A Brief Discussion on Different Types of Abortion/Miscarriage.

Spontaneous Miscarriage is associated with

• vaginal bleeding an abdominal discomfort. 
• Severe pain, 
• heavy bleeding, 
• passage of clots or tissue, and 
• hypotension may also be present. 

Threatened Abortion: Mild cramping an vaginal bleeding that are not accompanied by passage of tissue or cervical dilation constitutes a threatened abortion.

Inevitable Abortion: Uterine cramping with progressive cervical dilation indicates an inevitable abortion.

Incomplete Abortion: An incomplete abortion is diagnosed when some products of conception (POC) have passed, while other retained intrauterine tissue leads to ongoing symptoms.

Septic Abortion: Fever, leukocytosis, pelvic tenderness, and malodorous cervical discharge suggest a septic abortion.

Completed Abortion: is characterized by the passage of confirmed POC, followed by resolution of bleeding and closure of the cervical os. Large blood clots or intrauterine decidual casts may be mistaken for POC and their presence cannot be use to rule out ectopic pregnancy.

Management: 

• Immediately obtain large-bore intravenous access an institute aggressive fluid resuscitation for any patient with severe pain, heavy bleeding, or hypovolemia. Also request cross-matched blood an urgent gynecologic consultation. 
• Stable patients can undergo routine Emergency department evaluation with complete blood count (CBC), human chorionic gonadotrophin (hCG), pelvic exam, and ultrasoun (US). 
• Send all identified tissue to pathology for definitive identification. 
• Ectopic pregnancy must be ruled out by US, close clinical follow-up, and serial hCG testing
• Administer anti-Rh immunoglobulin (RhoGAM) in all cases of vaginal bleeding where the mother is Rh-negative.

Points To Remember
1. The passage of large clots usually indicates rapid heavy bleeding.
2. Heterotopic pregnancy is rare, but should be considerde in patients with significant ongoing symptoms despite identification of a viable early intrauterine pregnancy (IUP).
3. Septic abortion may extendto the surrounding tissues or blood , with the potential for septic shock, ARDS, DIC, and group A strep induced toxic shock syndrome.