Threatened abortion

Any bleeding other than spotting during early pregnancy may represent a threatened miscarriage.

The incidence of threatened abortion is approximately 25%.

The estimate of the percentage of threatened abortions that progress to pregnancy loss has varied from 10% to 20% or more.

A miscarriage is also be ref2242ed to as a spontaneous abortion.

Vaginal bleeding is common in early pregnancy, as one of every four pregnant women has some bleeding during the first few months.

About half of women with early pregnancy bleeding stop and have a normal pregnancy.

For the other half of these women, cramping and bleeding worsen and they will eventually miscarry.

Threatened abortion is defined as bleeding through the vagina, with a closed cervix, that occurs before the gestational age at which a fetus would be viable outside the uterus.

The bleeding and pain associated with threatened miscarriage are usually mild.

Pain and cramping occur in the lower abdomen, and may be on one side, both sides, or in the middle.

The pain may be ref2242ed to the lower back, buttocks, and genitals.

When a miscarriage is inevitable, the cervical os is open, bleeding is often heavier, and abdominal pain and cramping often occur.

With an incomplete miscarriage the cervical os is open, and the pregnancy is in the process of being expelled.

With an incomplete miscarriage an ultrasound examination may reveal some material that is remaining in the uterus.

With an incomplete miscarriage bleeding may be heavy and abdominal pain is almost always present.

With a complete miscarriage, bleeding and abdominal pain have usually subsided, and products of conception have been passed.

With a complete miscarriage ultrasound reveals an empty uterus.

Symptoms of threatened abortion include vaginal bleeding and abdominal pain.

Bleeding may vary from slight to heavy.

The most common reasons for threatened abortion include the following:

An abnormal fetus is almost always the cause of miscarriages during the first trimester.

Chromosomal abnormalities in the fetus are found in more than half of miscarried fetuses, and the risk of such changes increases with the woman’s age.

Miscarriage during the second trimester is usually related to an abnormality in the mother rather than in the fetus.

Chronic illnesses, are frequent causes of a miscarriage.

Rarely, inadequate hormone production is a cause of miscarriage.

Acute infections: German measles, cytomegalovirus, and mycoplasma can cause miscarriage.

Certain diseases and disorders of female organs can also cause miscarriage:abnormal uterus, fibroids, weakness in the cervix, abnormal growth of the placenta and multiple pregnancy.

Certain drugs, excessive caffeine, alcohol, tobacco, and cocaine, may be the cause.

Pregnancy tests may be run on urine or blood-human chorionic gonadotropin or hCG.

If a miscarriage is inevitable the cervix can be dilated and the contents of the womb extracted by curettage or the woman be monitored as the body expels the pregnancy on its own.

The dilation and curettage procedure involves dilating the uterine cervix so that the endometrium of the uterus can be removed by scraping or suction.

There is no way to predict or prevent miscarriage in most cases.

Human chorionic gonadotropin rises rapidly after implantation of the conceptus and then falls while estrogen and pregnanediol levels rise rapidly for the remainder of pregnancy.

The initial rise in these hormones followed by a premature fall is associated with spontaneous abortion.

In a progesterone trial participants were randomly assigned, in a 1:1 ratio, to receive vaginal suppositories containing either 400 mg of micronized progesterone or matching placebo twice daily.

In threatened abortion the primary outcome, the incidence of live births after at least 34 weeks of gestation, occurred in 75% of the women in a progesterone group and in 72% of the women in the placebo group, which are not different.

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