Make table of type and symptoms of abortion
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Types of Abortion and Their Symptoms
| Type | Definition | Vaginal Bleeding | Cervical Os | Products of Conception Passed | Uterine/Abdominal Pain | Other Features |
|---|---|---|---|---|---|---|
| Threatened Abortion | Bleeding in the first half of pregnancy; pregnancy still viable | Present (bloody discharge or frank bleeding) | Closed | None passed | Mild lower back discomfort or midline pelvic cramping | Fetal cardiac activity present on US; ~50% will miscarry; managed expectantly |
| Inevitable Abortion | Miscarriage is unavoidable; tissue has not yet passed | Present, may be heavy | Open (dilated) | None passed yet | Present | Cervical dilation or rupture of membranes; surgical intervention often required |
| Incomplete Abortion | Only some products of conception have been expelled | Present, often heavy | Open (dilated) | Partial - some passed, some retained | Midline cramping | Most common between 6-14 weeks; uterus must be evacuated (D&C or misoprostol) |
| Complete Abortion | All products of conception have been expelled | Present initially, then resolving | May be closed (closing) | All passed | Cramping that subsides after passage | Confirmed by US (empty uterus) and falling β-hCG levels; can be safely discharged |
| Missed Abortion | Fetal death without expulsion of any tissue | Absent or minimal | Closed | None passed | None (no uterine activity) | Fetal demise at <20 weeks; pregnancy retained >4 weeks after death; diagnosed on US (absent cardiac activity) |
| Septic Abortion | Infection complicating any stage of abortion (most often incomplete) | Present | Variable | Variable | Uterine tenderness | Fever, foul-smelling vaginal discharge, leukocytosis; systemic sepsis possible; requires IV antibiotics + urgent evacuation |
| Recurrent Spontaneous Abortion | Three or more consecutive first-trimester pregnancy losses | Present with each episode | Variable | Variable | Variable | Prompts workup for chromosomal, anatomic, immunologic, or endocrine causes |
Additional Notes
- Most common cause of spontaneous abortion: chromosomal aneuploidy (~60% of cases)
- Incidence: 20-40% of pregnancies abort spontaneously; ~75% occur before 8 weeks
- Key diagnostic workup: quantitative serum β-hCG, pelvic ultrasound, CBC, blood type and Rh factor
- Rh-negative patients should receive anti-D immunoglobulin (Rh immunization prophylaxis) following any type of abortion
Ultrasound classifications (additional):
- Anembryonic pregnancy (blighted ovum): gestational sac >16-45 mm with no fetal pole
- Embryonic/fetal demise: embryonic pole visible but no cardiac activity
Sources: Textbook of Family Medicine 9e; Tintinalli's Emergency Medicine; Swanson's Family Medicine Review
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