Threatened abortion – This course is designed to understand the care of pregnant women and newborn: antenatal, intra-natal and postnatal; breast feeding, family planning, newborn care and ethical issues, The aim of the course is to acquire knowledge and develop competencies regarding midwifery, complicated labour and newborn care including family planning.
Threatened abortion
Definition of Threatened Abortion:
It is a condition where the process of abortion has started but has not progressed to a state from which recovery is impossible.
Management of Threatened Abortion:
A. Clinical features:
1. Short history of amenorrhoea, usually 2-3 month
a) Symptoms:
2. Symptoms of early pregnancy – Morning sickness, enlargement of breast, increased frequency of micturation.
3. P/V bleeding: Usually brisk red (bright red and small in amount)
4. Usually no H/O pain
5. H/O passage of any product of conception
b) Signs:
1. P/A: Height of uterus corresponds with the period of amenorrhoea. Uterus and cervix felt soft.
2. P/V:
- Cervix is not dilated
✓ External OS: Closed in multi-Para
✓ Internal OS: closed - Speculum examination: Bleeding if any escapes through external OS.
B. Investigation:
1. Blood: Hb%, ABO and Rh blood grouping
2. Urine for RME and for immunological test of pregnancy
3. USG-Trans-vaginal
C. Management:
1. Bed rest
2. Sedation and relieve of pain by Pethidine 100 mg initially followed by Diazepam 5 mg 8 hourly
3. Hormone therapy: Progesterone (17 a-hydroxy progesterone) deep IM or orally (twice weekly initial 16 weeks). For effective continuation of pregnancy.
4. If mothers is Rh (-ve) – Inj. Anti Dig (y-globulin) 50 units
5. Treatment of the cause –
- Folate deficiency: Folic acid 5 mg 8 hourly
- Hypertension: Control by anti hypertensive drugs
- Cervical incompetence: Cervical suture
6. Antibiotics: If infection is suspected
7. Advice:
- Avoid travelling and coitus
- Repeated visit to antenatal clinic
- To report if pain and or bleeding aggravates
- Avoid heavy work
Fates of Threatened Abortion:
1. Continuation of pregnancy
2. Missed abortion.
3. Inevitable abortion.
4. Incomplete abortion
5. IUGR
6. IUD
7. Congenital malformation
8. Still birth
9. Premature labour
10. Placenta praevia
Difference between Threatened Abortion and Inevitable Abortion:
| Traits | Inevitable abortion | Threatened abortion |
| 1. Bleeding | Fresh blood & clots profuse | Fresh & scanty |
| 2. Pain | Severe pain | Usually painless |
| 3. OS | Open | Close |
| 4. Fate | Irreversible | About 2/3rd cases are reversible |
| 5. Hypovolumic Shock | Usually present | Usually absent |
| 6. Prognosis | Bad | Good |
Difference between Threatened Abortion and Missed Abortion:
| Traits | Threatened abortion | Missed abortion |
| 1. Pregnancy symptoms | Present | Subside |
| 2. Maternal weight | Progressive | Failure to weight gain |
| 3. P/V discharge | Slight per vaginal bleeding | Slight peer vaginal bleeding followed by persistence of brownish discharge |
| 4. Breast change | Present | Retrogression of breast changes |
| 5. Foetal movement and heart sound | Present | Absent |
| 6. Height of the uterus | Corresponds to the period of amenorrhoea | Smaller then the period of amenorrhoea |
| 7. P/V examination | Cervix closed and felt soft. Bleeding may present | Cervix closed and felt firm. Brownish discharge present |
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