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Abortus incipiens – Causes, Symptoms and Treatment

Abortus incipiens is an inevitable miscarriage in early pregnancy characterized by cervical dilation, uterine contractions, and vaginal bleeding that cannot be stopped.

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Things worth knowing about "Abortus incipiens"

Abortus incipiens is an inevitable miscarriage in early pregnancy characterized by cervical dilation, uterine contractions, and vaginal bleeding that cannot be stopped.

Definition

Abortus incipiens (Latin: beginning abortion) refers to an inevitable miscarriage in which the process of pregnancy loss has already begun and cannot be halted. Unlike a threatened miscarriage (abortus imminens), where the pregnancy may still be saved, an abortus incipiens will invariably result in the loss of the pregnancy. It typically occurs during the first trimester (up to 12 weeks of gestation).

Causes

The causes of abortus incipiens are varied. Chromosomal or genetic abnormalities of the embryo are the most frequent underlying factor. Other contributing causes include:

Chromosomal abnormalities of the embryo (most common cause, accounting for approximately 50–60% of cases)
Hormonal disorders, such as luteal phase deficiency
Anatomical uterine abnormalities (e.g., uterine septum)
Infections (e.g., listeriosis, toxoplasmosis, rubella)
Immunological factors (e.g., antiphospholipid syndrome)
Systemic maternal illnesses (e.g., poorly controlled diabetes mellitus, thyroid disorders)
Trauma or significant physical stress

Symptoms

The clinical presentation of abortus incipiens is characteristic and distinguishes it from other types of miscarriage:

Vaginal bleeding: often heavier than in a threatened miscarriage, possibly containing tissue fragments
Cervical dilation: the cervical os is already open – this is the defining clinical feature
Uterine contractions: cramping lower abdominal pain similar to menstrual cramps or labor contractions
Lower back and pelvic pain
Possible passage of amniotic fluid or pregnancy tissue

Diagnosis

Diagnosis of abortus incipiens is based on a combination of clinical examination and diagnostic imaging:

Gynecological Examination

An open cervical os is the hallmark clinical finding. Inspection of the cervical canal and vagina provides information about the stage of the miscarriage and the presence of any retained tissue.

Transvaginal Ultrasound

Transvaginal ultrasound is used to assess the size and position of the gestational sac. Absence of embryonic cardiac activity and an irregular gestational sac confirm the diagnosis. Ultrasound also helps determine whether retained products of conception remain in the uterine cavity.

Laboratory Tests

Serum beta-hCG (human chorionic gonadotropin) levels are measured. In abortus incipiens, these values are typically low or declining over time. A full blood count and blood group typing (including Rh factor) are also performed.

Treatment

Since the miscarriage cannot be stopped, treatment is aimed at ensuring complete and complication-free emptying of the uterus and providing appropriate care for the patient.

Expectant Management

In uncomplicated cases, a watchful waiting approach may be taken to allow spontaneous and complete expulsion of the pregnancy tissue. This requires close follow-up with repeat ultrasound examinations.

Medical Treatment

Misoprostol (a prostaglandin analogue) may be administered to stimulate uterine contractions and facilitate the expulsion of the gestational tissue. This is commonly used when spontaneous passage is incomplete or delayed.

Surgical Treatment

Surgical intervention may be necessary in cases of heavy bleeding, signs of infection, or incomplete miscarriage:

Curettage: mechanical removal of uterine contents
Vacuum aspiration (suction curettage): a less traumatic procedure for removing retained products of conception, now generally preferred

Rh Prophylaxis

Women with Rh-negative blood type should receive anti-D immunoglobulin following a miscarriage to prevent sensitization against Rh-positive red blood cells, which could endanger future pregnancies.

Psychological Support

A miscarriage is often a traumatic experience for affected women and their partners. Psychological counseling, supportive conversations, and grief support are an essential component of comprehensive patient care.

References

Cunningham FG et al. – Williams Obstetrics, 26th Edition. McGraw-Hill Education, 2022.
World Health Organization (WHO) – Medical management of abortion. WHO Press, Geneva, 2018.
Betts P, Odendaal H – Early Pregnancy Loss. In: Comprehensive Gynecology, 7th Edition. Elsevier, 2017.

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