II. The clinical and laboratory differentiation of spontaneous and induced abortion

Abstract 1. 1. To differentiate abortion from other pelvic conditions is not always easy. Thirteen per cent of this series were erroneously diagnosed on admission. Without curettage, probably half of these errors in diagnosis would have remained unrectified. 2. 2. To differentiate induced from spontaneous abortion is often impossible. No effort should be spared, however, in the attempt to learn the circumstances surrounding the interruption of pregnancy, since these have the greatest significance for prognosis. In this series the mortality in 10 cases admitting induction by a midwife was 30 per cent; in 13 cases induced by a physician it was 7.7 per cent; in 478 cases claiming self-induction or spontaneous abortion it was nil. 3. 3. “Drug-induced” seems to be practically synonymous with spontaneous abortion, by every criterion except the purely psychologic. The two groups correspond closely in laboratory findings, clinical course, and outcome. 4. 4. Thirty-three per cent of previously gravid patients who claimed to have had spontaneous abortions at this time gave a history of previous spontaneous abortion. Only 5 per cent of the comparable group who admitted mechanical induction gave such a history. 5. 5. Induced abortion has been said to favor spontaneous abortion in subsequent pregnancies. In this series only 5 per cent of patients who claimed that the present abortion was spontaneous gave a history of past induction. 6. 6. Spontaneous abortion was no more frequent in first pregnancies than in those of higher order. Induced abortion increased with order of pregnancy. That is, the probability of an abortion being induced, all things being equal, increases with the number of pregnancies the woman has previously undergone. This does not apply to pregnancies of very high order (10 or more). Of these there were too few in the present series to furnish a basis for conclusion. 7. 7. Low sedimentation rate, fever, leucocytosis and acute inflammation of the decidua and chorion were found to be more frequently associated with mechanically induced abortion than with drug-induced or spontaneous. These evidences of infection were, however, by no means confined to the former group. 8. 8. The Wassermann test was positive in 5 per cent of drug-induced and of spontaneous, in only 1 per cent of mechanically induced abortions. 9. 9. Low hemoglobin determinations were not significantly more frequent in any one category than in the others. 10. 10. Bacteriology showed little correlation with history in this series. The fact that here cervical culture cast scant light on differential diagnosis or prognosis should not lead to the conclusion that it is of no value. Infection with the virulent hemolytic streptococcus is relatively rare (it did not appear in this series), but its prompt recognition is of vital importance. 11. 11. Curettage was performed in 59 per cent of the mechanically induced group, 68 per cent of the drug-induced, and 71 per cent of those claiming spontaneous abortion. Operative mortality was 0.6 per cent. Average stay in the hospital of curetted patients was five to seven days.