Threatened Abortion

Threatened abortion

Clinical presentation

• Mild vaginal bleeding

• Mild or no lower abdominal pain

• Cervix is closed on digital examination

Investigation

• Check Hb level

Management of threatened abortion in dispensary and health centre

• Adequate bed rest at home

• Avoid strenuous activities and sexual intercourse until all symptoms have subsided

• Schedule a follow-up within 7 days

• Tell the woman to come immediately if:

  • Bleeding becomes heavy

  • Experiences offensive discharge

  • Severe abdominal pain

Referral

Refer to a higher-level health facility with adequate expertise and diagnostics if:

• Bleeding recurs

• Experiences fever

• Experiences offensive discharge

• Experiences severe abdominal pain

Management in higher-level health facilities

• Take a thorough history and perform investigations to establish the causes

• Perform ultrasound to confirm pregnancy, gestational age, foetal viability, and potential causes of abortion

• Admit the patient and manage appropriately

• Encourage bed rest

• For unexplained recurrent miscarriage (3 consecutive abortions) or PRL due to luteal phase defect, manage with:

Pharmacological treatment

Dydrogesterone (PO)

• 40 mg stat, then 10 mg every 24 hours until the bleeding stops for threatened abortion

OR

• 10 mg every 24 hours from conception up to 20 weeks for luteal phase defect.