See also:
Vaginal bleeding Ddx
Medical abortion
Hx
Pregnant patient
Lower abdominal pain
Vaginal bleeding
Workup
Pelvic exam
Urine hCG
U/S-pelvis
CBC
PT/PTT
Quantitative serum hCG
Missed abortion
Document the absence of fetal heart movement on ultrasound.
May get coagulation studies as retained products of conception (POC) can rarely cause coagulopathy.
Ensure that there is complete elimination of the POC from the uterus, this may be done:
Surgically with dilation and curettage
Medically with vaginal misoprostol or PO mifepristone (RU486)
Expectantly by simply monitoring the mother with serial imaging
Complete abortion
A form of spontaneous abortion where the whole conceptus passes through the cervix.
The cervix then closes, and the associated pain and uterine contractions subside.
Ultrasonography shows an empty uterus.
Incomplete abortion
Implies the evacuation of some of the fetal tissue while the remainder is retained in the uterine cavity.
Threatened abortion
Refers to any hemorrhage from the uterine cavity occurring before the 20th week of gestation with a live fetus.
The cervix is closed and there is no passage of fetal tissue.
Mild lower abdominal pain may be noted, and the fetal heart is active on ultrasound.
Inevitable abortion
Presents as
Vaginal bleeding
Lower abdominal cramps
Dilated cervix
Ultrasonography demonstrates a ruptured or collapsed gestational sac with absence of fetal cardiac motion
