Complete Abortion 

Definition

Complete abortion occurs when all products of conception are expelled from the uterus. The uterus is typically well-contracted, and vaginal bleeding is minimal or absent.

Etiology / Risk Factors

• Spontaneous miscarriage that progresses naturally to completion

• Effective medical or surgical termination of pregnancy

Signs and Symptoms

1. Vaginal bleeding: Minimal or absent

2. Uterus: Smaller than expected for gestational age; well-contracted

3. Cervical examination: Cervix may be open or closed

Investigations

• Ultrasound: To confirm complete expulsion and absence of retained products

• Full Blood Count (FBC): Evaluate for anemia

• Optional: Blood group and cross-match if blood transfusion is anticipated

Management

Supportive Care

• Post-abortion antibiotics:

  • Amoxicillin 500 mg PO every 8 hours for 5 days

  • Metronidazole 400 mg PO every 8 hours for 5 days

• Iron and folate supplementation:

  • FeFol 1 tablet twice daily for 3 months; reassess hemoglobin every 4 weeks

Emergency Management (if patient is in shock)

• Call for help and mobilize resources

• ABCD principles: Airway, Breathing, Circulation, Dehydration

• IV fluids: RL/NS 3 liters or more within the first hour

• Blood transfusion if indicated

• Indwelling urethral catheter insertion

• IV antibiotics: Ceftriaxone 1 g + Metronidazole 500 mg stat

• Laboratory tests: HB, grouping, cross-match

• Referral: Transfer patient to hospital with a nurse escort

Patient Education and Counselling

• Discuss post-abortion contraception options and provide method of choice

• Advise on signs of complications: excessive bleeding, fever, foul-smelling discharge, abdominal pain

• Provide emotional support and counselling for the patient

Summary / Key Points

1. Complete abortion: All products expelled, minimal bleeding, well-contracted uterus

2. Investigations: Ultrasound to confirm, FBC to monitor anemia

3. Treatment: Supportive care, antibiotics, iron and folate

4. Shock management: ABCD resuscitation, IV fluids, antibiotics, blood transfusion

5. Patient counselling: Contraception and signs of complications