4.1 Definition of Abortion

It is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability.


4.2 Classification of Abortion

1.Maternal – general ill health especially those associated with hyperpyrexia e.g. malaria, other conditions like aneamia, diarrhea, and dysentery, pyelonephritis, high BP, chronic nephritis, untreated syphilis, diabetes, hormonal imbalance, extreme emotional stress, accidents/violent exercise, abnormal conditions of the birth canal and certain drugs.

2. Fetal – the zygote may die as a result of disease or mal-development.



1. Spontaneous

Threatened Abortion – any vaginal bleeding during pregnancy other than spotting is considered threatened abortion. The bleeding is so slight that the pregnancy may continue to term with good management. There may be presence of backache or intermittent low abdominal pain. Cervical os is close.-

Inevitable Abortion – the bleeding is heavier with clots. In this case the pregnancy can’t be saved because a good portion of the placenta has detached and cervical os is dilating. The accompanying back ache and intermittent lower abdominal pain are severe, where the uterus is palpable, strong uterine contractions may be felt abdominally. The membranes may rupture and part of the products of conception may protrude through the dilating cervical os. It can end up as any one of the following: 


In this case the whole product of conception is expelled. Bleeding and abdominal pain which has occurred usually decreased. USS reveals on empty uterus. The cervix, when inspected is closed, reforming and the uterus becomes smaller in size. Complete abortion is more common before the 8th week of pregnancy.

In this type of abortion, part of the product of conception, usually the fetus is passed and the placenta and membranes are retained. The pregnancy is often more than 12 weeks old. So the placenta is firmly embedded and the slender cord breaks. The bleeding continues and may become profuse, because the presence of the retained product does not allow for efficient contraction and retraction of the uterus and therefore control of the bleeding. There is pain as well as backache, the cervical os is usually open and the uterus remains bulky.


Habitual Abortion – it is also called recurrent abortion and the term is used when a woman had three (3) or more consecutive spontaneous abortions. The cause is often unknown. However, in situations where the abortion is associated with incompetence of the internal cervical os, the features include:


Missed Abortion – in this kind of abortion the fetus dies and is retained in utero. Subsequently the signs of threatened abortion subside except for some brownish discharge which is not associated with pain. The uterus fails to grow, the breasts become soft and the other signs of pregnancy disappear. The dead fetus may be retained for as long as 3 – 4 weeks.

Blood and Carneous Mole – blood mole may arise in case of missed abortion in which the decidual capsularis remain intact and permits the zygote to be surrounded by layers of blood. When fluid is extracted from the blood, the fleshy, firm, hard mass is known as carneous mole.


2. Therapeutic Abortion 

It is the evacuation of the uterus done by a qualified medical practitioner in the interest of the mother’s life or her total well-being. The indications are usually medical conditions threatening the mother’s life or likely to cause gross fetal abnormalities. These conditions include cardiac disease, chronic nephritis, and German measles contracted in the first 12 weeks of pregnancy.

        The evacuation should be perform as early as possible in pregnancy to avoid complications.


Criminal Abortion – it is the abortion that is illegally procured. Such abortions are often done by unqualified persons having little regards for the consequences. Risk of sepsis, uterine perforation, cervical laceration, and haemorrhage are associated with criminal abortion. Other dangers are sudden death and acute renal failure. This type of abortion is largely responsible for a high percentage of infertility and maternal morbidity.


Septic Abortion – it is usually a sequel of incomplete abortion, often criminally induced. The patients are usually anaemic, ill with a high temperature, rapid pulse, headache, vomiting, and lower abdominal pain (especially if there is pelvic peritonitis). The lochia are profuse and offensive. The patient becomes jaundiced and looks toxic, especially if the condition is complicated by septicaemia.


4.2.1 Causes of Abortion

1. In the first trimester of pregnancy, an abnormal fetus is almost always the cause of miscarriage. Problems in the genes cause an abnormal fetus and are found in more than half of miscarriage fetuses. The risk of defective gene increases with the woman’s age.

2. In the second trimester of pregnancy, it is usually related to an abnormality in the mother rather than the fetus. It includes: -

     - Chronic illness like Diabetes, Severe high BP, Kidney diseases, Hyper and Hypo thyrodism.

    - Inadequate ovarian hormones

    - Acute infection including German measles, cytomegalovirus, mycoplasma (walking pneumonia) and other unusual germs, and severe emotional shock.

     - Diseases and abnormalities of the internal female organs e.g. abnormal uterus, fibroids, poor muscle tone in the cervix, abnormal growth of the placenta and multiple pregnancy.

    - Other factors include drugs, excessive caffeine, alcohol, tobacco, and cocaine.