eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology

Abortion, Complications: Differential Diagnoses & Workup

Author: Slava V Gaufberg, MD, Assistant Professor of Medicine, Harvard Medical School; Director of Transitional Residency Training Program, Cambridge Health Alliance
Contributor Information and Disclosures

Updated: Dec 12, 2008

Differential Diagnoses

Abortion, Complete
Ovarian Torsion
Abortion, Incomplete
Pregnancy, Ectopic
Abortion, Inevitable
Pregnancy, Trauma
Abortion, Missed
Pregnancy, Urinary Tract Infections
Abortion, Septic
Trauma, Lower Genitourinary
Abortion, Threatened
Urinary Tract Infection, Female
Appendicitis, Acute
Vaginitis
Dysfunctional Uterine Bleeding
Vulvovaginitis
Dysmenorrhea
Ovarian Cysts

Other Problems to Be Considered

Perforated viscus
Acute peritonitis

Workup

Laboratory Studies

  • Complete blood count, platelets
  • Complete metabolic screen
  • Beta-human chorionic gonadotropin, quantitative level may provide useful information and a basis for future comparison.
  • Prothrombin time/activated partial thromboplastin time
  • Urinalysis
  • Type and screen or type and cross with antibody screen (with severe hemorrhage)
  • Fibrinogen and fibrin split products if DIC is suspected
  • D-dimer

Imaging Studies

  • To exclude free air as a result of bowel perforation, perform either upright chest x-ray or upright abdominal x-ray.
  • Order or perform ultrasound with a vaginal probe to rule out ectopic pregnancy, retained products of conception, and hematometra.
  • Order arteriography if injury to large blood vessels is suspected.

More on Abortion, Complications

Overview: Abortion, Complications
Differential Diagnoses & Workup: Abortion, Complications
Treatment & Medication: Abortion, Complications
Follow-up: Abortion, Complications
References

References

  1. Darney PD, ed. Handbook of Office and Ambulatory Gynecologic Surgery. Blackwell Science Inc; 1987:108.

  2. Grimes DA, Cates W Jr. Deaths from paracervical anesthesia used for first-trimester abortion, 1972-1975. N Engl J Med. Dec 16 1976;295(25):1397-9. [Medline].

  3. Grossman D, Blanchard K, Blumenthal P. Complications after second trimester surgical and medical abortion. Reprod Health Matters. May 2008;16(31 Suppl):173-82:[Medline].

  4. Hakim-Elahi E, Tovell HM, Burnhill MS. Complications of first-trimester abortion: a report of 170,000 cases. Obstet Gynecol. Jul 1990;76(1):129-35. [Medline].

  5. Lohr PA. Surgical abortion in the second trimester. Reprod Health Matters. May 2008;16(31 Suppl):151-61:[Medline].

  6. Sam C, Hamid MA, Swan N. Pyometra associated with retained products of conception. Obstet Gynecol. May 1999;93(5 Pt 2):840. [Medline].

  7. Shannon C, Brothers LP, Philip NM, Winikoff B. Infection after medical abortion: a review of the literature. Contraception. Sep 2004;70(3):183-90. [Medline].

  8. Shulman SG, Bell CL, Hampf FE. Uterine perforation and small bowel incarceration: sonographic and surgical findings. Emerg Radiol. Aug 16 2006;[Medline].

  9. Stuart GS, Sheffield JS, Hill JB, et al. Morbidity that is associated with curettage for the management of spontaneous and induced abortion in women who are infected with HIV. Am J Obstet Gynecol. Sep 2004;191(3):993-7. [Medline].

  10. Stubblefield PG. First and second trimester abortion. In: Nichols DH, ed. Gynecologic and Obstetric Surgery. Mosby-Year Book; 1993:1016-1030.

  11. Stubblefield PG. Pregnancy termination. In: Obstetrics: Normal and Problem Pregnancies. 3rd ed. Churchill Livingstone; 1996:1249-1276.

  12. Stubblefield PG, Grimes DA. Septic abortion. N Engl J Med. Aug 4 1994;331(5):310-4. [Medline].

Further Reading

Keywords

miscarriage, abortion complications, spontaneous abortion, therapeutic abortion, postabortion complications, complications of anesthesia, postabortion triad, vaginal bleeding, hematometra, retained products of conception, uterine perforation, bowel and bladder injury, failed abortion, septic abortion, cervical shock, cervical laceration, disseminated intravascular coagulation, DIC, complications of abortion

Contributor Information and Disclosures

Author

Slava V Gaufberg, MD, Assistant Professor of Medicine, Harvard Medical School; Director of Transitional Residency Training Program, Cambridge Health Alliance
Slava V Gaufberg, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Roy Alson, MD, PhD, FACEP, FAAEM, Associate Professor, Department of Emergency Medicine, Wake Forest University School of Medicine; Medical Director, Forsyth County EMS; Deputy Medical Advisor, North Carolina Office of EMS; Associate Medical Director, North Carolina Baptist AirCare
Roy Alson, MD, PhD, FACEP, FAAEM is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, North Carolina Medical Society, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Mark Zwanger, MD, MBA, Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University
Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

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