Threatened Abortion – Reasons, Signs & Treatments

Nearly every pregnant mother has had the most dreadful thought cross her mind: the possibility of a miscarriage. This is why most mothers take the utmost precaution in ensuring the baby is not harmed in any way or under any circumstances. However, at times, pregnant women may experience health issues like unexplained abdominal pain or vaginal bleeding. Such situations need to be addressed immediately since they could signify a threatened abortion. It is crucial for expecting mothers to be aware of these symptoms and seek prompt medical advice. Read on to know more about threatened abortion, its causes, signs, and treatment options available.

What Is Threatened Abortion?

Wondering what’s the definition of threatened abortion? In the first 20 weeks of pregnancy, nearly 1/3rd of women experience bleeding from the vagina, and most of them do complete the entire term of pregnancy. However, in some mothers, vaginal bleeding could be accompanied by abdominal cramping and pain in the region. These signs could indicate the possibility of a miscarriage, needing pre-emptive measures to protect the mother. Since it is a possibility, it is termed as a threatened abortion or a threatened miscarriage.

How Common Is It?

A threatened abortion is relatively common during pregnancy, occurring in about 20% to 25% of all pregnancies, particularly during the first trimester. While a threatened abortion signals an increased risk of miscarriage, many pregnancies proceed without further issues, especially with proper medical care and monitoring. Certain risk factors, including maternal age, previous miscarriages, and health conditions like diabetes or thyroid disorders, can increase the likelihood of experiencing a threatened abortion.

How Long Does It Last?

The duration of a threatened abortion can vary widely depending on individual circumstances. Typically, symptoms of a threatened abortion, such as vaginal bleeding or abdominal cramping, may last from a few hours to several days. In some cases, symptoms might persist for a couple of weeks. The outcome largely depends on the underlying cause and the body’s response to the situation.

Causes of Threatened Abortion

Here are some of the causes of a threatened abortion/threatened miscarriage:

• Certain anomalies such as Down syndrome, Edwards’ syndrome, and Patau syndrome, present in the chromosomes of the embryo have been termed to be responsible for a miscarriage in the initial stages of pregnancy.
• Most women face threatened abortion due to a cervix that can’t hold the baby. Other reasons like fibroids of the uterus, or even the presence of other diseases and conditions could lead to threatened miscarriage/abortion.
• Any swelling or inflammation in the interior parts of the uterus could trigger a miscarriage as well.
• Feverish chills, extreme fatigue, and physical, mental, and emotional stress are all factors that could cause a threatened abortion.
• Mothers who have had multiple children have higher chances of a threatened miscarriage.
• The blood types of the mother and the foetus could lead to threatened abortion. In the case of an Rh-negative mother and an Rh-positive foetus, the mother’s body would create antibodies to attack the foetus.

The cause of threatened abortion could be one or several of these as every woman goes through a major physical and mental change during pregnancy. The regular checkups come in handy to diagnose any signs and symptoms of threatened abortion and also prevent severe pregnancy-related complications. 

Symptoms of Threatened Abortion

Nearly all threatened abortions are preceded by vaginal bleeding, which majorly occurs in the initial 20 weeks of pregnancy. Here are some more symptoms of threatened abortion:

• Cramping in the abdominal area, along with vaginal bleeding.
• Either dull but constant or sharp pain in the lower back or the abdominal region.
• A clot or a tissue passing out from their vagina.

Who Is at Risk of Threatened Abortion

Several factors can increase the likelihood of experiencing a threatened abortion, and recognizing these risks is crucial for managing a healthy pregnancy. Here are some key risk factors:

• Women over the age of 35 are at a higher risk of experiencing a threatened abortion due to age-related changes in reproductive health.
• A history of prior miscarriages can increase the risk of a threatened abortion in subsequent pregnancies.
• Chronic health issues such as diabetes, thyroid disorders, or clotting disorders can raise the risk of complications that may lead to a threatened abortion.
• Smoking, excessive alcohol consumption, and drug use can negatively impact pregnancy and increase the risk of a threatened abortion.

Diagnosis of Threatened Abortion

In the case of vaginal bleeding and abdominal pain, every pregnant woman should get a thorough diagnosis done for threatened abortion. Doctors start from the source of the problem and try to pinpoint the reason for vaginal bleeding. Simultaneously, they also check if the amniotic sac is intact. This examination usually involves checking the vagina, uterus and the cervix for any anomalies.

The doctor would then recommend a threatened abortion ultrasound to check the foetal health, the heartbeat, and whether the growth is normal. For bleeding emerging from the uterus, an ultrasound helps confirm it, and allows the gynaecologist to take necessary actions. In the initial weeks of pregnancy, gynaecologists prefer images obtained from transvaginal ultrasound instead of a transabdominal because the image quality is better. The probe of a transvaginal ultrasound is inserted a few inches deep in the vagina to create a vivid image of the internal foetal structure using high-frequency sound waves. However, in cases of excessive bleeding, transabdominal ultrasound is preferred. Also, the images from transvaginal cannot rule out anomalies, for which transabdominal ultrasound is preferred.

Since hormones can also be responsible for the condition, a blood test that includes a full blood count would be undertaken to measure the levels of HCG (human chorionic gonadotropin), as well as progesterone. Both these hormones are produced to invoke and support pregnancy and are necessary to be present in a pregnant woman’s body in the right amount. However, the blood test can be done in early pregnancy only (upto a maximum of 12 weeks).

Treatment & Medication

In case the diagnosis indicates a threatened abortion, the patient would have to undergo treatment. Here’s what the gynaecologist is most likely to prescribe if there is a case of threatened miscarriage.

• Bedrest is the primary requirement to recover from threatened abortion. Any kind of physical activity, including sexual intercourse, should be strongly avoided.
• In case of the presence of diabetes or thyroid-related complications, the doctor might prescribe appropriate medication to treat them to ensure a healthy pregnancy.
• In certain cases, when a mother’s blood type is Rh negative while the foetus’ is Rh positive, the mother’s body would start creating antibodies and combat the format of the foetus’ blood. In such cases, doctors administer Rh immunoglobulins to keep this behaviour in check.
• If the tests reveal reduced levels of hormones, the gynaecologist will prescribe progesterone.
• To stop the bleeding or uterine contractions, your gynaecologist may prescribe haemostatic drugs.

In most cases, treatment of threatened abortion/threatened miscarriage can lead to a full-term of pregnancy; however, some mothers-to-be might experience complications. Read on to know more.

Complications of Threatened Abortion

With any health-related condition, and especially when it comes to pregnancy, there are strong chances of complications occurring even after taking the right actions. Here are some complications of threatened abortion:

• The mother-to-be could lose a substantial amount of blood and end up suffering from anaemia. In extreme conditions, doctors might even advise undertaking a blood transfusion in order to raise and normalise the iron levels in the blood quickly.
• If she suffers from illnesses, an infection might make its way to the foetus.
• The mother-to-be could experience a miscarriage, either because she loses her foetus or because the foetus is not in a state to be carried to full term. This can be quite taxing for the mother physically as well as emotionally. Complications such as ectopic pregnancy could also lead to a threatening abortion.

These complications are unavoidable in some cases, but taking preventive measures is always recommended to avoid threatened abortion/threatened miscarriage. Here are some ways you could prevent this condition.

Ways to Prevent Threatened Abortion

The measures given below could help you prevent threatened abortion and carry for the entire pregnancy term.

• Avoid alcohol, tobacco, drugs, and cigarettes completely.
• Reduce the intake of caffeine-based drinks to the very minimal.
• Refrain from consuming any food items that are known to be harmful during pregnancy.
• Treat infections as soon as they are diagnosed.
• Have a healthy and balanced diet, with supplementary vitamins and nutrients.
• Follow a safe and healthy exercise routine under medical supervision.
• Avoid exposure to harmful chemicals and polluted/stressful environments.

In case none of these measures has helped you prevent a threatened abortion, you must seek medical assistance immediately and follow the doctor’s instructions to the T.

When to Consult a Doctor?

Knowing when to consult a doctor is essential for managing potential complications during pregnancy and ensuring both the mother and baby’s health. If you experience any of the following signs or symptoms, it’s important to seek professional medical advice:

• Heavy or Persistent Bleeding: Continuous or heavy vaginal bleeding, especially if it is more than light spotting or accompanied by clots, warrants a doctor’s visit.
• Severe Abdominal Pain: Intense or worsening abdominal pain that doesn’t subside should be evaluated to determine its cause and appropriate management.
• Passage of Tissue: If you notice the passage of tissue or clots from the vagina, it is important to consult a doctor as this could indicate a miscarriage or other serious issue.
• Severe Cramping: Persistent or severe cramping, particularly if it is accompanied by other symptoms, should be checked by a healthcare provider.
• Signs of Infection: Symptoms like fever, chills, or unusual discharge could signal an infection that needs prompt medical attention.
• Unusual Symptoms: If you experience dizziness, fainting, or any other concerning symptoms, seek medical advice to ensure everything is progressing normally.

Always ensure you have an open conversation with the gynaecologist and get answers to all your questions. You may also refer to the FAQs provided below before you consult your doctor.

FAQs

1. Will I be able to work after a threatened abortion?

Listening to your body and understanding it is the best way to know if you’re ready for work or not. In case your work is physically intensive, then it is highly advised to take some more time off and get as much rest as possible to recover properly. If your work is mostly sedentary and you feel that you are well-rested and fine, you may gradually start going to work.

2. Will I deliver a healthy baby after a threatened miscarriage?

Most women deliver healthy babies even after experiencing the conditions of a threatened miscarriage. It primarily depends on the conditions of the cervix, uterus, and your hormone levels.

In case you do suffer from a miscarriage, you can still have a successful pregnancy after that. If you have had multiple miscarriages sequentially, then a thorough examination is highly advised.

3. Which month is a pregnant woman most likely to experience a threatened abortion?

Not all pregnant ladies experience threatened abortion; however, one in every seven mothers-to-be run a risk of a threatened miscarriage within 20 weeks of gestation.

4. Can frequent travel or long commutes affect a threatened abortion?

Frequent travel or long commutes, especially if they involve prolonged periods of sitting or physical strain, can contribute to discomfort and stress during pregnancy. While occasional travel is generally not harmful, it’s important to take precautions such as staying hydrated, taking breaks to move around, and avoiding heavy lifting. If you are experiencing symptoms of a threatened abortion, it’s best to limit travel and consult your doctor for personalized advice.

5. Can a threatened abortion be caused by a recent change in medication?

Certain medications or abrupt changes in medication can potentially impact pregnancy. If you have recently started or changed medications, inform your healthcare provider, as some drugs may pose risks or interact with pregnancy. It’s crucial to discuss any medication changes with your doctor to ensure they are safe and to address any potential effects on your pregnancy, especially if you are experiencing symptoms of a threatened abortion.

Management of threatened abortion or threatened miscarriage is not simply a medical activity. The entire process can affect a mother emotionally and cause anxiety and stress during pregnancy. Talk to people who provide you with emotional support, and don’t hesitate to undertake therapy if required.

References/Resources:

1. Threatened Miscarriage; Cleveland Clinic; https://my.clevelandclinic.org/health/diseases/25055-threatened-miscarriage

2. Chan. D, Cheug. K, Ko. J, Yung. S, et. al.; Use of oral progestogen in women with threatened miscarriage in the first trimester: a randomized double-blind controlled trial (Human Reproduction); National Library of Medicine; https://pubmed.ncbi.nlm.nih.gov/33331637/; February 2021

3. FAQs: Bleeding During Pregnancy; American College of Obstetricians and Gynecologists; https://www.acog.org/womens-health/faqs/bleeding-during-pregnancy

4. Mouri. M, Hall. H, Rupp. T; Threatened Miscarriage; National Library of Medicine; https://www.ncbi.nlm.nih.gov/books/NBK430747/

5. DeVilbiss. E, Naimi. A, Mumford. S, Perkins. N, Sjaarda. L; Vaginal bleeding and nausea in early pregnancy as predictors of clinical pregnancy loss (American Journal of Obstetrics & Gynecology); National Library of Medicine; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994023/; April 2020

6. Miscarriage Symptoms; NHS; https://www.nhs.uk/conditions/miscarriage/symptoms/

7. Pregnancy loss; Office on Women’s Health; https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/pregnancy-loss

Also Read:

Medical Abortion
Period after Abortion
After-Abortion Side Effects
Abortion Procedures for Termination of Pregnancy

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