20.2.3 Clinical classification of abortion
The outcomes of either a spontaneous or induced abortion are classified based on clinical presentation, as judged by the health care provider. It is important for you to know the different categories, because how you treat the woman depends on the clinical classification.
Complete abortion
A complete abortion means that all parts of the fetus and placenta have been expelled through the vagina; nothing is left behind in the uterus and the cervix has closed. No treatment procedure to evacuate (empty) the uterus is usually necessary. After a complete abortion which has been safely induced, the woman may feel light cramping pains in her abdomen, and bleeding from her vagina should be no more than during a normal menstrual period.
If bleeding is light to moderate, and there is fetal tissue protruding through the mouth of the uterus, you can gently remove it with a sterile gloved finger. Do not attempt to do this until you have completed your practical training in this competency. Give the woman 400µg (micrograms) of misoprostol orally before you refer her to the nearest health facility.
Incomplete abortion
An incomplete abortion is when part of the fetal tissue or placenta is still in the uterus and the cervix is open. If you leave an incomplete abortion without treatment for some time there is an increased risk that it will be complicated with infection and this could be life-threatening for the woman.
When you attend the practical skills training associated with this study session you will see how the tissue left behind in the uterus can be removed with instruments, using a technique called evacuation and curettage. You will also learn how to give drugs to the woman by mouth (orally) and by injection into the muscles of her thigh or buttocks (intramuscular injection, or IM) to assist this process.
Threatened abortion
When a pregnancy is complicated by bleeding from the vagina, but the cervix is closed, this may signal a threatened abortion. There is a chance that the pregnancy may continue normally, provided the fetus is showing signs of life.
If you suspect an abortion is threatened, refer the woman to the nearest health facility, where they may be able to preserve the pregnancy.
Inevitable abortion
An inevitable abortion is when the fetus is entirely in the uterus, but the pregnancy will definitely end in the expulsion of the fetus. Often the woman has lower abdominal pain and a cervical change called effacement, when the cervix has pulled back and become thinner; then the cervix starts to dilate and open as though during a normal full-term labour. (You will learn about effacement and dilatation of the cervix in Labour and Delivery Care, the next Module in this curriculum.) The contents of the uterus will often spontaneously come out, but if this does not happen soon, you will be taught to give the woman 400 µg (micrograms) of misoprostol orally, repeated once after 4 hours if necessary. Do not attempt to do this until you have completed your practical training in this competency.
Missed abortion
When the fetus is entirely in the uterus, but it has no signs of life and the cervix is completely closed, this situation is called a missed abortion. The dead fetus is likely to be retained in the uterus for some time unless there is an intervention in a specialised health facility.
Removing a dead fetus after a missed abortion usually requires the specialised services of a district hospital, so you should make every effort to transfer the woman to the highest available health facility.
20.2.2 Induced abortion