Pelvic Bleeding

Miscarriage or abortion
An abortion is the expulsion of the products of
conception before the 24th week of pregnancy.
The word abortion is often considered by women
to be a procured termination of pregnancy, legal or
criminal. Hence, the softer term miscarriage is better
used for the spontaneous event. A simple classification
is helpful in understanding the various
terms used (Fig. 8.1).
Causes of spontaneous miscarriage
These are maternal, fetal and possibly paternal or
genetic.
Maternal causes
General
• Age.
• Obesity.
• Acute febrile illness.
• Septicaemia with infection of the fetus.
• Severe hypertension or renal disease.
• Diabetes.
• Hypothyroidism.
• Trauma.
• A surgical operation.
• Emotional shock, perhaps more in folklore than
actuality.
Drugs like ergot, quinine and lead may be taken
to induce abortion. They are not very effective and
the risk of poisoning is great.
Local
• Uterine fibroids.
• Congenital uterine malformations.
• Incompetence of the internal os:
• congenital;
• acquired after difficult dilatation of the
cervix.
• Hormone deficiency:
• progesterone—the corpus luteum usually produces
progesterone which helps embedding of
the embryo;
• systemic lupus erythematosus;
• anti-phospholipid syndrome.
Fetal causes
• Genetic abnormalities.
• Congenital malformations.
• Faulty implantation.
Congenital and genetic malformations
Examination of the chromosomes in material from
spontaneous abortion shows gross abnormalities
in over half—often the embryo has failed to develop
or has been absorbed. In these cases, miscarriage
usually takes place at about eight weeks. Ultrasound
shows that the amniotic sac contains no
95
Chapter 8
Bleeding in pregnancy
Chapter 8 Bleeding in pregnancy
96
embryo. In other cases, gross malformation of the
fetus is shown.
Faulty implantation
The embryo may become implanted in an unfavourable
site in the uterus, for example in the
isthmus, cervical canal or in the...