First-Trimester Abortion: Causes, Types, Diagnosis & Management (0–13 Weeks)

First-trimester abortion refers to the termination or loss of pregnancy during the first 13 weeks of gestation. This can occur spontaneously (miscarriage) or intentionally (elective abortion). Understanding the causes, diagnosis, and safe treatment options is vital for women's health and well-being.

Types of First-Trimester Abortion

1. Spontaneous Abortion (Miscarriage)

• Threatened Abortion: Bleeding with closed cervix—pregnancy may continue.
• Inevitable Abortion: Open cervix with bleeding—miscarriage is unavoidable.
• Incomplete Abortion: Some but not all products of conception expelled.
• Complete Abortion: Entire pregnancy tissue expelled.
• Missed Abortion: Fetus has died, but pregnancy tissue retained.
• Septic Abortion: Miscarriage complicated by infection (often from unsafe methods).

2. Induced Abortion

Medical or surgical termination of pregnancy, often by choice or due to fetal/maternal indications.

Causes and Risk Factors

Common Causes:

• Chromosomal abnormalities
• Hormonal imbalances (e.g., low progesterone)
• Infections (toxoplasmosis, listeria, etc.)
• Chronic diseases (diabetes, thyroid disorders)
• Uterine abnormalities (fibroids, septum)

Risk Factors:

• Maternal age >35 years
• Smoking, alcohol, or drug use
• High fever or trauma
• Previous miscarriage
• Poor nutrition

Diagnosis

• Ultrasound: Transvaginal preferred. No heartbeat + crown-rump length >7 mm = nonviable pregnancy.
• β-hCG Blood Tests: Serial hCG levels help confirm pregnancy viability.
• Clinical Symptoms: Bleeding, cramping, and loss of pregnancy symptoms.

Management

Expectant Management

Wait and observe. Natural miscarriage usually completes in a few days to weeks. Requires monitoring.

Medical Management

• Mifepristone 200 mg orally, followed by
• Misoprostol 800 mcg vaginally or buccally after 24–48 hours
• Effective in 85–95% of early pregnancy losses

Surgical Management

• Manual Vacuum Aspiration (MVA)
• Dilation and Curettage (D&C)
• Preferred in case of heavy bleeding, infection, or failed medical therapy

Complications

Complication	Description
Hemorrhage	Heavy bleeding needing intervention
Infection	Due to incomplete expulsion or septic abortion
Retained products	May cause prolonged bleeding or infection
Uterine perforation	Risk during surgical abortion procedures

Recovery & Aftercare

• Pelvic rest for 2 weeks
• Follow-up with ultrasound or β-hCG to confirm completion
• NSAIDs for pain control
• Counselling and contraceptive advice if needed

Emotional & Psychological Support

Emotional distress is common after abortion. Psychological counselling, support groups, and empathetic care are crucial for recovery.

FAQs

1. How early can abortion be done?

As early as 5–6 weeks, once the pregnancy is confirmed via ultrasound or hCG levels.

2. What is the safest method?

Medical abortion (mifepristone + misoprostol) is considered very safe and effective for up to 10 weeks of gestation.

3. How soon can I get pregnant again?

You may ovulate as early as 2–4 weeks after miscarriage. Medically, you can try again after your next menstrual cycle.

4. Will abortion affect future fertility?

No, if managed correctly. Complications like infection or uterine trauma may affect fertility but are rare.

Featured Snippet

First-trimester abortion refers to pregnancy termination before 13 weeks—either via medical methods (mifepristone + misoprostol) or surgical suction/vacuum aspiration. It’s 95–99% effective and safe when appropriately managed.