Abortion is a common condition in obstetrics and gynecology. Upon experiencing abortion symptoms, timely and appropriate management should be implemented based on the specific type of abortion.
1. Threatened Abortion
Rest is essential, sexual intercourse should be avoided, and vaginal examinations must be performed gently. For patients with insufficient luteal function, progesterone supplementation may be administered to help preserve the pregnancy. Additionally, vitamin E and low-dose thyroxine (for hypothyroid patients) may be prescribed.Psychological support is crucial for patients with threatened abortion to stabilize emotions and boost confidence. If symptoms persist or worsen despite treatment, it may indicate embryonic abnormalities. Conduct B-mode ultrasound and β-HCG testing to assess the embryo's condition and determine appropriate management, including termination of pregnancy if necessary.Inevitable Abortion
Once confirmed, complete expulsion of the embryo and placental tissue should be facilitated as soon as possible. For early abortion, prompt vacuum aspiration should be performed, with careful examination of the products of conception and submission for pathological analysis. In late abortion, where uterine enlargement complicates aspiration or curettage, intravenous infusion of 10 units of oxytocin in 500 ml of 1% glucose solution may be administered to induce uterine contractions.After fetal and placental expulsion, verify completeness and perform curettage if necessary to remove residual products of conception. 3. Incomplete Abortion Upon confirmation, promptly perform curettage or forceps evacuation to remove retained tissue. Administer blood transfusions and intravenous fluids for severe hemorrhage with shock, along with antibiotics for infection prevention.
4. Complete Abortion
No special treatment is generally required if there are no signs of infection.
5. Missed Abortion
Management is more challenging. The placental tissue may undergo organization, adhering tightly to the uterine wall and complicating curettage. Prolonged retention may cause coagulation disorders, leading to disseminated intravascular coagulation (DIC) and severe hemorrhage.Prior to management, perform complete blood count, bleeding/clotting times, platelet count, fibrinogen level, prothrombin time, clot retraction test, and plasma protamine sulfate (3P) test. Prepare for blood transfusion if indicated.
For uteri smaller than 12 weeks gestation: Curettage may be performed, with uterotonic agents administered intraoperatively to minimize bleeding. If the placenta is organized and tightly adherent to the uterine wall, the procedure requires particular caution to prevent perforation. If complete evacuation is not achieved in one session, repeat curettage may be performed after 5–7 days.For uteri larger than 12 weeks gestation, administer oxytocin intravenously. Prostaglandins or isoxazoline may also be used to induce labor and facilitate expulsion of the fetus and placenta. If coagulation disorders are present, promptly administer heparin, fibrinogen, and fresh blood transfusions. Proceed with induction or curettage only after coagulation function has improved.
6. Habitual Abortion
Women with a history of habitual abortion should undergo necessary preconception examinations, including ovarian function tests, chromosomal analysis for both partners, blood typing, and semen analysis for the husband. The female partner should also receive a detailed reproductive tract examination to assess uterine abnormalities or pathologies and check for cervical incompetence.If causes are identified and correctable, treatment should be completed before conception.
7. Infection Following Abortion Infection following abortion typically results from incomplete abortion complicated by infection. Treatment principles emphasize aggressive infection control. If vaginal bleeding is minimal, administer broad-spectrum antibiotics for 2–3 days. After infection is controlled, perform curettage to remove residual uterine tissue and stop bleeding.
For heavy vaginal bleeding, administer broad-spectrum antibiotics intravenously and perform blood transfusion concurrently. Use an ovular forceps to remove residual tissue from the uterine cavity to reduce bleeding. Avoid using curettes for comprehensive scraping of the uterine cavity to prevent spreading infection.Continue antibiotic therapy postoperatively, performing a thorough curettage only after infection control is achieved. For patients with septic shock, actively correct the shock. If infection is severe or abscesses form in the abdomen or pelvis, perform surgical drainage and consider hysterectomy if necessary.