Abortion has a negative connotation in the society because of the presence of induced incidence where the already developing babies get killed intentionally. There are still an increasing incidence of induced abortions among the women in the Philippines. They took abortifacients as form of contraception. Efforts to eradicate those who sell the herbal and the medical forms of abortifacients in the city of Manila remains futile.
When I talked to the majority of patients, I was amazed. They were not aware what abortion was. They all thought that abortion was always something of human act made by illegal abortionists. Thus, when we said that they had abortion, they felt apprehended. It was, then, when we told them that abortion could also have unintentional causes that were beyond our control.
Technically, according to Dr. Vern L. Katz, spontaneous abortion is the loss of pregnancy before it reach viability outside the womb or prior to twenty weeks age of gestation. The word, miscarriage, has been used because of the charged connotation to the word abortion. According to Dr. Zaida Gumilla, the Royal College of Obstetrics and Gynecology recommended that the word miscarriage pertains to the fetal loss under twenty four weeks of gestation.
Now, what could possibly cause the spontaneous abortion? There are fetal, maternal and environmental factors that could contribute. An abnormal zygote development that is known as blighted ovum could cause an early spontaneous abortion. Dr. Katz, however, described that the major cause of abortion is aneuploidy, which is a kind of chromosomal aberration that occurred in the embryo. Mothers may be curious about how their conditions could contribute to the occurrence of miscarriage. Infectious organisms, according to Dr. Gamilla, was implicated. Causal relationship was, however, not confirmed by studies. There are uterine defects that also could cause abortion. These are Asherman’s syndrome, myoma and abnormal uterine structures like didelphys. The hyperthyroidism and poorly- controlled diabetes mellitus has been a known factor. The severely malnourished and the obese women tends to have abortion. Blood group incompatibility due to ABO, and Rh are also implicated.
There are environmental exposures that perhaps predispose the women to having miscarriages. These are smoking, frequent alcohol consumption, radiation, antineoplastic drugs, organophosphates and organochlorine.
The types of abortion are threatened abortion, inevitable abortion, incomplete abortion and the missed abortion. If the cervix is closed, there is bloody vaginal discharge, and uterine enlargement, threatened abortion is diagnosed. Treatment only composed of bed rest and acetaminophen-based analgesia for pain. Transvaginal ultrasound and HCG levels could be checked to assure viability. D-negative patients should be given anti-D immunoglobulin because more than 10 % have significant fetomaternal hemorrhage.
Inevitable abortion are those with dilated cervix and ruptured bag of water. There is no passage of conceptus. Since this is already true miscarriage, evacuation should be done. The incomplete abortion has passage of the placenta or fetus already. Cervix is open and there could be profuse bleeding. Curettage is the treatment. Bleeding is further controlled with oxytocin or methyergonometrine. Missed abortion is diagnosed if the dead fetus is retained. Cervix is closed. Bleeding could be minimal or none. Uterus is incompatible with age of gestation and there is note of disappearance of the signs and symptoms of pregnancy. Laminaria could be used to dilate the cervix. Then, evacuation and curettage is done.
There are times when infection complicates abortion and is heralded by fever, foul-smelling discharge and possibly by a tender uterus . The endotoxins released after cell death can go to the blood stream and cause septic shock. Sometimes, it is caused by the unsterile instruments used in aborting the pregnancy. Intravenous antibiotics are loaded and then, curettage is immediately done.Hysterectomy is possible if the case is extreme.
List of Sources:
Gamilla, Z. Abortion. In: Sumpaico WW, Andres ID, Blanca-Capito LR, Carnero S, Gamilla,Z. Textbook of Obstetrics, 3rd ed. Philippines: Association of Writers of OBGYN Philippine Textbook , 2002.
Katz, Vern. Spontaneous and Recurrent Abortion. In: Katz VL, Lobo RA, Lentz GM, Gershenson DM. Comprehensive Gynecology, 5th ed. Philadelphia: Mosby Elsevier ,2007