From the Research
In a case of threatened abortion, immediate assessment of the cervical os is crucial to determine the best course of action and provide prognostic information, with a closed cervical os being reassuring and an open os indicating a more advanced stage of abortion. Perform a speculum examination to evaluate if the cervical os is open or closed, looking for any visible products of conception or active bleeding, and avoid digital cervical examination as it may increase the risk of infection 1.
Key Considerations
- If the os is closed and bleeding is minimal, recommend pelvic rest (no intercourse or tampons) for the patient, as bed rest has not been shown to be effective in preventing miscarriage 2.
- Administer progesterone supplementation, typically 200 mg vaginally twice daily, to support the pregnancy, as some evidence suggests it may reduce the rate of miscarriage 3.
- Monitor hCG levels every 48-72 hours to ensure appropriate rise, and perform a transvaginal ultrasound to confirm fetal viability and rule out ectopic pregnancy.
- If the cervical os is open or there is heavy bleeding, prepare for possible inevitable abortion and provide appropriate counseling and support, as spontaneous abortion occurs in less than 30% of these women 4.
Prognostic Factors
- The presence of subchorionic hematoma, particularly those larger than 20 cm2, may be associated with a higher risk of spontaneous abortion 4.
- Previous abortions, advanced maternal age, and heavy bleeding are also risk factors for miscarriage 1, 3.
Management
- Treatment with progesterone, uterine sedatives, folic acid supplementation, and hormonal treatment may improve outcomes in cases of threatened abortion 4.
- Close monitoring and follow-up are essential to detect any complications, such as antepartum hemorrhage, intrauterine growth retardation, or intrauterine death of the fetus 4.