Spontaneous abortion, or miscarriage, comes in many forms. From first-trimester bleeding to ectopic pregnancy, find out what to look for.
From its use in social issue and public policy debates, the word abortion is often assumed to mean elective termination, but the word technically refers to any interruption of a pregnancy, including spontaneous miscarriages. Under the heading of abortion, there are several designations that are clinically important.
Threatened Abortion—Threatened Miscarriage
It is most frightening for a woman to experience bleeding in the first part of her pregnancy. First trimester bleeding is any bleeding noted during the first 12 weeks, and it is one of the most common symptoms that sends a woman to her obstetrician. And rightly so, because until a non-threatening cause is identified, all first trimester bleeding is labeled “threatened miscarriage,” or “threatened AB.”
Serial hCG levels can determine well-being or danger. Ultrasound is also important following such a condition.
This refers to a pregnancy that is no longer viable but hasn’t passed or caused any bleeding yet. In a missed abortion, either waiting to see if a complete miscarriage occurs or jumping right to dilation and curettage (D&C;) are all acceptable options. If you wait, however, there has to be a time limit, as infection or clotting disorders may complicate matters.
Inevitable Abortion—Inevitable Miscarriage
When the cervix begins to dilate (a sure sign of impending expulsion of the fetus from the uterus) but before actual expulsion has begun. Sometimes this is the result of an incompetent cervix.
Complete Abortion—Complete Miscarriage
A miscarriage is considered “complete” when the entire gestational sac, placental tissue, and fetus are expelled. No further treatment is necessary. Yet, when in doubt, doctors usually lean to doing the D&C.; It can be done at any time that it’s felt there’s been incomplete emptying, and sometimes this diagnosis takes time to make. Following hCG levels until they fall to a certain level is common.
Septic Abortion—Septic Miscarriage
Any type of miscarriage associated with an infection of remaining pregnancy tissue or of the uterus itself is considered septic. Additional symptoms may include fever, chills, and foul-smelling discharge. This kind of miscarriage calls for urgent care (usually IV antibiotics) to prevent damage to the uterus, tubes, or ovaries.
This is a pregnancy that implants anywhere but the right place, the uterus. Most ectopic pregnancies are in the fallopian tubes, but they can be seen in the pelvis, ovary, and even the higher abdomen. Since most ectopic pregnancies are in the tube, diagnosis is often easy. The tube has a limited capacity for the growing process and will quickly stretch enough to cause pain.
The very rare ectopic pregnancy, in the pelvis for example, may get further along before there are symptoms of trouble, making blood loss worse with surgical treatment. Non-surgical treatments are also available.
This type of conception spans the gamut of looking nothing like a pregnancy to looking a lot like a normal pregnancy (sometimes called “incomplete mole”). It occurs when something goes amiss in the fertilization process, resulting in cells that would make up a placenta, but with no fetus or, in an incomplete mole, cells of a placenta and a fetus with such severe abnormalities that it could not survive.
Molar pregnancy is actually a tumor of pregnancy tissue, but usually only pre-cancerous. Thankfully, molar pregnancies are fairly rare.