An abortion is the expulsion of products of conception whether spontaneous or induced before the 28 weeks of gestation.

Causes

Chromosomal Abnormality

• Autosomal abnormalities such as autosomal Trisomy, Tetraploidy, Triploidy 
• Faulty development of the fertilized ovum

Trauma

• The trauma of sexual intercourse
• Accidental fall ( dislodge implanted ovum)

Placental abnormalities

• Acute hydramnios
• Multiple pregnancies
• Hydatidiform mole
• Placenta praevia

Maternal disease

• Acute infections such as Malaria with high fever, Typhoid fever
• Chronic infections such as Toxoplasmosis, Listeria, Mycoplasma, Genital herpes, rubella, cytomegalovirus, parvovirus B 19
• Hypertension
• Diabetes
• Chronic nephritis.
• Collagen vascular diseases such as Systemic lupus erythematous, Antiphospholipid antibody syndrome
• Thyroid Disease
•  Blood ABO group incompatibility
• Uterus deformities such as Bicornuate uterus, Septate, Subseptate, Arcuate uterus
• Submucous or polypoid fibromyoma
• Incompetent Os
• Cervical laceration
• Any surgical operation
• Corpus Luteal Phase Defects
• Any emotional disturbance

Faults in gamete

• Aging of gamete(sperm/egg)
• Abnormal sperm
• Radiation exposure

Poor nutrition

Excess to alcohol and Smoking

 Classification of abortion

On the basis of the degree	On the basis of cause	On the basis of infection
Threatened	Spontaneous	Septic
Inevitable	Recurrent	Non-septic
Incomplete	Induced
Complete
Missed

Signs and symptoms

Types of abortion	Signs	Symptoms
Threatened	Bleeding through the cervical canal   Closed Os	a.    Amenorrhoea of 2-3 months   b. Slight painless vaginal bleeding c.    Bright red colour bleeding d.    Mild/no discomfort
Inevitable	Dilated cervical canal   The palpable the lower pole of the sac The size of uterus corresponds to the duration of amenorrhoea	a. Severe vaginal bleeding in the beginning   b. Then heavy bleeding with passage of clots c. Painful uterine contractions
Incomplete	Open internal Os   Admit one finger Soft and enlarged uterus	a. Continuous bleeding/passage of large clots   b. Bleeding may continue for months c. Regular menstruation is not established d. Lower abdominal pain may be present
Complete	Closed cervix Firm and bulky uterus	a. Less or no bleeding   b.  No pain c.  Brownish vaginal  discharge stops within 7-10 days d. Regular menstruation is established within 1-2 months
Missed	Uterus soft   Size less than a period of amenorrhoea Closed Os	a.    Amonorrhoea of 4-5 months with early pregnancy symptoms   b. Slight, repeated vaginal bleeding which may subside on rest or aggravates despite treatment c. No progressive enlargement of abdomen/breasts
Spontaneous	Non-specific	a. Heavy bleeding with products of conception   b. No/less abdominal pain c. Bleeding subsides completely only after expulsion of sac
Recurrent	Incompetent Os	a. Abortion occurs at least 3 times   b. It is spontaneous
Septic	Tender lower abdomen   Distension may be present Tachycardia Bowel sounds may be sluggish or absent Os may or may not be open Bulky, soft uterus Firm and indurated adnexa with marked tenderness	a. Fever with chills and rigour   b. Pain in the abdomen c. Vomiting d. Diarrhoea e. Dry, coated tongue f. Scanty/heavy bleeding g. Purulent offensive vaginal discharge

Investigations

• Routine investigations such as ABORh, Hb, Urine c/e, RBS
• Ultrasonography
• Vaginal cytology
• Thyroid function test
• TORCH test
• Blood culture
• Kidney and Liver function test
• Endocervical swab and High vaginal swab (for septic abortion)

Treatment              

• Bed rest
• Avoid coitus
• Anti-D immunoglobulin for Rh-ve mothers
• Treating maternal disease
• Adequate nutrition along with supplements of Iron, Calcium, folic acid and Multivitamins

Complications

• Placental Polyp
• Shock
• Haemorrhage
• Sepsis
• Cervical Lacerations
• Perforation of the uterus
• Asherman Syndrome
• Thrombophlebitis
• Hypofibrinogemia
• Oliguria
• Anaemia
• Paralytic ileus
• Gas gangrene
• Tetanus
• Death