation while fetal weight under 1000 grams
➢ Missed Abortion ➢ Habitual Abortion ➢ Septic Abortion
Clinical Presentations
Threatened Abortion ➢ light vaginal bleeding with mild abdominal
pain ➢ cervical os closed, fetal membranes unbroken ➢ treatment might work , continue pregnancy
Dilated
Normal or slightly small
Incomplete Light to Abortion heavy
Relieved
Partial
Dilated or Small obstructed
Complete Light to none None Abortion
Complete Closed
abdominal pain alleviating ➢ cervical os closed ➢ uterus normal for the
presumed gestational week
Different Stages of Abortion
threatened abortion continue pregnancy
Pathology
Before 8 weeks: chorionic villi immature
➢ Fetal death→basal decidual bleeding →uterine contraction→expulsion of all the products of conception, light bleeding
➢ genetic counseling ➢ cervical incompetence：cervical cerclage
during 14～18 weeks of gestation ➢ with unclear causes：progesterone therapy
until 10 weeks of gestation ➢ active immunotherapy：intradermic injection
After 12 weeks: placenta fully formed.
➢ Uterine contraction→ expulsion of all the products of conception，light bleeding
Symptoms
Amenorrhea, vaginal bleeding , and abdominal pain
