The main feature of threatened abortion is the presence of vaginal bleeding, or sometimes spotting may be encountered as well. Other symptoms include abdominal pain or cramping, back aches, or period pains, which may be overlooked, as they commonly appear during regular pregnancy. Not all threatened abortions progress to miscarriage. However, the chances are high in women that present with threatened abortion with an open cervix.

• Pain

  In conclusion, patients with threatened abortion benefit from vaginal progesterone by a reduction of UCs and pain. [ncbi.nlm.nih.gov]

  Common signs of a miscarriage are pain and bleeding. A small amount of bleeding can be normal during the first 3 months of pregnancy. Often the pain and bleeding stop, and you have a normal pregnancy and baby. [fairview.org]

  Lower abdominal pain as a sign of a threatened abortion usually goes on for a long time and is a dull, throbbing pain. Inform your practitioner immediately if you’re experiencing such pains. [baby-pedia.com]

• Falling

  Values falling below the 10th percentile of the normal population were classified as positive (i.e., pathological) results; the others were considered negative. [ncbi.nlm.nih.gov]

  Even minor falls won’t cause a miscarriage. Miscarriages happen because things were not developing as they were supposed to. No medicine can prevent a miscarriage. Again, understand that things are uncertain right now. [fairview.org]

  Small falls, injuries or stress during the first trimester of pregnancy can cause threatened miscarriage. It occurs in almost one half of all pregnancies. The chance of miscarriage is higher in older women. [mountsinai.org]

• Severe Pain

  Call 911 Call 911 if you have: Severe pain and very heavy bleeding Severe lightheadedness, passing out, or fainting Rapid heart rate Difficulty breathing Confusion or difficulty waking up When to seek medical advice Call your healthcare provider right [fairview.org]

• Chills

  and threatened abortion or threatened miscarriage is also due to them, but can also be caused by the following factors: An incompetent cervix, uterine fibroids, inflammation of the villi, and other illnesses or conditions Intrauterine inflammation Chills [baby-pedia.com]

  Such infections are characterized by fever, chills, uterine tenderness and occasionally, peritonitis. The responsible bacteria are usually a mixed group of Strep, coliforms and anaerobic organisms. [brooksidepress.org]

• Malaise

  Malaise, sweating, headache, and joint pain. Jaundice and /or haematuria is an ominous sign, indicating haemolysis due to chemicals used in criminal abortion or haemolytic infection as clostridium welchii. [gfmer.ch]

• Abdominal Pain

  Women with mild abdominal cramping received amoxicillin plus erythromycin for 1 week; those with severe abdominal pain received amoxicillin plus clindamycin for 1 week. [ncbi.nlm.nih.gov]

  Lower abdominal pain as a sign of a threatened abortion usually goes on for a long time and is a dull, throbbing pain. Inform your practitioner immediately if you’re experiencing such pains. [baby-pedia.com]

  Symptoms of threatened abortion include spotting (light bleeding from the vagina), abdominal pain or cramping, back aches, while period pains may also be observed. [symptoma.com]

  Factors that may contribute to miscarriage include A genetic problem with the fetus Problems with the uterus or cervix Chronic diseases, such as polycystic ovary syndrome Signs of a miscarriage include vaginal spotting, abdominal pain or cramping, and [icdlist.com]

  Bleeding may be heavy and abdominal pain is almost always present. With a complete miscarriage, bleeding and abdominal pain have occurred but have usually subsided. Products of conception have been passed. [emedicinehealth.com]

• Vomiting

  […] in pregnancy O21.0 Mild hyperemesis gravidarum O21.1 Hyperemesis gravidarum with metabolic disturbance O21.2 Late vomiting of pregnancy O21.8 Other vomiting complicating pregnancy O21.9 Vomiting of pregnancy, unspecified O22 Venous complications and [icd10data.com]

  A history of vomiting was predictive of a viable pregnancy. CONCLUSION: The clinical assessment of threatened abortion is unreliable in most cases and should be superseded by ready access to sonographic assessment. [ncbi.nlm.nih.gov]

  […] dysplasia, cervix 654.6 early onset of delivery (spontaneous) 644.2 eclampsia, eclamptic (coma) (convulsions) (delirium) (nephritis) (uremia) 642.6 edema 646.1 effusion, amniotic fluid 658.1 embolism emesis (gravidarum) - see Pregnancy, complicated, vomiting [icd9data.com]

  Without treatment, these symptoms may be followed in several days or weeks by severe pelvic pain, shoulder pain (due to blood from a ruptured ectopic pregnancy pressing on the diaphragm), faintness, dizziness, nausea or vomiting. [nairaland.com]

• Lower Abdominal Pain

  Recurrence was documented on the basis of either lower abdominal pain or vaginal bleeding. RESULTS: Of the 23 women included, 15 (65%) had abnormal vaginal flora (a score above 4, Nugent's criteria). [ncbi.nlm.nih.gov]

  Lower abdominal pain as a sign of a threatened abortion usually goes on for a long time and is a dull, throbbing pain. Inform your practitioner immediately if you’re experiencing such pains. [baby-pedia.com]

  Some pregnant women have lower abdominal pain followed by missed period, but if lower abdominal pain is associated with uterine bleeding, it may predict impending abortion. [jri.ir]

  Clinical picture: The patient complains of considerable bleeding and severe lower abdominal pain referred to the back. On examination, the products of conception is felt through the dilated cervix. [gfmer.ch]

• Suprapubic Pain

  Abdominal examination: Suprapubic pain and tenderness. Abdominal rigidity and distension indicates peritonitis. Local examination: Offensive vaginal discharge. Minimal inoffensive vaginal discharge is often associated with severe cases. [gfmer.ch]

• Chest Pain

  Hyperglycemia, steroids Most side effects of beta-2 agonists result from their concurrent beta-1 activity, and include increase in heart rate, rise in systolic pressure, decrease in diastolic pressure, chest pain secondary to MI, and arrhythmia. [slideshare.net]

• First Trimester Bleeding

  CONCLUSIONS: First trimester bleeding with visible fetal heart beat appears to associate significantly with higher subsequent spontaneous abortion rate than those without. [ncbi.nlm.nih.gov]

  Patients with first trimester bleeding had a significantly higher percentage of low implantation sites (25.8%) than the controls (4.8%). [journals.lww.com]

  Epidemiology Prevalence : First Trimester Bleeding in 25% of pregnant women III. [fpnotebook.com]

  Trisomy 21 (extra #21 chromosome) in a male (one X and one Y chromosome) Any bleeding during the first trimester of pregnancy is abnormal. [brooksidepress.org]

  An association between low vitamin D levels and an increased risk of first trimester miscarriage has been identified but it is not known if it is causal [ 6 ]. [patient.info]

• Grieving

  Physicians should encourage the patient and her partner to allow themselves to grieve. The woman and her partner may grieve differently; specifically, they may go through the stages of grief in different orders or at different rates. [aafp.org]

  There is inevitably a time of grieving. A trained counsellor with a special interest in abortion can provide support and help you come to terms with your loss. Pregnancy after abortion. [2womenshealth.com]

• Dizziness

  Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider Pain in your lower belly (abdomen) that gets worse Weakness or dizziness Passage of anything that resembles tissue. [fairview.org]

  Precautions: Immediate Return Indications Anemia symptoms (light headedness, Near Syncope or Dizziness ) Heavy bleeding (2 sanitary pads per hour for 2 consecutive hours) Pelvic Pain ( Ectopic Pregnancy ) Images: Related links to external sites (from [fpnotebook.com]

  Without treatment, these symptoms may be followed in several days or weeks by severe pelvic pain, shoulder pain (due to blood from a ruptured ectopic pregnancy pressing on the diaphragm), faintness, dizziness, nausea or vomiting. [nairaland.com]

• Seizure

  hypotonia, spasticity, Guillain-Barre syndrome, and acute brachial plexopathy Human herpesvirus 5 strain Merlin NC_006273 169, 235,646, 57.5 HHV-6/human herpesvirus 6/T-cell lymphotropic virus Roseola, febrile seizures, and fulminant hepatitis Human [hindawi.com]

  It’s not that I didn’t want an imperfect child; even if we had all the interventions, she’d have seizures 70 percent of the time, never suck or breathe. We couldn’t have detected the problem until then. My first thought was of my 2-year-old son. [nymag.com]

• Agitation

  […] conductance, and decreased myosin light chain kinase activity leads to smooth muscle relaxation and bronchodilation. tachycardia secondary to peripheral vasodilation and cardiac stimulation; tachycardia can be accompanied by palpitations. tremor, sweats, agitation [slideshare.net]

• Vaginal Discharge

  The increase of uNK cells level with the decrease of HLA-G expression in vaginal discharge of threatened-abortion pregnant women is an indicator of mother's immune dysregulation. [ncbi.nlm.nih.gov]

  I get vaginal discharge last week light brown todayoff white discharge llittle cramps here n there so I'm lost anyone know or experienced anything like this Can someone please give me answers!!! [babycenter.com]

  You have new or worsening vaginal bleeding. You have vaginal pain or itching, or vaginal discharge that is yellow, green, or foul-smelling. You have questions or concerns about your condition or care. [drugs.com]

• Pelvic Pain

  Threatened Abortion There is bleeding and sometimes pelvic pain but the cervix is closed and ultrasound indicates an ongoing pregnancy within the uterus. Inevitable Abortion The pregnancy is not continuing. [2womenshealth.com]

  History Quantity and rate of blood loss Bleeding similar or worse than Menstrual Bleeding is associated with Early Pregnancy Loss Pelvic Pain or cramping Exclude Ectopic Pregnancy ! [fpnotebook.com]

  The secondary objectives will be the efficacy of progesterone in reducing both pain and uterine contractions. [clinicaltrials.gov]

  Threatened miscarriage Vaginal bleeding, abdominal/pelvic pain of any degree, or both during early pregnancy represents a threatened miscarriage. [emedicine.medscape.com]

• Cervical Incompetence

  Diagnosis History: Abortion due to cervical incompetence is characterised by: History of a previous operation as dilatation or amputation of the cervix may be present. [gfmer.ch]

  By progression of pregnancy, the role of insufficient progesterone level declines and uterine structural malformation with or without cervical incompetency is responsible more than hormonal deficit. [jri.ir]

  Congenital or acquired uterine defects, fibroids, cervical incompetence, abnormal placental development, or grand multiparity. 4. Endocrine factors: Endocrine factors potentially contribute to recurrent abortion in 10-20% of cases. [slideshare.net]

  Other diseases or abnormalities of the reproductive system that may result in miscarriage include congenital or acquired uterine defects, fibroids, cervical incompetence, abnormal placental development, or grand multiparity. [emedicine.medscape.com]

• Uterine Tenderness

  Such infections are characterized by fever, chills, uterine tenderness and occasionally, peritonitis. The responsible bacteria are usually a mixed group of Strep, coliforms and anaerobic organisms. [brooksidepress.org]

  On vaginal examination, the internal cervical os is closed and no cervical motion tenderness or tissue is found. Diffuse uterine tenderness, adnexal tenderness, or both may be present. [emedicine.medscape.com]

• Uterine Cramps

  Abstract Threatened abortion is associated with bleeding and/or uterine cramping while the cervix is closed. This stage of abortion may progress to spontaneous incomplete or complete abortion. [ncbi.nlm.nih.gov]

The diagnosis of threatened abortion is made during a clinical examination when the absence of cervical dilation is observed in the setting of vaginal bleeding. Other forms of abortion (incomplete, inevitable) almost always include the presence of cervical dilation. However, ultrasonography (either abdominal or vaginal) is a recommended diagnostic procedure to evaluate the status of the fetus (the fetus may be expelled in the case of missed abortion, which can also present without cervical dilation) [10]. Additionally, levels of beta-hCG should be measured, but results may be inconclusive. It is important to obtain a diagnosis early so that appropriate steps can be taken in terms of therapy, and in the case of recurrent miscarriage, several diagnostic tools should be included, such as genetic testing, evaluation of hormonal status, and other tests [11].

• Progesterone Decreased

  Estrogen and progesterone continue to be secreted in large amounts by the placenta up to the time of delivery Progesterone decreases estrogen-driven endometrial proliferation and leads to the development of a secretory endometrium (Figure 40–3), and the [slideshare.net]

The main therapeutic principle in threatened abortion is observation and treatment of the underlying cause, in order to prevent the development of miscarriage. Several factors, such as bed rest and avoidance of sexual intercourse have been recommended by certain studies, but with inconclusive results [12].

Management of accompanying illnesses, such as diabetes mellitus, hypothyroidism, is vital in minimizing the risk of pregnancy loss. Infections in early pregnancy should be treated appropriately, and screening of bacterial vaginosis with proper antibiotic therapy has resulted in reduced rates of miscarriages [13]. The Antiphospholipid syndrome has also been established as a potential cause of pregnancy loss, and therapy consists of heparin combined with aspirin. Environmental factors, such as alcohol consumption and cigarette smoking, should be ceased or avoided, as well as drug abuse and increased caffeine intake.

Supplemental therapy with progesterone is a topic of debate across the world since numerous studies have implicated progesterone, as well as dydrogesterone (a synthetic analog of progesterone) supplementation to be beneficial for threatened miscarriage [14]. However, more evidence is necessary to prove that it is beneficial and that it can be used in general practice.

About 30% of all threatened abortions end in eventual miscarriage and pregnancy loss, which is why it is of vital importance to establish the diagnosis promptly, and identify possible factors which may contribute to pregnancy loss. Inevitable, incomplete or complete abortion can be emotionally debilitating for couples, especially for women who experience recurrent miscarriages.

The exact causes of threatened abortion are not always identified, and it may commonly remain unknown. However, several theories have been proposed:

• Infectious etiology - viral pathogens, such as parvovirus, rubella virus, cytomegalovirus, as well as herpes virus have been implicated as causative agents of miscarriages and recurrent pregnancy loss.
• Environmental factors - use of drugs such as cocaine, caffeine, alcohol abuse, as well as cigarette smoking, have been established as factors that contribute to pregnancy loss.
• Genetic defects - numerous pregnancies end because of chromosomal abnormalities, and defects in fetal development.

Numerous maternal factors have been proposed to be of influence to the fetus, including genital tract and uterine abnormalities, endocrine factors (reduced levels of progesterone and human chorionic gonadotropin (beta - hCG), poorly controlled diabetes mellitus, disorders of the thyroid gland, as well as other conditions, such as antiphospholipid syndrome, both acquired and hereditary thrombophilias, and trauma.

It is estimated that threatened abortion occurs in about 20-25% of all pregnancies, and is associated with an increased rate of fetal loss. Namely, miscarriage rates in women with threatened abortion are much higher (ranging from 15-50%) compared to women in whom this condition did not develop (between 2-7% of pregnancies result in miscarriage).

Risk factors for threatened abortion, but for other types of abortion as well, have been proposed and include:

• Prior miscarriage
• Older age (> 35)
• Drug and alcohol abuse
• Presence of maternal diseases (e.g. diabetes mellitus, thyroid dysfunction)
• Cigarette smoking
• Hormonal disbalance (reduced levels of progesterone and beta-hCG)
• Infection during early pregnancy

The pathogenesis of threatened abortion is incompletely understood, as it primarily depends on the underlying cause, but several studies have implicated that progesterone levels are one of the key factors in maintaining a normal pregnancy [5] [6]. Progesterone maintains the structure and function of the uterus, as well as cervical competency, and it has been established that sufficient levels of progesterone induce lymphocytic production of progesterone-induced blocking factor (PIBF), which shows anti-abortive properties in animal models [7]. PIBF also performs other important functions during pregnancy, such as modulation of maternal immune response to mediate the reaction to the fetus, as well as relaxation of uterine smooth muscles [8], indicating that progesterone therapy may be a valid approach in women with threatened abortion. However, there is still no concrete evidence for progesterone use in general practice, and more studies need to be performed to solidify these findings [9].

Prevention of threatened miscarriage is directed at maintaining good prenatal care, which consists of regular check-ups, avoiding toxins that may harm the fetus, including alcohol, cigarettes, and certain drugs that have proven harmful effects to the fetus, while caffeine should be completely avoided, and intake of this compound should be reduced to a minimum; and management of accompanying conditions, such as diabetes, hypothyroidism, or autoimmune disorders should be done.

Threatened abortion is a term that implies vaginal bleeding before reaching 20 weeks of gestation, but without cervical dilation, and may lead to preterm delivery, low birth weight, or it may lead to fetal death and loss of pregnancy [1]. The cause often remains unknown, but several factors have been proposed, including infectious, genetic and environmental. Risk factors for threatened abortion have been proposed, such as cigarette smoking, uterine abnormalities, previous miscarriages, use of certain drugs, reduced levels of progesterone, increased age, as well as other illnesses and conditions. Threatened abortion is estimated to occur in about 20% of early gestations, and about 50% of them will progress to miscarriage, with the majority of threatened miscarriages occurring between 14 and 20 weeks of gestation [2]. Clinical presentation of threatened abortion, in addition to vaginal bleeding, may include abdominal pain and backache [3]. The diagnosis can be made by clinical examination and abortion criteria, while ultrasonography is used to confirm the diagnosis, through recognizing the fetus and evaluation of vital signs. Treatment of threatened abortion includes supportive therapy, correction and proper management of other accompanying illnesses and conditions, and observation. Because of the psychological burden, it carries [4], proper prenatal care and avoidance of risk factors that may harm the fetus are recommended, to avoid pregnancy loss, and in the case of recurrent miscarriages, extensive evaluation should be conducted to identify the cause.

Threatened abortion is a term used to describe the presence of vaginal bleeding within the first 20 weeks of pregnancy, but without cervical dilation. It is important to note that threatened abortion does not imply pregnancy loss, it is rather a predisposing condition which may lead to miscarriage. Threatened abortion occurs in about a quarter of all pregnancies, and rates of miscarriage range from 15-50%, depending on numerous factors. Smoking, alcohol and drug abuse, age over 35 years, uterine abnormalities, poor monitoring and management of accompanying illnesses (such as diabetes mellitus) and prior miscarriages are all proposed as risk factors. The exact cause of threatened abortion is not known, while several factors have been mentioned. Infection by certain viruses has been proposed as a potential cause, while genetic defects, genital, and uterine abnormalities, as well as environmental factors, are also considered. However, the exact cause often remains unknown.

Symptoms of threatened abortion include spotting (light bleeding from the vagina), abdominal pain or cramping, back aches, while period pains may also be observed. The majority of symptoms are commonly encountered in normal pregnancy, but whenever there is the presence of bleeding, an immediate visit to the physician is necessary to identify the possible case, because threatened abortion may lead to pregnancy loss.

The diagnosis can be made during clinical examination, while ultrasound can be performed (either abdominal or vaginal) to assess the status of the fetus. In the case of recurrent pregnancy loss, a detailed diagnostic workup should be performed, including genetic testing, and evaluation of hormonal status. Treatment of threatened abortion should be directed at the underlying cause, if discovered, while supportive measures, such as bed rest and avoidance of sexual intercourse have been proposed, but a clear benefit has not been established. Supplemental use of progesterone is a topic of many discussions, because of the key roles this hormone has during pregnancy, but more evidence is necessary for this method to be used in everyday practice. Management of underlying illnesses, such as diabetes, hypothyroidism, or autoimmune diseases, should be performed, while prevention measures include proper prenatal care with regular check-ups, avoidance of risk factors that may harm the fetus, and proper management of accompanying illnesses.

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