COMPLICATIONS (Part Two)

In some cases, uterine infection may develop: septic abortion, and the woman may experience the following symptoms:

• Fever
• General malaise
• Lower abdominal pain
• Severe vaginal discharge with odor

DIAGNOSIS

• Pelvic examination: assesses changes in the cervix, shortening, softening, opening, size of the uterus, and its palpable enlargement.
• Ultrasound: during which gestational sac, embryo, and presence of heartbeats are observed to determine if the development is normal.
• Blood tests: if a spontaneous abortion occurs, blood levels of the hormone beta Hcg are measured to monitor the complete elimination of placental tissues.
• Tissue tests: if fetal or placental tissues are expelled, they are sent to the laboratory to determine their nature.

Spontaneous abortion can take several forms:

• Risk of failure: if there is bleeding but the cervix is not open, pregnancy can continue without complications with medical treatment or lifestyle adjustments.
• Inevitable abortion: in the case of bleeding, continuous uterine contractions, and an open cervix.
• Incomplete abortion: if fetal or placental tissues have partially exited and the rest remains inside the uterine cavity.
• Missed abortion: when embryonic and placental tissues are inside the uterus, but the embryo has no heartbeats or has not formed at all.
• Complete abortion: if all embryonic and placental tissues have exited the uterine cavity, most commonly before the 12th week of pregnancy.
• Septic abortion: when an infection occurs inside the uterus, endangering the woman's health with potential complications. Immediate medical care is needed in such cases.

TREATMENT

Risk of failure: besides medication, a rest is recommended until bleeding subsides, or pain becomes very mild. Physical activity and sexual intercourse should be avoided. While these measures have not been proven to reduce the risk of failure, they provide general relief. Travel, especially to areas without medical coverage, should be avoided.

Failure: through ultrasound examination, the condition of the embryo is assessed, whether it is formed or not, and if there are heartbeats. In any case, since abortion is inevitable, several management approaches can be followed.

Expectant management: if there are no signs of infection, the abortion can be allowed to occur naturally, usually within a few weeks (unfortunately, 3-4 weeks). This can be emotionally challenging, and if complete expulsion of tissues does not occur, medical or surgical treatment will be necessary.

Medical treatment: if desired by the patient, the process of expelling pregnancy products can be expedited using medications, taken orally or vaginally (for increased effectiveness and reduced side effects), such as combinations and vomiting. In about 70 to 90% of cases, this takes effect within the first 24 hours.

Surgical treatment: (D&C) During this procedure, the cervix is dilated using dilators, and then the remaining contents in the uterine cavity are removed by suction with a suitable cannula for pregnancy development.

Complications are rare and include:

• Injury to the uterine and cervical lining
• Formation of internal adhesions (Asherman's syndrome)
• Impact on subsequent fertility and increased risk of various complications in future pregnancies.

Surgical treatment is necessary in cases of significant hemorrhage and infection.

The woman can be discharged home within a day and can resume normal activities 1-2 days later.

Sexual intercourse can be resumed after at least a 2-week period.

Depending on the woman's condition, the doctor may recommend taking antibiotics or different soothing medications.

In subsequent pregnancies, it is generally possible for the woman to become pregnant in the following cycle, but it is advisable for the woman to start a new pregnancy when she is physically and emotionally ready.

In more than 5% of cases, women may experience consecutive miscarriages, and over 1% of them may have three or more.

If there are more than one miscarriage, the woman will undergo additional examinations to find the causative or predisposing factors.