Inevitable Abortion 

Definition

Inevitable abortion occurs when the cervix is dilated and expulsion of products of conception is imminent, making continuation of the pregnancy impossible, though all products of conception are still in the uterus. It represents a progressive miscarriage that will inevitably result in pregnancy loss.

Etiology / Risk Factors

• Chromosomal abnormalities of the embryo

• Uterine anomalies (e.g., septate or bicornuate uterus)

• Infection (e.g., bacterial vaginosis, chlamydia)

• Maternal chronic conditions (e.g., diabetes, thyroid disorders)

• Trauma or excessive uterine activity

• Lifestyle factors: smoking, alcohol, substance use

Signs and Symptoms

1. Vaginal bleeding

   • Moderate to severe, often with clots

2. Pain

   • Severe lower abdominal cramps

   • Continuous uterine contractions

3. Cervical status

   • Dilated, indicating imminent expulsion

4. Membrane status

   • May be ruptured with draining amniotic fluid, or intact

5. Fundal height

   • May correspond with gestational age

6. Other

   • Evidence of uterine contractions

   • Anxiety and distress in the patient

Investigations

1. Full Blood Count (FBC)

   • Assess for anaemia from blood loss

2. Blood Group and Cross-match

   • Prepare for possible transfusion if bleeding is significant

3. Ultrasound (optional)

   • Confirm gestational age, detect retained products, and assess foetal viability

Management

Immediate Measures

• Apply ABCD principles (Airway, Breathing, Circulation, Dehydration)

• Establish IV access and begin fluid resuscitation:

  • IV Ringers Lactate (RL) or Normal Saline (NS) 2 litres

Augmentation (if membranes ruptured)

• Administer oxytocin 20 IU in 500 mL RL/NS at 40–60 drops/minute

• Monitor for adequate uterine contractions

Post-expulsion Management

1. Complete abortion

   • All products of conception expelled

   • Observe for ongoing bleeding

2. Incomplete abortion

   • Retained products require manual vacuum aspiration (MVA) or surgical evacuation

   • Medical management may be used if appropriate (e.g., misoprostol)

Referral Criteria

• Persistent bleeding despite augmentation

• Unavailable MVA or medical abortion services

• Need for higher-level care or surgical intervention

Supportive Measures

• Pain management:

  • Paracetamol 1 g PO 4–6 hourly

  • Ibuprofen 400 mg PO 8 hourly

• Emotional support and counselling:

  • Explain the inevitability of the abortion

  • Provide grief counselling if needed

• Post-abortion care:

  • Contraceptive counselling and initiation

  • Anti-D immunoglobulin for Rh-negative, non-sensitized women

    • <12 weeks: 50 mcg IM

    • ≥12 weeks: 100 mcg IM

Complications to Monitor

• Hemorrhage

• Infection / septic abortion

• Retained products of conception

• Psychological distress

Summary / Key Points

1. Inevitable abortion = dilated cervix + products of conception in situ + imminent expulsion.

2. Moderate/severe bleeding and severe cramps are classic features.

3. Immediate resuscitation (ABCD, fluids, blood) is critical in heavy bleeding.

4. Oxytocin is used to augment uterine contractions if membranes are ruptured.

5. Post-abortion management depends on whether the abortion is complete or incomplete.

6. Referral is required if resources are unavailable or complications persist.