Threatened/Spontaneous Abortion

Definition/Etiology:

• Threatened abortion occurs when a pregnant patient less than 20 weeks’ gestation has vaginal bleeding. Usually due to a chromosomal abnormality.
• In a spontaneous abortion, the cervical os is open, products of conception may be expelled or there may be no fetal heartbeat.

Pathophysiology:

• Threatened abortion: The cervical os remains closed and therefore does not meet criteria for a spontaneous abortion. More than half of all threatened abortions will eventually abort.
• Spontaneous abortion – cervical os is open and fetus/products of conception may be expelled.

Clinical Presentation:

• Vaginal bleeding
• Abdominal Pain/cramping
• Positive pregnancy test/ beta hCG

Collaborative Management:

• Ultrasound
• Determine fetal cardiac activity
• Beta hCG to ensure appropriate progression
• CBC to ensure there is no elevated WBC
• Type and Screen
• D&C may be needed with a spontaneous abortion that has not fully evacuated
• Pitocin may be used if incomplete abortion. Antibiotics may be used in the case of septic abortion

Evaluation | Patient Monitoring | Education:

• Avoid strenuous activity
  • Pelvic rest
• Bed rest has not been found to prevent a threatened abortion from progressing towards a spontaneous abortion, so it is usually not recommended

Linchpins: (Key Points)

• Threatened abortion is the chance of an abortion due to vaginal bleeding but is not actually aborting at this point
• Spontaneous abortion =unviable pregnancy.
• Monitor for sepsis
• Don’t forget the RhoGAM!