What is the management for a threatened abortion?

Management of Threatened Abortion

The management of threatened abortion should include transvaginal ultrasonography to confirm fetal viability, rule out ectopic pregnancy, and detect subchorionic hematoma, along with Rh status evaluation and appropriate follow-up care. 1

Diagnostic Approach

• Transvaginal ultrasonography is the diagnostic method of choice to:

  • Confirm fetal viability
  • Detect the presence of subchorionic hematoma
  • Rule out ectopic pregnancy and other complications 1

• Clinical evaluation should include assessment of:

  • Bleeding pattern (ranging from spotting to heavier bleeding)
  • Abdominal pain (typically cramping in the hypogastric region)
  • Cervical status (closed in threatened abortion) 2

Treatment Protocol

Immediate Management

• Complete bed rest until 48 hours after cessation of bleeding 3
• Uterine sedatives to reduce cramping 3
• Folic acid supplementation 3

Hormonal Treatment

• Progesterone supplementation may be beneficial as it is the most important hormone for early pregnancy maintenance 4
• Human Chorionic Gonadotropin (hCG) has shown better outcomes compared to bed rest alone in some studies 5
• Hormonal treatment may be continued until 28 weeks of gestation in high-risk cases 3

Rh Status Management

• For Rh-negative women:
  • The American College of Obstetricians and Gynecologists states there is no evidence-based recommendation for anti-D immunoglobulin administration in threatened abortion with a viable fetus 1
  • However, 50 μg of anti-D immunoglobulin should be administered to Rh-negative women in all cases of documented first-trimester loss of established pregnancy 1

Follow-up Care

• Serial ultrasound examinations should be performed to assess fetal growth and development 1
• Monitor for potential complications that occur more frequently after threatened abortion:
  • Antepartum hemorrhage (7.5% of cases) 3
  • Intrauterine growth restriction (13.2% of cases) 3
  • Preterm premature rupture of membranes (5.66% of cases) 3
  • Intrauterine fetal death (5.66% of cases) 3

Prognostic Factors

• Presence and size of subchorionic hematoma:

  • Subchorionic hematoma is found in approximately 42.9% of threatened abortion cases 3
  • Spontaneous abortion is more common with subchorionic hematoma larger than 20 cm² 3

• Overall outcomes:

  • Approximately 75.8% of threatened abortions continue to term with appropriate management 3
  • Spontaneous abortion occurs in about 24.2% of cases despite treatment 3

Special Considerations

• Maternal factors that may contribute to threatened abortion should be addressed:

  • Endocrine disorders (diabetes, hypothyroidism)
  • Infections
  • Anatomical abnormalities of the uterus
  • Antiphospholipid antibodies 4

• Psychological support is essential:

  • Women are at increased risk for significant depression and anxiety for up to one year after spontaneous abortion 6
  • Counseling should address feelings of guilt and the grief process 6