Successful management of spontaneous abortion depends upon early diagnosis. Every patient should receive a general physical examination, and a complete history should be taken. Laboratory studies should include a complete blood count, blood typing, and cervical cultures to determine pathogens in case of infection.
If the diagnosis of threatened abortion is made, bed rest and pelvic rest is typically recommended, although neither has been shown to be helpful in preventing subsequent miscarriage. Prognosis is good when bleeding and/or cramping resolve. D&C may be necessary if significant bleeding persists or if products of conception are retained.
If the diagnosis of inevitable or incomplete abortion is made, evacuation of the uterus by suction D&C should be promptly performed. A type and cross-match for possible blood transfusion and determination of Rh status should be obtained. The prognosis for the mother is excellent if the retained tissue is promptly and completely evacuated.
If the diagnosis of complete abortion is made, the patient should be observed for further bleeding. The products of conception should be examined. As with inevitable and incomplete abortion, the prognosis for the mother is excellent.
If abortion has occurred after the first trimester, hospitalization should be considered. Oxytocics are helpful in contracting the uterus, limiting blood loss, and aiding in expulsion of clots and tissue. Ergot preparations, which contract the cervix as well as the uterus, may also be given if needed. A D&C may be necessary if significant bleeding persists or if products of conception are retained.
Uterine perforation may be manifested by signs of intraperitoneal bleeding, rupture of the bowel or bladder, or peritonitis. Oftentimes, there are no clinical signs and no sequelae. When uterine perforation is suspected, however, laparoscopy and/or laparotomy is indicated to determine the extent of laceration or bowel injury.
Revision date: June 11, 2011
Last revised: by Janet A. Staessen, MD, PhD