Abortion: Diagnosis And Treatment

Diagnosis

The diagnosis of an abortion is obvious in a pregnant woman who presents with vaginal bleeding or expulsion of POC. However it become difficult when there is scant bleeding or no bleeding which can happen in incomplete abortion. Hence it is the author's view that any bleeding more than just slight spotting be considered as abortion or threatened abortion and investigated appropriately.

A thorough history must be elicited from the lady, enquiring in detail about the quantity of bleeding, any associated pain and other symptoms. This should be followed by a general physical examination with emphasis on looking for pallor, tachycardia (Increased Heart rate), and BP.

Thereafter a visual inspection of the genital areas is done to estimate the actual bleeding. A PV examination is contraindicated and should not be done under any circumstance. A gentle palpation of the uterus through the abdomen may be done but is unlikely to reveal any abnormalities.

An USG is the gold standard diagnostic test for abortion. A ultrasound is mandatory in cases of suspected or confirmed cases of abortion. A USG will not only confirm the diagnosis, it will also point out any complications like retained products, infection, etc.

Apart from these routine lab investigations like complete blood count, urine analysis, and HCG levels are also done.

Treatment

Threatened Abortion is typically treated conservatively. Strict bed rest is usually advised for three to five days. Thereafter women are encouraged to move gradually. Any associated conditions like high BP should be corrected. Laxatives and fluids are usually prescribed to prevent straining in the toilet.

Many gynecologists prefer to prescribe progesterone to women with threatened abortion. However the author is of this view that this really does not help the pregnancy. Although there are certain anecdotal evidence that progesterone may prolong pregnancy, there is no clear evidence to this effect.

A complete abortion will usually require no treatment other than just ensuring that all products of conception have been expelled.

An incomplete and missed abortion will both require medical intervention to expel the retained products of conception. This is conveniently done by surgical procedures like D&C or may be done by using drugs used in medical abortion like misoprostol.

Pregnancy After Abortion

An abortion will usually have no deleterious effects on further fertility. After abortion, normal periods should return by about 4-6 weeks time. In the meantime women may notice recurrent spotting or other bleeding intermittently, which is quite normal and will not require any specific management.

Medical Abortion or Abortion using pills has been a boon to many women. It provides privacy and control which no abortion clinic can provide. It is safe, effective and cheaper than the regular surgical options. Hence world wide there is an increasing trend towards use of abortion pills. Click this link to know more about medical abortion, including the drugs used and the expected complications.