Inevitable abortion

Inevitable abortion

Abortion is said to be inevitable when it is not possible for the pregnancy to continue and the cervix is dilated, but all the products of conception are in situ.

Clinical presentation

• Moderate or severe per vaginal bleeding

• Moderate or severe lower abdominal pain

• Membranes may be intact or ruptured with leakage of fluid

• The uterine fundal height may correspond with gestational age

• The cervix is dilated

Management of inevitable abortion in dispensary and health centre (BEmONC facilities)

• Apply Airway, Breathing, Circulation and Dehydration (ABCD) principles of resuscitation

• Give compound sodium lactate (IV) or 0.9% sodium chloride (IV), depending on the amount of blood loss

• Perform Manual Vacuum Aspiration (MVA) if gestational age is below 12 weeks

• Augment the process by administering oxytocin 20 IU in 500 mL RL/NS at 40–60 drops/minute if gestational age is above 12 weeks

• Manage as incomplete abortion if, after augmentation, some products of conception remain in the uterus

• Manage as complete abortion if all products of conception are expelled

Referral

Refer to a hospital if:

• MVA is not possible

• Bleeding is persistent or severe enough to necessitate blood transfusion

Management of inevitable abortion in the hospital

• Apply Airway, Breathing, Circulation and Dehydration (ABCD) principles of resuscitation

• Obtain blood samples for Hb, grouping, and cross-matching

• Give compound sodium lactate (IV) or 0.9% sodium chloride (IV), aiming to replace three times the amount of estimated blood loss

• Give blood transfusion if indicated

• Perform Manual Vacuum Aspiration (MVA) if gestational age is below 12 weeks

• Augment the process by administering oxytocin 20 IU in 500 mL RL/NS at 40–60 drops/minute if gestational age is above 12 weeks

• Manage as incomplete abortion if, after augmentation, some products of conception remain in the uterus

• Manage as complete abortion if all products of conception are expelled.