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Abortion - A Simple Medical Guide

What is Abortion?

Abortion (from Latin aboriri, meaning "to miscarry") is the premature ending of a pregnancy before the fetus is able to survive outside the uterus - generally before 20 weeks of gestation. Any tissue expelled is called the abortus.

Globally, 25% of all pregnancies end in abortion. About 56 million abortions occur each year worldwide.

Two Big Categories

Category	What it means
Spontaneous Abortion (Miscarriage)	Happens naturally, without any medical intervention
Induced Abortion	Deliberately ended by medicine or surgery

Types of Abortion (Spontaneous)

Here is what each type means:

1. Threatened Abortion

Vaginal bleeding with or without cramping
Cervix is CLOSED - pregnancy may still continue
Occurs in ~25% of recognized pregnancies
About half of these will eventually miscarry

2. Inevitable Abortion

Cervix has opened (dilated)
Heavy bleeding and cramping
Pregnancy cannot be saved at this point

3. Incomplete Abortion

Cervix is open
Some tissue has passed, but some remains in the uterus
Most common between 6-14 weeks
Requires uterine evacuation (medical or surgical)

4. Complete Abortion

All tissue has passed out of the uterus
Cervix closes again, bleeding stops
Confirmed by ultrasound showing an empty uterus

5. Missed Abortion

The embryo/fetus has died but stays inside the uterus
No cramping or bleeding - often no symptoms at all
Discovered on ultrasound (no heartbeat)

6. Septic Abortion

Any stage of abortion complicated by infection
Signs: fever, uterine tenderness, foul-smelling discharge
A medical emergency requiring antibiotics and uterine evacuation

7. Habitual (Recurrent) Abortion

3 or more consecutive spontaneous abortions
Requires investigation for underlying causes

Causes of Spontaneous Abortion

Most spontaneous abortions (80%) happen in the first trimester. Common causes include:

Cause	Examples
Chromosomal abnormalities	Aneuploidy, polyploidy - present in ~50% of cases
Maternal hormones	Poorly controlled diabetes, thyroid disorders, luteal phase defect
Uterine problems	Fibroids, polyps, uterine malformations
Infections	Toxoplasma, Mycoplasma, Listeria, certain viruses
Immune factors	Antiphospholipid antibody syndrome
Advanced maternal age	Risk rises sharply after age 35
Exposure to toxins	Heavy metals, tobacco, some anesthetic agents

"Fetal chromosomal anomalies are present in approximately 50% of early abortions." - Robbins Pathologic Basis of Disease

How is Abortion Diagnosed?

Doctors use several tools:

Pelvic exam - Is the cervix open or closed? Is tissue visible?
Quantitative β-hCG blood test - Measures pregnancy hormone levels
Transvaginal Ultrasound - Checks for fetal heartbeat, gestational sac, retained tissue
CBC - Checks for blood loss

Treatment Options

For Spontaneous Abortion:

Expectant Management - Wait and allow the body to expel tissue naturally, with monitoring via serial β-hCG and ultrasound.

Medical Management:

Misoprostol (a prostaglandin) given vaginally - causes uterine contractions to expel tissue
Works better in incomplete or inevitable abortion than missed abortion

Surgical Management:

Manual Vacuum Aspiration (MVA) - A hand-held syringe empties the uterus
Dilation & Curettage (D&C) - Surgical widening of the cervix + removal of uterine contents
Preferred when medical management fails, or if heavy bleeding occurs

Induced Abortion Methods

Medical Abortion (the "Abortion Pill")

Used up to ~10 weeks of pregnancy.

Mifepristone (200 mg orally) - Blocks progesterone, causing the uterine lining to break down
Misoprostol (800 mcg, given 24-48 hours later) - Causes uterine contractions to expel the pregnancy

Success rate: 96-99%
Resembles a miscarriage
Heavy cramping and bleeding expected for several hours

Surgical Abortion

Vacuum Aspiration (D&C)

Used up to ~13 weeks
A cannula (thin tube) is inserted into the uterus and suction removes the pregnancy
Takes under 30 minutes, local or general anesthesia
Success rate: >98%
Major complication rate is very low (~0.16%)

Dilation & Evacuation (D&E)

Used in the second trimester (after 14 weeks)
More complex, requires greater cervical dilation
Still safer than continuing pregnancy at advanced gestational age

Safety: Legal vs. Unsafe Abortion

Global Abortion Safety Distribution by Region

Figure: Proportion of safe, less-safe, and unsafe abortions by world region (Berek & Novak's Gynecology)

Key facts:

Legal abortion mortality rate: 0.7 per 100,000 procedures (extremely safe)
Unsafe abortion: ~25 million per year globally; kills 47,000 women annually
Africa has the highest proportion of unsafe abortions
Northern America and Northern Europe have nearly 100% safe abortions
Where abortion is legal and accessible, it is safe. Where it is illegal or restricted, complications and deaths are common.

Key Investigations at a Glance

Test	Why it's done
β-hCG (blood)	Confirms pregnancy; tracks hormone fall
Ultrasound	Confirms viability, rules out ectopic pregnancy
Blood type + Rh	Rh-negative women need Rh immunoglobulin (RhoGAM) to prevent future pregnancy problems
CBC	Checks for anemia from blood loss

Quick Summary

Type	Cervix	Tissue	Heartbeat	Action
Threatened	Closed	Inside	Present	Monitor, rest
Inevitable	Open	Inside	Present	Evacuation
Incomplete	Open	Partial	Absent	Evacuation
Complete	Closed	None	Absent	Monitor only
Missed	Closed	Inside	Absent	Medical/surgical
Septic	Open	Inside + infected	Absent	Urgent antibiotics + evacuation

Sources: The Developing Human (Moore et al.), Berek & Novak's Gynecology, Tintinalli's Emergency Medicine, Robbins Pathologic Basis of Disease, Pfenninger & Fowler's Procedures for Primary Care, Swanson's Family Medicine Review.

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