In context, abortion and miscarriage mean different things. Both speak of a termination of pregnancy. Abortion is a colloquial term and may mean induced termination of pregnancy. Miscarriage speaks of a spontaneous termination or threat at termination of the pregnancy. Here, I use the term “abortion” to refer to induced termination of pregnancy and the term “miscarriage” to refer to spontaneous termination of pregnancy.
What is Abortion?
Existence of abortion as a medical entity is apparent since ancient Egyptian civilizations to the modern era. In 1550 BCE, records suggest medical induction of abortion was done using plant fibre “pad” coated with a preparation made with dates and honey. Aphorisms manuscript section V, part 31 translates “If a woman with child be bled, she will have an abortion, and this will be the more likely to happen, the larger the foetus”. The original Hippocrates Oath taken by doctors mentions that abortion translating into English as “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion”, dictating moral guidelines for ancient doctors preventing malpractice. Elective abortion may be the parent’s choice or it may be indicated due to some clinical condition.
The factors taken into consideration in a therapeutic abortion are the current clinical condition of mother, prognosis of any medical conditions she may have, the current status of the pregnancy, prognosis of the foetus, and effects on the prognosis of the mother if the pregnancy is continued. Chief among indications for therapeutic abortions is cancer during pregnancy, although the incidence is rare. Breast cancer (1 in 3000 pregnancies), cervical cancer (1% – 3% in United States), melanoma, ovarian cancer, colorectal cancers are few of the common malignancies found during pregnancy, incest, rape and foetal abnormalities that can result in a child being born with mental or physical abnormality or in the death of the new-born, are important considerations concerning abortion. There are medical and surgical methods of abortion. Surgical methods of abortion include manual or vacuum aspiration, suction curettage, sharp curettage, dilatation and evacuation, labour induction, saline infusion abortion, hysterectomy, intact dilatation and extraction, hypertonic urea infusion abortion, and foetal intra-cardiac digoxin /KCL injection. The choice of method is according to the gestational age.
What is Miscarriage?
Miscarriage is defined medically as the expulsion or a threat at expulsion of products of conception prior to less than 24 weeks of gestation. After 24 weeks, it is called intra-uterine death, and the management plan is a bit different. There are four types of miscarriages. They are complete, incomplete, inevitable, and missed miscarriages. All except missed miscarriage presents with vaginal bleeding after a period of amenorrhoea. There may be abdominal pain. Complete miscarriage features expulsion of all the uterine contents without the need for surgical or medical evacuation. Incomplete miscarriage needs evacuation. Inevitable miscarriage is a condition where expulsion of products is inevitable but not occurred yet. The uterine cervix is open and foetal heart may or may not be there. Inevitable miscarriage may cause massive bleeding. Missed miscarriage occurs unbeknownst to the mother. There is no bleeding, and the cervix is closed. Ultrasound scan doesn’t show a beating foetal heart. Gynaecologist may wait for spontaneous expulsion or dilate and evacuate.
What is the difference between Abortion and Miscarriage?
• Abortion is induced while miscarriage is spontaneous.
• Abortion brings a viable foetus out while miscarriage expels a non-viable foetus.
• Abortion is the choice of the parents while miscarriage is not.
• There are medical and surgical methods of abortion. Similar methods are used to expel the retained not viable products of conception in miscarriages.
• Miscarriages present with vaginal bleeding except in missed miscarriage. Abortion carries a high risk of bleeding.
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