A few facts about threatened abortion

Overview

Every pregnant woman takes the utmost care of herself and the child to avoid any harm or any chance of abortion.  Even then, the statistics say that even in the United States, there are around 12 abortions per 1,000 women aged between 15 to 44 years. Threatened abortion is a term that is commonly used for vaginal bleeding and other symptoms that indicate that a woman is running a high risk of miscarriage. This generally happens within the first three months or twenty weeks of pregnancy. In general, a case of spontaneous abortion is divided into four stages, which are the threatened, inevitable, incomplete, and complete. There are no distinct lines of separation between the stages that have been determined as yet. It is also a fact that many women experience some amount of vaginal bleeding during the first few weeks of pregnancy. Most of them complete the full term of the pregnancy without any complications.

However, in some cases, vaginal bleeding can be accompanied by severe abdominal cramping and pain in the surrounding area. The bleeding can be mild to moderate in nature. Such a scenario can indicate a higher chance of a miscarriage and a pre-emptive abortion might be required to save the mother. Since the scenario presents the possibility of abortion, it is called threatened abortion or at times, a threatened miscarriage. This is a condition that requires medical attention without any delay. Threatened abortion is common among all races and is most common in women who bear children at an advanced age. Factors like certain chronic illnesses including diabetes and thyroid disorders can increase the risk of threatened abortion. Some research has also pointed out that lifestyle choices including the use of alcohol, tobacco, and illicit drugs can also lead to the scenario.

The causes behind threatened abortion

It is not always possible to know the exact causes that are behind a threatened miscarriage. But there are a few factors that increase the overall risks. These are mentioned below.

• Certain chromosomal problems with the foetus
• Problems with the placenta
• Advanced maternal age, generally over or near 40
• Obesity
• Smoking
• Alcohol use during pregnancy
• Drug use
• Excessive caffeine intake (over 200mg per day)
• Feverish chills, extreme fatigue, physical and mental stress

The diseases that can lead to a threatened miscarriage include unmanaged diabetes, kidney problems, thyroid disorders, and high blood pressure. There can also be structural problems with the uterus, cervix, or ovaries. It has also been found that repeat mothers who have had more than one child have higher risks. There are also a few other factors that can play the role and these include the following.

• Bacterial or viral infection during pregnancy
• trauma to the abdomen
• exposure to certain medications or chemicals

The symptoms of threatened abortion

The common symptoms associated with threatened abortion are also associated with conditions like ectopic pregnancy and molar pregnancy. It is also a common occurrence during normal gestation in many cases. Hence it is very important to study the symptoms and distinguish threatened abortion from other early pregnancy complications. Some of the most common symptoms include the following.

• Bleeding is accompanied by cramping in the abdominal area.
• Pain is experienced in the lower back or the abdominal region. While the pain can be dull in nature in most cases, at times a sharp rise can also occur.
• In some cases, there might be a discharge of some material resembling a clot or a tissue.

In case you have the following symptoms, it is best to contact the doctor at the earliest.

• In case there is a weakness or a feeling of faint. There can also be a fever.
• If there is trouble urinating or a burning sensation while urinating. There can also be a need to urinate frequently.
• If the vaginal bleeding worsens with time.
• Vaginal pain or itching and discharge that is yellow or green.
• Passing something that appears like a piece of tissue

Diagnosis of threatened abortion

The doctors start by trying to find the exact cause behind the vaginal bleeding and check whether the amniotic sac is intact.  A detailed set of questions is asked to ascertain the condition of the patient. Some of the subjects for the questions are listed here for reference.

• When was the last normal period?
• History of pregnancy
• The number of children
• Past miscarriages if any
• Any history of ectopic (tubal) pregnancy?
• The details about the use of any birth control before getting pregnant.
• Did you have an ultrasound yet that shows that the pregnancy is in the right place?
• Any medical problems that are present
• What are the medications that are consumed regularly?

In general, the following steps are taken to diagnose the condition.

• Blood tests and hormonal tests are done to check for infections and measure the hormonal levels in the blood. The overall medical history is also noted down.
• A pelvic exam is also done to check the size of the uterus and to check the cervix for dilation.
• An ultrasound of the uterus is conducted that shows the images of the foetus to find if its heart is still beating. The images of the reproductive organs are studied and the amount of bleeding is also monitored. The entire region is checked for any anomalies.
• β-hCG testing is also done in some cases to make a confirmed diagnosis.

If it is found that the bleeding is originating from the uterus, necessary actions are taken. The doctors also conduct a transvaginal ultrasound in the initial weeks of pregnancy by inserting a probe inside the vagina. The probe emits high-frequency sound waves that result in the generation of higher quality images than the traditional abdomen-based ultrasound. These images are used for a detailed study of the internal structure including that of the foetus. The levels of human chorionic gonadotropin hormone, as well as progesterone, are checked as these play a vital role in supporting pregnancy. A urine analysis can also be done since urinary tract infection (UTI) can play a role in causing abortion.

Treatment

While a miscarriage cannot be prevented in many cases, the doctor can recommend some steps to reduce the overall risk for the same. While recovering from the symptoms, the doctor can also suggest bed rest and avoiding certain physical activities, including sexual intercourse. A treatment plan can also be formed for chronic conditions like diabetes or hypothyroidism which might be responsible for the complications. However, when there are conditions like a chromosomal abnormality, the efficacy of bed rest has not been proven to have any direct positive effects. Since only a small proportion of threatened miscarriages eventually result in an actual miscarriage, statistical data to confirm the benefits of bed rest is not present yet. On the other hand, bed rest is considered safe, free from side effects and it also helps the patient to relax.

Hormonal injections like that of progesterone can be administered to increase hormonal levels. If the patient has Rh-negative blood and the developing baby has Rh-positive blood, the doctor can also administer Rh immunoglobulin. This will prevent the body from producing any antibodies against the blood of the baby. To stop the bleeding, haemostatic drugs and tocolytic agent-based medications are used. Follow-up care is very important and the doctor will plan for the next check-up as required. In some cases, surgical uterine evacuation is needed and this is often done when there are other complications like severe anemia, bleeding disorders, or cardiovascular diseases.

The process of abortion

There are a few types of abortions and these are classified based on how advanced the pregnancy is. In most cases, an abortion is performed by surgical methods and these involve a few steps. In the primary stages of pregnancy, most abortions are performed by using ‘suction aspiration’. This is generally done for patients within the first trimester or first three months of pregnancy. In this process, the cervix is widened or dilated using instruments, and a slim tube is inserted into the uterus. The foetus and the placenta are then withdrawn through a mild process of suction. Finally, the uterus is checked to ensure that it is clean. The process is also known as the dilation and curettage procedure (D&C).

When the pregnancy has passed the three weeks mark, the process is similar in nature but the cervix is dilated by using more elaborate methods. Initially, hormone-blocking tablets can be given to soften the cervix and these take a few hours to act. In the next stage, the cervix is opened by a small amount and a special device is inserted. This device expands in the next few hours and then the cervix is wide enough to allow the abortion to take place. Additional medication is also provided and the entire process may take two to three days.

An abortion done in the first trimester is the safest and it involves the minimum chances of complication. The various complications that can occur include injury to the uterus, the cervix, or any bleeding that can occur from the area. In the case of multiple abortions, the cervix can weaken, resulting in a condition called an ‘incompetent’ cervix. This can give rise to complications during future pregnancies. There can also be a subsequent infection that might require specific treatment. However, since abortions are conducted by experienced doctors in most cases, complications are rare.

Preventing threatened abortion

While a miscarriage cannot be avoided totally, there are some steps that can be taken to ensure a healthy pregnancy. These include the following.

• Abstaining from alcohol and tobacco.
• Not using any illegal or recreational drugs
• Minimum consumption of caffeine
• Avoiding foods that are harmful for your baby
• Do not expose yourself to toxic chemicals or harsh cleaning products
• Treating any viral or bacterial infections in consultation with the doctor
• Taking prenatal vitamins, such as folic acid as advised by the doctor
• Exercising safely at a proper schedule and consuming a healthy diet.
• Regular prenatal care

The condition is best overcome by taking sufficient rest that allows the body to recover. It is also important to listen to your body and realise when it is safe to head back to work or start leading a regular life.

Conclusion

Maintaining a healthy pregnancy and taking care of your health can go a long way in preventing the occurrence of threatened abortions. It is also necessary to keep an eye on the symptoms and reach out for help whenever any problem is faced. Most women who experience a threatened abortion go on to complete their pregnancies and deliver a healthy baby. This is also possible in cases where the cervix is not fully dilated and the foetus is firmly attached to the wall of the uterus. In many other cases, the right level of hormonal therapy can bring the condition of the patient back to normal.

On average 50 percent of the women who experience a threatened abortion do not have a miscarriage. Even if there has been a miscarriage, most women can have a successful pregnancy in the future. In case a patient has undergone multiple miscarriages in a row, the condition requires detailed medical attention. A threatened abortion can be a challenging experience for some patients and can lead to mental anxiety and depression. This is a condition that the doctor needs to be watchful of as it can affect the overall health of the mother and the child. Apart from seeking the right level of medical help, seeking local support groups with whom the condition can be discussed can also be helpful. In some cases, continuous support is needed and the partner of the patient is also included in the psychological care sessions.

While threatened abortion is a condition that can be mentally and physically stressful, it is not something that can lead to an abortion. With the right steps and proper medical help, it will not be an emotional burden for many women in the long run.

References

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