A complete miscarriage, also called a complete abortion, refers to a miscarriage in which all the pregnancy tissue is expelled from the uterus. Spontaneous abortion is a loss of pregnancy before the 20th week of pregnancy. Incomplete abortions occur in women who are <20 weeks pregnant. They are more common in women of advanced maternal age and women with lower socioeconomic status, or in women who behave in risky ways. The most frequently affected risk factors and patient population mimic those of spontaneous abortion. Women from third world countries, or those who live in areas with poor access to health care, also have an increased risk of incomplete abortions after a medically or surgically induced abortion. [6] A Danish national study by MÃ ̧lgaard-Nielsen et al. found that 147 of the 3315 women exposed to oral fluconazole at weeks 7 to 22 of gestation had a spontaneous abortion, compared to 563 of the 13,246 unexposed pregnancies. [13, 14] Further assessment of miscarriage also depends on the suspected type based on medical history and physical examination.
Because a missed abortion has no reliable symptoms or signs, it can only be diagnosed by measuring levels of beta-human chorionic gonadotropin (beta-hCG) and pelvic ultrasound. Beta-hCG levels are useful in the beginning because they help determine the likelihood of intrauterine pregnancy. For example, if the beta-hCG level is greater than 1,500-3,000 mIU/ml (the discriminatory level), intrauterine pregnancy should be evident on transvaginal ultrasound. If an intrauterine pregnancy is not observed on ultrasound with beta-hCG above the discriminatory level, early pregnancy loss or ectopic pregnancy should be suspected. [1] [2] [5] [2] [11] [12] Although there is no consensus, a complete abortion is often defined as the absence of a gestational sac on ultrasound with an endometrial band thickness of less than 30 mm. This ultrasound is usually performed 7 to 14 days after the start of medical treatment for spontaneous abortion. Resolution of convulsions and bleeding reported by the patient is also useful to confirm a complete abortion. [2] Beta-hCG levels do not need to be observed at 0 unless the location of pregnancy in the pelvis remains unknown or when persistent bleeding and constitutional symptoms of malignancy raise a suspicion of trophoblastic pregnancy disease. [14] Regardless of the therapeutic approach, patients should be informed of the extent of bleeding that would warrant treatment. [2] This is often defined as soaking two menstrual inserts per hour for two consecutive hours.
[2] [5] Women who are Rh(D)-negative and who are not yet sensitized to Rh(D) factor should receive Rh(D) immunoglobulins within 72 hours of the onset of miscarriage. [2] A dose of 50-120 mcg is recommended in the first trimester and 300 mcg in the second trimester. [15] The most common treatment is expectant and women can expect to continue bleeding for 1 to 2 weeks. Obstetric follow-up is very important for repeated ultrasounds and beta-hCG levels in series to ensure that all design products have been completely excreted. It is also important to educate patients that uncomplicated abortions do not affect future fertility, and ovulation can occur as early as eight days after the expulsion of fetal tissue. [10] In addition to beta-hCG measurement and ultrasound, hemoglobin and hematocrit levels must be achieved to rule out acute anemia with blood loss. If unknown, maternal blood type and Rh status should be determined to prepare for possible blood transfusion or Rh(D) immunoglobulin administration. Since spontaneous abortion can be triggered by infection, wet screening and screening for gonorrhea and chlamydia should also be considered.
[2] [5] [12] This is especially important in septic abortions, where cultures of urine, blood, endocervical secretions and vented products of conception are recommended. [7] Hormonal contraception can be initiated immediately after resolution of early pregnancy loss, including the placement of an intrauterine device, which is only contraindicated in the cessation of septic abortion [2]. Attempting conception is also safe, and couples who attempt conception within three months of a miscarriage experience higher rates of successful pregnancy and live delivery than those who postpone conception. [16] [17] However, the weeks to months following a miscarriage are often accompanied by feelings of grief or even guilt, anxiety and depression for the woman and her partner. Although there is little evidence of the effectiveness of psychological counselling, patients and their families are likely to achieve better outcomes if these emotions and feelings are treated early. [1] A patient with unstable vital signs and heavy bleeding with abnormal hemoglobin needs an emerging obstetric assessment and possible intervention. Stable patients urgently need an obstetric consultation to ensure and ensure close follow-up of the patient. In many cases, the patient should pay attention to repeated quantitative levels of beta-hCG and, if necessary, additional medical or surgical treatment. Patients should also undergo obstetrics for contraception after an abortion. Signs and symptoms: A complete miscarriage is characterized by severe vaginal bleeding, severe abdominal pain, and the passage of pregnancy tissues. With a complete miscarriage, bleeding and pain should disappear quickly.
Complete miscarriages can be confirmed by ultrasound. Patients who have undergone an incomplete abortion usually have a good prognosis and, as expected, can be treated with a success rate of 82% to 96% without any future consequences on fertility. [4] [10] It has been shown that there are no significant differences in the medical and expectant treatment of incomplete abortion when gestational age is less than 12 weeks. Avoiding surgery has also been shown to be beneficial, as there are fewer adverse events. To some extent, the management of spontaneous abortion also depends on the type. However, the expected medical and surgical management has proven to be just as effective in general. Two notable exceptions are excessive bleeding and infection, in this case surgical treatment is preferred. [1] [2] [5] The expected treatment of a missed abortion also shows a variable success rate of 25 to 76%. Therefore, surgical or even medical treatment of a missed abortion is generally accepted as the preferred method of treatment. [3] An impending and unavoidable abortion can be managed in an expected manner, unless the patient requests medical or surgical intervention. An incomplete abortion can also be treated with expectation.
[1] [2] [5] However, it can take up to eight weeks for 80% of women to undergo a complete abortion with expected care alone. As a result, medical treatment of incomplete abortion is becoming more and more common. [2] A complete abortion is unlikely to result in a significant risk of mortality unless there is significant blood loss or infection. Morbidity would be increased if anemia or infection developed. Pregnant patients can bleed quickly and significantly. It is important to distinguish the causes of bleeding during pregnancy. Complete abortion is defined as a “complete” passage of all products of conception. [5] Recurrent abortion is defined as three or more consecutive pregnancy losses. [1] [5] Septic abortion can occur when retained products of conception are infected, which usually occurs in the context of a non-sterile induced abortion.
[7] Other symptoms, such as fever or chills, are more characteristic of the infection, such as septic abortion. Septic abortions must be treated immediately, otherwise they can be life-threatening. The threat of abortion is very common during the first trimester; About 25-30% of all pregnancies have bleeding during pregnancy. Less than half of them perform a full abortion.