Abortion/miscarriage

Abortion is the removal or destruction of an embryo or fetus before birth. It may be spontaneous or induced.

Types of Abortion:
1. Spontaneous abortion or miscarriages
- is a type of abortion that occur without medical or other intervention.  About 90% of miscarriages occur during the first trimester (first three months, or 12 weeks of pregnancy).

Symptoms of Miscarriage:

• A typical 10^th week miscarriage is characterized by a very heavy menstrual period. A pregnant woman may experience several days of bleeding and cramps before the contents of the uterus are removed, followed by a short period of bleeding until the lining of the uterus heals.
• Miscarriage after the 12^th week is like a mild version of the labor of during childbirth, with strong contractions that dilate the cervix and expel the fetus.
• Miscarriages between the 13^th and 24^th weeks (second trimester) are most often caused by faulty attachment of the placenta to the walls of the uterus or from a weak cervix that dilates too soon.

Medical names of the various stages of actual or possible miscarriages:

• Threatened abortion is a condition of pregnancy, occurring before the 20^th week of gestation, the patient usually experiences vaginal bleeding with or without some cramps, and the cervix is closed.

• Inevitable abortion is when the bleeding continues and becomes heavy, it usually means that the cervix is dilating and the contents of the uterus are being expelled. Pregnant women will experience lower abdominal cramping and bleeding.

• Complete abortion is when all the contents are expelled.  

• Incomplete abortion is a name given to abortion where the uterus retains part or all of the placenta. Bleeding may occur because part of the placenta may adhere to the uterine wall and the uterus does not contract to seal the large blood vessels that feed the placenta. 

• Missed abortion - is a case in which an intrauterine pregnancy is present but is no longer developing normally. 

2. Induced abortion
- this type of abortion uses drugs or instruments to stop the normal course of pregnancy.

Different methods for performing abortions:

• Menstrual Extraction (endometrial or vacuum aspiration). This method is used for most abortions performed during the first trimester(about 8 weeks). It is done by suctioning out the lining of the uterus (endometrium) through a thin opening of the undilated cervix.

 

• Dilation and Evacuation (D & E) (also called vacuum suction or suction curettage) and Dilation and Curettage (D & C). This method is commonly used for late first trimester or early second trimester abortions. Some doctors use a hollow, spoon-shaped knife, or curette, to ensure that all the placental tissues are removed by scraping the uterine walls.

• Prostaglandin or Saline Administration. This method is done by injecting prostaglandins or saline solution through the uterine wall and into the amniotic sac holding the fetus to induce labor and delivery of a nonviable fetus. This procedure is commonly used for second trimester abortions.

• Hysterotomy. The uterus is opened through a small abdominal incision and the fetus is removed. Hysterotomy is usually performed only when other methods have failed repeatedly, it is performed under general anesthesia. It is used between the 12^th and the 24^th week of pregnancy. 

Causes of the abortion

• Spontaneous
• Uterine anatomy(not suitable for fetus to implant)
• Luteal phase defect ( inadequate secretion of progesterone cause infertility)
• Fetal genetic anomalies
• Incompetent cervix (dilatation of cervix during pregnancy)
• Infections
• Antifetal antibodies
• Alloimmune disease 
• Radiation
• Intrauterine contraceptive device (IUCD)
• smoking
• Alcohol ingestion
• Heavy caffeine consumption 
• Antiphospholipid antibodies
• ectopic pregnancy (fetus implant somewhere other than uterus)
• molar pregnancy (tissue that normally becomes a fetus instead becomes a growth,called mole)
• dysfunction of uterine

Habitual abortion, recurrent miscarriage or recurrent pregnancy loss (RPL) is the occurrence of three or more pregnancies that end in miscarriage of the fetus, usually before 20 weeks of gestation.