Abortion resident survival guide
Synonyms and keywords: Approach to miscarriage; Approach to pregnancy termination, Abortion workup, Abortion management

# Overview
Abortion refers to pregnancy loss occurring before 20 weeks of gestation. Without external intervention is known as Spontaneous abortion. An example of a life-threatening cause that may result in death or permanent disability within 24 hours if left untreated is a ruptured Ectopic pregnancy. Other causes include chromosomal abnormalities, infections, cervical anomalies, etc. Ultrasound, -HCG, and progesterone levels are helpful in confirming diagnosis and treatment could be conservative, medical, or surgical depending on the cause, presentation, and/or patient's preference. Administer Rhogam to Rh (D) negative mothers, and counsel, accordingly if pregnancy is subsequently desired. Medical management is contraindicated in conditions like severe anemia, bleeding disorders, etc while surgical intervention is not indicated with an unconfirmed diagnosis of spontaneous abortion.

# Causes

## Life Threatening Causes
- Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
Ruptured ectopic pregnancy
Blunt abdominal trauma with hemodynamic instability
- Ruptured ectopic pregnancy
- Blunt abdominal trauma with hemodynamic instability

## Common Causes
- Unknown
- Chromosomal abnormalities such as:
Trisomies
Molar pregnancy
Blighted ovum
- Trisomies
- Molar pregnancy
- Blighted ovum
- Congenital anomalies
- Infections
- Cervical insufficiency
- Abnormalities of the reproductive system e.g. uterine malformations, fibroids especially submucosal.
- Behavioural/lifestyle causes such as illicit drug and alcohol use, smoking
- Environmental such as exposure to radiation
- Uncontrolled chronic diseases (Diabetes, Hypertension, Hypo/Hyperthyroidism, Antiphospholipid syndrome, etc)
- Iatrogenic such as amniocentesis, chorionic villus sampling

# Diagnosis
- Shown below is an algorithm summarizing the diagnosis of Abortion. 

# Treatment
- Shown below is an algorithm summarising the treatment of abortion.

# Do's
- Administer Rhogam to Rh (D) negative mothers and counsel accordingly if pregnancy is subsequently desired.
- Counsel/Reassure patients and their partners when they are available on how to deal with guilt, the grieving process, and handling friends and family.
- Reversible risk factors can be addressed professionally.
- Reassure when the cause is unknown.

# Don'ts
- Contraindications to conservative management/use of uterotonic drugs are:
Severe blood loss leading to anemia
Septicemia or pelvic infections
Shock
Equivocal diagnosis of abortion/desired pregnancy
Presence of bleeding disorder
Ectopic pregnancy
Molar pregnancy
Adverse reaction to uterotonic agents
12 weeks uterine volume
- Severe blood loss leading to anemia
- Septicemia or pelvic infections
- Shock
- Equivocal diagnosis of abortion/desired pregnancy
- Presence of bleeding disorder
- Ectopic pregnancy
- Molar pregnancy
- Adverse reaction to uterotonic agents
- >12 weeks uterine volume
- Surgical management is contraindicated in the following settings:
Presence of bleeding disorder that has not been corrected
Unconfirmed diagnosis of abortion
- Presence of bleeding disorder that has not been corrected
- Unconfirmed diagnosis of abortion