Threatened Abortion

Definition

Threatened abortion refers to a clinical scenario in early pregnancy characterized by mild vaginal bleeding, with or without lower abdominal pain, but with a closed cervix and all products of conception retained in the uterus. It represents a warning sign that an abortion may occur, but the pregnancy is still potentially viable.

Epidemiology

• Occurs in approximately 20–25% of pregnancies during the first trimester.

• Risk factors include:

  • Maternal age (<20 or >35 years)

  • Previous miscarriage or uterine anomalies

  • Trauma or infections

  • Lifestyle factors (smoking, heavy physical exertion, substance use)

Signs and Symptoms

1. Vaginal bleeding:

   • Mild and intermittent

   • Often spotting, not heavy flow

2. Pain:

   • Mild lower abdominal cramps

   • Occasional lower backache

3. Cervical status:

   • Closed cervix

   • No products of conception visible in the vaginal canal

Investigations

1. Ultrasound scan

   • Confirm gestational age

   • Assess foetal viability (cardiac activity)

2. Full Blood Count (FBC)

   • Assess anaemia from blood loss

3. Infection screening

   • Urinalysis

   • RPR (syphilis)

   • RVD/HIV status

Management

General Measures

• Rest: Discourage excessive physical activity.

• Sexual activity: Avoid coitus during the period of bleeding.

• Counselling: Reassure the patient that most threatened abortions do not result in miscarriage.

• Monitoring: Regular follow-up for ongoing symptoms or complications.

Indications for Admission / Intensive Management

• Foetal death confirmed on ultrasound

• Recurrent or heavy bleeding

• Fever or signs of systemic infection

• Foul-smelling vaginal discharge (possible septic abortion)

• Severe abdominal pain

Medical Management

• No specific pharmacological intervention is usually needed if foetal viability is confirmed and symptoms are mild.

• Progesterone therapy may be considered in selected cases, especially in women with recurrent threatened abortion.

Supportive Care

• Emotional support and counselling for anxiety and fear of pregnancy loss.

• Ensure the patient understands red-flag symptoms requiring urgent attention:

  • Increased bleeding

  • Fever

  • Severe abdominal pain

  • Loss of foetal movements (if gestation >12 weeks)

Prognosis

• Approximately 50–70% of threatened abortions continue to a successful term.

• Early detection and careful monitoring improve maternal and foetal outcomes.

• Timely intervention in cases of non-viable pregnancy or infection prevents complications.

Summary / Key Points

1. Threatened abortion = mild vaginal bleeding + closed cervix + retained products of conception.

2. Ultrasound is the main diagnostic tool to assess viability.

3. Conservative management is usually sufficient; hospitalization is indicated if complications arise.

4. Patient education and reassurance are critical.

5. Red-flag signs (heavy bleeding, fever, foul discharge, severe pain) require immediate medical attention.