Abortion: Types, Causes, Symptoms, Diagnosis, Prevention, and Treatment
Introduction
Abortion is a medical term that refers to the termination of pregnancy before the fetus can survive outside the uterus. It can occur spontaneously (miscarriage) or be induced intentionally for medical or personal reasons. Abortion has been practiced for centuries and remains one of the most debated topics globally, involving ethical, legal, and health considerations.
From a medical standpoint, abortion may be performed to save a woman’s life, prevent complications, or remove a non-viable fetus. However, unsafe abortions remain a major cause of maternal morbidity and mortality, especially in developing countries. Understanding the types, causes, signs, diagnosis, prevention, and treatment is vital for women’s reproductive health and safety.
What is Abortion?
Abortion is defined as the termination of pregnancy before 20 weeks of gestation (or before the fetus reaches viability, around 500 grams). When it occurs naturally, it’s called spontaneous abortion (miscarriage); when medically or surgically induced, it’s known as induced abortion.
The World Health Organization (WHO) defines abortion as the expulsion or extraction of an embryo or fetus weighing less than 500 grams or before 22 completed weeks of gestation.
Types of Abortion
Abortion is classified based on whether it occurs naturally or is induced intentionally.
1. Spontaneous Abortion (Miscarriage)
This occurs naturally without any medical intervention. It is often due to genetic, hormonal, or anatomical causes. Spontaneous abortions are common in early pregnancy and may go unnoticed in some women.
Types of Spontaneous Abortion
1. Threatened Abortion – Vaginal bleeding occurs, but the cervix remains closed, and the pregnancy may still continue.
2. Inevitable Abortion – The cervix opens, bleeding increases, and abortion cannot be stopped.
3. Incomplete Abortion – Only part of the pregnancy tissue is expelled; the rest remains inside the uterus.
4. Complete Abortion – All pregnancy tissue is expelled, and bleeding stops.
5. Missed Abortion – The fetus dies but is retained inside the uterus for several weeks without symptoms.
6. Septic Abortion – Occurs when abortion is complicated by infection, often due to unsafe or unhygienic practices.
7. Recurrent (Habitual) Abortion – Occurs when a woman has three or more consecutive miscarriages, usually due to hormonal or anatomical issues.
2. Induced Abortion
Induced abortion refers to the deliberate termination of pregnancy by medical or surgical means.
Types of Induced Abortion
1. Medical Abortion – Uses medications to terminate early pregnancies (up to 9 weeks usually).
• Drugs used: Mifepristone and Misoprostol.
• Mechanism: Mifepristone blocks progesterone, while Misoprostol induces uterine contractions to expel the embryo.
2. Surgical Abortion – A medical procedure performed by trained professionals to remove pregnancy tissue.
• Vacuum Aspiration (Suction Curettage): Used up to 14 weeks of pregnancy.
• Dilation and Evacuation (D&E): Used in the second trimester (14–24 weeks).
• Dilation and Curettage (D&C): Involves scraping the uterine lining.
Hysterotomy or Hysterectomy: Rarely performed in severe or life-threatening cases.
Causes of Abortion
The causes of abortion vary depending on whether it is spontaneous or induced.
1. Causes of Spontaneous Abortion
• Genetic abnormalities in the embryo (most common cause).
• Hormonal imbalance, especially low progesterone levels.
• Maternal infections (e.g., rubella, cytomegalovirus, syphilis, toxoplasmosis).
• Chronic medical conditions like diabetes, hypertension, thyroid disorders, or lupus.
• Uterine abnormalities, such as fibroids, septate uterus, or cervical incompetence.
• Immune disorders that cause rejection of the embryo.
• Lifestyle factors – smoking, alcohol, drugs, malnutrition, or exposure to toxins.
• Trauma or stress.
Advanced maternal age (above 35 years).
2. Causes of Induced Abortion
• Unplanned or unwanted pregnancy.
• Pregnancy resulting from rape or incest.
• Risk to the mother’s life or health.
• Fetal anomalies or genetic defects incompatible with life.
• Socioeconomic reasons, such as inability to care for a child.
• Contraceptive failure.
Signs and Symptoms of Abortion
Recognizing the early signs of abortion helps in preventing complications. Symptoms vary based on the stage and type of abortion.
Common Signs and Symptoms
1. Vaginal bleeding or spotting – May be light or heavy.
2. Lower abdominal cramps or pain – Similar to menstrual cramps.
3. Passage of clots or tissue from the vagina.
4. Back pain or pelvic discomfort.
5. Fever and chills – Indicate infection, especially in septic abortion.
6. Decreased pregnancy symptoms such as reduced breast tenderness or nausea.
7. Foul-smelling vaginal discharge.
8. Open cervix detected during pelvic examination.
Diagnosis of Abortion
Accurate diagnosis is essential to confirm abortion and rule out other causes of bleeding during pregnancy.
1. Medical History and Physical Examination
The doctor will ask about symptoms, duration of pregnancy, and any history of previous abortions or miscarriages. A pelvic examination checks cervical dilation, uterine size, and bleeding.
2. Ultrasound Examination
Confirms whether the fetus is alive or dead.
• Detects retained products of conception.
• Differentiates between threatened, incomplete, or missed abortion.
3. Laboratory Tests
• Pregnancy test (hCG levels) – Declining levels indicate abortion.
• Hemoglobin and hematocrit – To assess blood loss.
• Rh typing – Important for Rh-negative women to prevent isoimmunization.
• Infection markers – WBC count and CRP in septic cases.
4. Histopathological Examination
Tissue expelled during abortion may be examined to confirm products of conception and rule out molar pregnancy or ectopic pregnancy.
Prevention of Abortion
While not all abortions can be prevented, several measures help reduce the risk of miscarriage and complications.
1. Maintain a Healthy Lifestyle
• Eat a balanced diet rich in vitamins and minerals.
• Avoid smoking, alcohol, and illicit drugs.
• Stay hydrated and maintain a healthy weight.
2. Manage Chronic Conditions
• Control diabetes, thyroid disorders, or hypertension before and during pregnancy.
• Regularly monitor and follow up with healthcare providers.
3. Avoid Infections
• Practice safe sex to prevent STDs.
• Get vaccinated for rubella and influenza.
• Maintain personal hygiene.
4. Prenatal Care
• Attend all antenatal visits.
• Take prenatal vitamins, especially folic acid.
• Avoid unnecessary medications or self-medication.
5. Avoid Unsafe Abortions
• Seek medical help from certified practitioners.
• Avoid traditional or illegal methods of terminating pregnancy.
6. Manage Stress
Emotional stress can affect pregnancy hormones, so relaxation techniques and counseling may help.
Treatment of Abortion
Treatment depends on the type and severity of abortion and whether it is complete, incomplete, or missed.
1. Medical Management
• Misoprostol and Mifepristone: Used to induce abortion in early pregnancy (medical abortion).
• For incomplete abortion, medications help expel remaining tissue.
2. Surgical Management
• Manual Vacuum Aspiration (MVA) or Dilation and Curettage (D&C) to remove retained tissue.
• Dilation and Evacuation (D&E) for second-trimester cases.
• Hysterectomy in rare, life-threatening situations.
3. Antibiotic Therapy
In cases of septic abortion, broad-spectrum antibiotics (e.g., ampicillin, gentamicin, metronidazole) are administered.
4. Rh Immunoglobulin
Given to Rh-negative women after abortion to prevent Rh incompatibility in future pregnancies.
5. Supportive Care
• Fluid replacement in case of dehydration or blood loss.
• Blood transfusion if necessary.
• Psychological counseling for emotional recovery.
6. Follow-Up Care
Regular follow-up is essential to:
• Confirm complete evacuation of the uterus.
• Monitor recovery.
• Discuss contraceptive options to avoid unintended pregnancy.
Complications of Abortion
Although safe when performed medically, abortion can lead to complications, especially if unsafe methods are used.
Common Complications
• Excessive bleeding (hemorrhage)
• Uterine infection (endometritis)
• Incomplete evacuation of uterus
• Uterine perforation
• Pelvic inflammatory disease (PID)
• Infertility
• Psychological trauma
• Death (rare but possible in unsafe abortions)
Legal and Ethical Aspects of Abortion
Abortion laws vary across countries. In India, abortion is regulated under the Medical Termination of Pregnancy (MTP) Act, which allows termination up to 24 weeks under specific medical, social, or humanitarian conditions.
Ethically, abortion raises debates around women’s rights, fetal life, and religious beliefs, making it essential to balance medical safety, personal autonomy, and moral considerations.
Recovery After Abortion
• Recovery depends on the type of abortion and the woman’s overall health.
• Physical Recovery
• Rest for a few days.
• Expect light bleeding or spotting for 1–2 weeks.
• Avoid intercourse and tampons until bleeding stops.
• Take prescribed antibiotics and painkillers.
Emotional Recovery
Emotional healing is equally important. Women may feel sadness, guilt, or relief. Counseling or support groups can be beneficial.
When to Seek Medical Help
• Immediate medical attention is required if a woman experiences:
• Heavy bleeding (soaking more than 2 pads/hour)
• Foul-smelling discharge
• High fever or chills
• Severe abdominal pain
• Dizziness or fainting
FAQs on Abortion
1. What is the safest method of abortion?
The safest methods are medical abortion (Mifepristone + Misoprostol) for early pregnancies and vacuum aspiration for up to 14 weeks when performed by qualified professionals.
2. Is abortion legal in India?
Yes. Under the MTP Act, abortion is legal up to 24 weeks for medical, social, or humanitarian reasons.
3. Can abortion affect future fertility?
When done safely by professionals, abortion usually does not affect fertility. However, unsafe abortions can cause infections or damage to the uterus, leading to infertility.
4. How long does it take to recover after an abortion?
Most women recover physically within 1–2 weeks, though emotional recovery may take longer.
5. What are the risks of unsafe abortion?
Unsafe abortions can lead to infection, excessive bleeding, uterine perforation, infertility, or even death.
6. Can natural remedies induce abortion safely?
No. Using herbs or unsafe home methods is extremely dangerous and can cause serious complications or death.
7. How can abortion be prevented?
Preventing unintended pregnancies through effective contraception, sex education, and early prenatal care helps reduce abortion rates.
Conclusion
Abortion is a complex issue with medical, ethical, and emotional dimensions. While it can be a necessary medical procedure in certain situations, ensuring safe and legal abortion services is crucial for protecting women’s health. Education, awareness, and access to reproductive healthcare play key roles in preventing unsafe abortions and reducing maternal mortality.
By understanding the types, causes, signs, diagnosis, prevention, and treatment, women can make informed decisions about their reproductive health and ensure better outcomes for themselves and their families.
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Writer: Vandita Singh, Lucknow (GS India Nursing Group)