ABORTION

Abortion may be:

1) THREATENED ABORTION:
the patient has lower abdominal cramps, minimal vaginal spotting, closed cervix, DO an US to check fetal life activity (fetus is alive in threatened abortion). This is to differentiate it from missed abortion which presents with the same presentation but US will show a dead fetus. MANAGE conservatively with home bed rest and follow up with US after one week of diagnosis.

2) MISSED ABORTION:
the patient says that she doesn't feel fetal kicks. Uterus no longer grows, brownish vaginal discharge, milk secretion, closed cervix. DO an US (it shows dead fetus with no cardiac activity). Screen for DIC. If gestational age is less than 16 weeks, do D&C. If gestational age is more than 16 weeks, we can do vaginal delivery with oxytcoin. IMMEDIATELY search for a cause to prevent recurrence of fetal death in next pregnancies.

3) INEVITABLE ABORTION:
the patient presents with lower abdominal cramps, vaginal bleeding, open cervix, concepus is totally INTRAUTERINE. The patient doesn't claim any tissue that dropped down. Do suction & curettage.

4) INCOMPLETE ABORTION:
the same as for inevitable abortion but some of the conceptus is outside the uterus and the remainder is retained inside. Do suction & curettage.

5) COMPLETE ABORTION:
the patient has dropped out all parts of conceptus outside the uterus and the cervix closed. NOTHING is needed EXCEPT a follow up with B-hCG not to miss intrauterine parts.

ATTENTION

ALL patients who are Rh negative and not sensitized MUST receive Anti-Rh (RhoGAM) after each type of abortion