Abortion Management Approaches
Classification and Diagnostic Approach
- The American College of Obstetricians and Gynecologists classifies abortion into several types, including threatened abortion, characterized by vaginal bleeding with a closed cervix and viable fetus, inevitable abortion, incomplete abortion, complete abortion, missed abortion, and septic abortion 1
- The American College of Obstetricians and Gynecologists recommends transvaginal ultrasound as the primary diagnostic method to assess fetal viability, gestational sac characteristics, and placental status 1, 4
- Serial β-hCG measurements can be used to diagnose abortion, with levels that fail to rise appropriately or decrease suggesting abortion 1
Management Options
- The American College of Obstetricians and Gynecologists recommends dilation and evacuation (D&E) as the preferred method for second-trimester abortion, with advantages including lower risk of hemorrhage (9.1% vs 28.3%) and infection (1.3% vs 23.9%) compared to medical abortion 1
- Expectant management for previable preterm prelabor rupture of membranes (PPROM) carries significantly higher maternal morbidity (60.2%) compared to abortion care (33.0%) 2, 3
- The American College of Obstetricians and Gynecologists recommends offering abortion care to all patients with previable PPROM 3, 5
Complications and Prevention
- Hemorrhage is more common with medical abortion (28.3%) than surgical methods (9.1%) 1
- Infection is higher with medical abortion (23.9%) than surgical methods (1.3%) 1
- Retained tissue is more frequent with medical abortion (17.4%) than surgical methods (1.3%) 1
- Uterine perforation is a potential complication of surgical procedures 1
- Asherman syndrome risk increases with multiple or aggressive curettage procedures 1
- Rh immunoglobulin should be administered to Rh-negative women to prevent Rh alloimmunization 1