Severe or persistent hemorrhage during or following abortion may be life threatening. The more advanced the gestation, the greater the likelihood of excessive blood loss. Sepsis develops most frequently after selfinduced abortion. Infection, intrauterine synechia, and infertility are other complications of abortion. Perforation of the uterine wall may occur during dilatation and curettage (D&C) because of the soft and vaguely outlined uterine wall and may be accompanied by injury to the bowel and bladder, hemorrhage, infection, and fistula formation.

Multiple pregnancy with the loss of one fetus and retention of another (“vanishing twin”) is not only possible but has been well documented in 20% of early pregnancies closely monitored by ultrasound. Usually the fetus is simply resorbed, but the loss of one fetus in multiple gestation may be accompanied by cramping or vaginal bleeding.

Even with very early miscarriage, a loss can have a significant effect on the family. The fact that most of these losses are unexpected intensifies this grief. Each person responds differently to his or her tragedy. It is the health care worker’s responsibility to help parents mourn by acknowledging their loss and identifying potential support systems.

Prevention

Some losses can be prevented by early obstetric care, with adequate treatment of maternal disorders such as diabetes and hypertension, by protection of pregnant women from environmental hazards, and from exposure to infectious diseases.