ABORTION

 Defined as spontaneous or induced termination of pregnancy before fetal viability

 WHO definition: pregnancy termination before 20 weeks of gestation or with a fetus weighing <500g

TYPES OF ABORTION

1. Spontaneous abortion
a. Threatened abortion
- Presumed when vaginal bloody vaginal discharge or bleeding appears through a closed cervical
so during the first 20 weeks
- Must be differentiated w/ implantation bleeding. With miscarriage, bleeding usually begins first
and cramping abdominal pain follows hours to days later
- Must be differentiated w/ ectopic pregnancy using serum b-hCG, progesterone levels,
transvaginal sonography
- Decreasing b-hCG and progesterone levels indicates spontaneous miscarriage and dying
pregnancy
- Transvaginal sonography is used locate the pregnancy if the fetus is alive. If this cannot be done
then, it is called pregnancy of unknown location (PUL)
- Management: acetaminophen based analgesia, bed rest
b. Inevitable abortion
- Gross rupture of the membranes along w/ cervical dilatation
c. Incomplete abortion
d. Complete abortion
e. Missed abortion/Early pregnancy failure
f. Septic abortion
 2. Recurrent abortion
- Repetitive early spontaneous pregnancy includes recurrent spontaneous abortion, recurrent
pregnancy loss, habitual abortion
- Defined as 3 or more consecutive pregnancy losses at ≤20 weeks or with a fetal weight <500g
3. Induced abortion
a. Therapeutic abortion
b. Elective or Voluntary abortion

FIRST-TRIMESTER SPONTANEOUS ABORTION

 80% of spontaneous abortion occur w/in the first 12 weeks of gestation

 Pathogenesis:
o Death of the embryo or fetus nearly always precedes spontaneous expulsion
o Death is accompanied by hemorrhage into decidua basalis, followed by adjacent tissue necrosis that
stimulates uterine contractions and expulsion
 Fetal Factors:
o Anembryonic (blighted ovum) – no identifiable embryonic elements
o Embryonic – displays a developmental abnormality of the zygote, embryo, fetus, or at times, the
placenta
 Autosomal trisomy is the most frequently identified chromosomal anomaly
 Other: Monosomy X (Turner’s syndrome), Triploidy, Tetraploidy, Structural anomalies
 Maternal Factors
o Infections: B. abortus, C. fetus, Toxoplasma gondii
o Medical disorders: celiac disease, anorexia nervosa
o Medications: IUD increased risk of abortion
o Cancer: previously treated w/ abdominopelvic radiotherapy
o DM: increase risk w/ insulin-dependent DM
o Thyroid disorders: Hashimoto thyroiditis
o Surgical procedures: Bariartric surgery
o Nutrition: severe dietary deficiency and morbid obesity
o Social and Behavioral factors: heavy use of legal substances (alcohol, cigarette smoking, caffeine)
o Occupation and environmental factors: benzene, arsenic, lead , formaldehyde, ethylene oxide
o Immunological: APS
o Inherited thrombophilia
o Uterine defects
 Paternal factors: chromosomal abnormality in sperm, increasing paternal (lowest risk = before 25yo)