Abortion

Key Information

Appropriate Tests

 

Full blood count. Blood group.

Rh (D) immunoglobulin should be administered if patient is Rh (D) negative.

Histology of tissue passed, or curette specimen.

See also Fetal death.

Pervaginal bleed first trimester; Urea, Electrolytes, Glucose, Beta HCG quantitation (female), Full blood count, Blood group and antibody screen, Ward test urine and MCS if positive. Consider PCR on FCU or vaginal (cervical) swab for chlamydia and gonorrheae.

See Guideline on Pathology testing in the Emergency department: Appendix 2.

Induced

See above.

Spontaneous

Serial Beta HCG quantitation. 

Serology for Syphilis (RPR or TPPA), HIV infection antibodies.

Further investigation of underlying cause is usually only indicated if abortion recurs.

Trophoblastic disease

Beta HCG quantitation.

Infection, especially Parvovirus B19

See Parvovirus B19 infection.

Habitual

Defined as three or more consecutive spontaneous abortions.

Investigation for Systemic lupus erythematosus, STI, (serological tests for sexually transmitted infections) some viruses eg Cytomegalovirus infection, Toxoplasma gondii Ab. 

Uterine abnormalities

 

Endocrine disorders, especially

 

  • Diabetes mellitus

Fasting Glucose, Glucose urine (POCT dip stick)

  • Thyroid disorders

TSH receptor Ab.

Autoimmune disorders, especially

 

  • Phospholipid antibody syndrome
  • SLE

APTT, Lupus anticoagulant, Cardiolipin Ab, Antinuclear Ab. See Antiphospholipid syndrome.

Inherited thrombophilias

Factor V Leiden, Prothrombin gene mutation, Protein C, Protein S, Antithrombin III.

See Thrombophilia

Genetic abnormalities

Blood for Cytogenetics - constitutional (test both parents).

Cytogenetics - prenatal and fetal may be helpful (consult geneticist). Currently, molecular genetics is not indicated.

Examination of fresh fatal tissue for cytogenetics.

Septic

 

Uterine infection
  • Streptococcus pyogenes
  • Group B streptococci
  • Clostridium perfringens
  • Neisseria gonorrhoea
  • Chlamydia trachomatis
  • Mycoplasma /Ureaplasma 


Cervical cytology, curettage tissue - microscopy and culture.

Culture, PCR, Genital swab for Neisseria gonorrhoea and Chlamydia trachomatis.

Blood culture. Full blood count. Blood film. See also Septicaemia.

PCR or culture of Genital swab 

  • Listeria monocytogenes

See Listeriosis.