Risk of abortion

Abortion is defined as fetal death occurring before 20 weeks of gestation. A large proportion of these occur before the 12th week of pregnancy. The incidence of miscarriage is up to about 20% in confirmed pregnancies. 

It usually manifests with vaginal bleeding and lower abdominal pain. It is important to note that bleeding in the first trimester of pregnancy is a common finding. Between 20 and 30% of women with confirmed pregnancies bleed during the first 20 weeks of pregnancy. Of these, approximately half will miscarry.

The history and risk factors of the pregnant woman are relevant: women over 35 years of age, previous history of miscarriages, structural alterations of the cervix, invasive prenatal tests, women who smoke or who are overweight (malnutrition - obesity). 

Diagnosis requires a gynecological examination and vaginal examination to assess the intensity of bleeding and whether the cervix is open. Also, a transvaginal ultrasound should always be performed to assess the condition of the fetus.

If pregnancy is present and cardiac activity is present, it is considered a threatened miscarriage. If there is no heartbeat of the embryo, it is considered a missed abortion. It is useful to perform a blood test to assess for anemia or to check the levels of human choriogonadotropic hormone (b-HCG).

Treatment for threatened abortion is rest and watchful waiting. Occasionally, the use of progesterone can reduce the risk of miscarriage. When miscarriage is confirmed, expectant management until spontaneous expulsion occurs or uterine evacuation (pharmacological or surgical curettage) can be performed.

On some occasions, spontaneous abortion can become complicated. If the fetus or placenta remain in the uterus for too long, vaginal bleeding may persist or an infection may develop. This causes fever, pain and sometimes even becomes generalized and leads to sepsis.