Incomplete Abortion

Introduction

Abortion is when a pregnancy is ended so that it doesn’t result in the birth of a child. It is also called termination of pregnancy.
We have different types of abortion which include complete abortion, septic abortion, safe abortion, missed abortion, inevitable abortion, incomplete abortion, threatened abortion etc.

Symptoms of an incomplete abortion

The following are symptoms of an incomplete abortion

  1. Passage of large blood clots and/or the foetus and some products per vaginam
  2. Severe lower abdominal pain

Signs of an incomplete abortion

The following are the signs of an incomplete abortion

  1. If bleeding is severe: Pallor and/or Shock (collapsed peripheral vessels, fast pulse, falling BP and cold clammy skin)
  2. Uterine size is smaller than the dates
  3. Cervix is dilated with the foetus already aborted
  4. Whole placenta or parts thereof may be present within the uterine cavity

Investigations

  • FBC and sickling
  • Blood grouping and cross matching
  • Ultrasound scan (to be requested if doubt exists in the diagnosis especially in early pregnancies)

Treatment for an incomplete abortion

Treatment objectives

The treatment objectives of an incomplete abortion include the following:

  1. To resuscitate patient
  2. To evacuate the retained products of conception from the uterus
  3. To prevent infection with antibiotic prophylaxis
  4. To determine cause of abortion, if recurrent
  5. To prevent risk of Rhesus incompatibility in future pregnancies

Non-pharmacological treatment

  • Digital curettage during vaginal examination to remove as much of the retained tissues as possible
  • Surgical evacuation of retained products of conception e.g. manual vacuum aspiration (MVA) with or without anaesthesia
  • Post abortion abstention from sexual intercourse for at least 2 weeks
  • Post abortion counselling and psychological support (including Family Planning)

Pharmacological treatment

A. If in shock and/or severe bleeding

  • IV fluids and blood transfusion as necessary

B. Abortion with uterine size < 12 weeks

Evidence Rating: [A]
Ergometrine, IM/IV,

  • 500 microgram stat.

Or

Misoprostol, oral,

  • 600 microgram stat.

Or

Misoprostol, sublingual,

  • 400 microgram stat.

C. Abortion with uterine size > 12 weeks

Evidence Rating: [A]
Misoprostol, oral,

  • 600 micrograms stat.

Or

Misoprostol, sublingual,

  • 400 micrograms stat.

D. Abortion with uterine size > 24 weeks

Evidence Rating: [B]
Oxytocin, IV,

  • 20 units into 1 L of Sodium Chloride 30-60 drops per minute

Or

Misoprostol, oral,

  • 600 micrograms stat.

Or

Misoprostol, sublingual,

  • 400 micrograms stat.

E. To prevent infection

Amoxicillin, oral,

  • 500 mg 8 hourly for 5-7days

And

Metronidazole, oral,

  • 400 mg 8 hourly for 5-7days

E. To prevent infection – in patients with penicilin allergy

Erythromycin, oral,

  • 500 mg 8 hourly for 5-7days

And

Metronidazole, oral,

  • 400 mg 8 hourly for 5-7days

F. To prevent Rhesus Isommunization

Evidence Rating: [A]
Anti D Rh Immune Globulin, IM,

  • 300 microgram (1,500 Units), stat.
    within 72 hours of abortion