First Trimester Abortions
1. Chromosomal and genetic abnormalities: This is the major cause of abortions accounting for nearly 70% of all abortions during the first trimester. The proportion of abortions due to this cause decreases as pregnancy progresses. This is probably nature’s way of selection.
2. Uterine Abnormalities: Uterine abnormalities account of about 10-20% of all causes of abortion. Abnormalities which cause first trimester abortions include a separate uterus, sub mucosal fibroids, and other anatomical defects.
3. Placental Abnormalities: This is another important cause. Defects with the formation of the placenta can lead to abortions due to loss of many functions of the placenta including nutritive and hormonal functions. An abortion due to this cause is usually seen after 6 weeks as till that time, the placenta is still poorly formed. This is usually diagnosed by a stagnant or falling level of HCG in blood.
4. The other important causes include maternal alcohol consumption, smoking, use of illicit drugs like cocaine, malnutrition, exposure to drugs or radiation and trauma.
Second Trimester Abortions
The causes during second trimester are quite different. The proportion of cases due to genetic abnormalities and uterine abnormalities decrease and those due to trauma, maternal conditions like hypertension and cervical incompetence increase.
Trauma is an important cause of abortion in the second trimester and should always be suspected. Even minor blows and falls may lead to loss, especially in the setting of cervical incompetence which is present is about
Cervical incompetence is a condition associated with a short cervix with funneling and incompetence. It presents as a case of recurrent second trimester abortion. The abortions are usually quick, complete and painless.
The clinical features of abortion include the following:-
· Vaginal Bleeding: This is the most important and most relevant symptom. The bleeding is fresh; products of conception may be identified. The bleeding is directly proportional to the age of the pregnancy and the size of the uterus. Some women may have profuse bleeding.
· Lower abdominal pain and cramps: These are another important symptom that alerts the patient and the physician to an abortion. The pain is dull aching or dragging in nature, localised over the lower abdomen, below the umbilicus. The pain may radiate to the inner side of thigh. Women may also feel cramping as the uterus tries to expel the products of conception. However many women may abort without pain. This is especially seen with cervical incompetence.
· Systemic symptoms: Nausea, vomiting, fever, palpitations, sweating, and an impending sense of doom may all be seen due to excess blood loss resulting in shock. However this complication is quite rare.
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