Threatened Abortion
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Threatened Abortion

(Threatened Miscarriage; Threatened Pregnancy Loss)

En Español (Spanish Version)

Definition

Threatened abortion is a condition that occurs during the first 20 weeks of pregnancy in which vaginal bleeding suggests an increased risk of miscarriage .

Fetus in First Trimester

Nucleus image

© 2008 Nucleus Medical Art, Inc.

Causes

Early-pregnancy bleeding can originate from the uterus, cervix, or vagina, or it can come from outside the genitals. In many cases, the cause of the bleeding is due to a minor condition that requires no treatment. However, if you experience any vaginal bleeding during your pregnancy, particularly if it is associated with abdominal pain, you should consult your doctor. Possible causes of bleeding include:

  • Implantation of the embryo
  • Infection
  • Irritation (eg, after intercourse)
  • Miscarriage
  • Ectopic pregnancy —the baby starts to develop outside the uterus, such as in a fallopian tube
  • Molar pregnancy—usually benign formations of placental cells (trophoblasts) in the uterus that can spread to nearby tissues and become malignant

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Threatened abortion is common, with about 20-30% of pregnancies being complicated by bleeding in the first 20 weeks. About 10-15% of all established pregnancies ultimately abort (miscarry). Some factors thought to increase the risk of threatened abortion are:

  • Infection
  • Trauma
  • Certain medications
  • Advancing maternal age

Symptoms

The main symptom of threatened abortion is bleeding during the first 20 weeks of pregnancy, with or without abdominal cramping. The bleeding may be light or heavy.

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. Other tests may include:

  • Ultrasound —a test that uses sound waves to examine the body
  • Fetal heart monitoring—a procedure that places electrodes on the abdomen to detect the fetal heart rate (detectable at 8-10 weeks of pregnancy), and determine the strength and duration of uterine contractions
  • Blood tests

Treatment

Talk with your doctor about the best treatment plan for you. Many cases of threatened abortion require no treatment at all. In other cases, treatment options include:

Bed Rest

Your doctor may recommend bed rest if your bleeding is heavy. He or she may also give you instructions on limiting your activity.

Medications

Your doctor may prescribe progesterone , which is a female hormone that supports a pregnancy. It can also relax your uterus if you are experiencing a cramping uterus. Buphenine hydrochloride is another medication that can be used to relax your uterus.

Finally, if your blood is Rh-negative , and your partner is RH + your doctor may give you anti-D immunoglobulin. This will prevent your body from producing antibodies against your fetus' blood.

Prevention

There is usually no way to prevent a threatened abortion. But things you can do to increase your chance of having a healthy pregnancy include:

  • Avoid alcohol, cigarettes, and illegal drugs
  • Limit caffeine intake
  • Control any medical conditions such as diabetes and hypothyroidism
  • Talk with your doctor before taking medications to ensure they are safe during pregnancy
  • Diagnose and treat infection (eg, bacterial vaginosis , gonorrhea ) as early as possible
  • Avoid contact with toxins (eg, arsenic, lead, polyurethane, heavy metals, organic solvents)
  • Get regular prenatal care

RESOURCES:

American College of Obstetricians and Gynecologists
http://www.acog.org

American Pregnancy Association
http://www.americanpregnancy.org

CANADIAN RESOURCES:

Canadian Association of Pregnancy Support Services
http://www.capss.com

Canadian Parents
http://www.canadianparents.com

References:

Bleeding during pregnancy. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/pregnancycomplications/bleedingduringpreg.html . Accessed July 3, 2007.

Griebel CP, Halvorsen J, Golemon TB, Day AA. Management of spontaneous abortion. Am Fam Physician . 2005;72:1243-1250.

Sotirladis A, Papatheodorou S, Makrydimas G. Threatened miscarriage: evaluation and management. BMJ . 2004;329:152-155.



Last reviewed April 2008 by Ganson Purcell Jr., MD, FACOG, FACPE

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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