# Threatened Abortion

> Clinical picture, ultrasound prognosis, rest, progestogen role and Rh immunoglobulin in threatened abortion for NEET-PG Obstetrics and Gynaecology preparation.

- Canonical URL: https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/threatened-abortion
- Exam / course: NEET-PG · Subject: Obstetrics and Gynaecology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-08
- Last updated: 2026-10-08
- Reference basis: RCOG Green-top Guideline on the Management of Early Pregnancy Loss; Williams Obstetrics; D.C. Dutta's Textbook of Obstetrics
- How to cite: "Threatened Abortion", PrepElephant, https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/threatened-abortion

## Direct answer

Threatened abortion is vaginal bleeding before 20 weeks of gestation with a closed cervical os and no passage of products. Ultrasound confirms whether a live intrauterine pregnancy is present and gives the prognosis, since a live embryo with cardiac activity and a closed os has a good chance of continuing. Management is supportive, rest is advised without proven benefit, and Rh-negative women are assessed for anti-D immunoglobulin.

## What you must remember

- **Definition:** bleeding before 20 weeks with a closed cervical os, and a uterine size consistent with dates.
- **Prognosis on ultrasound:** an intrauterine sac with fetal cardiac activity and a closed os favours continuation; absent cardiac activity points to missed or inevitable miscarriage.
- **Subchorionic haematoma:** a common cause of bleeding, and its size guides the prognosis.
- **Rest and abstinence:** advised symptomatically, though bed rest has no proven benefit.
- **Progestogens:** trial evidence is inconsistent, and use depends on local protocol.
- **Rh-negative women:** anti-D immunoglobulin per protocol, commonly 300 micrograms intramuscularly in Indian practice.

## A stepwise approach to the bleeding woman

Threatened abortion is a diagnosis made by combining the history, the speculum view and the scan. The steps below run from first contact to follow-up.

1. **Confirm the diagnosis:** take a history of bleeding and pain, and inspect the cervix with a speculum to confirm the os is closed. Avoid digital examination.
2. **Scan the pregnancy:** perform a transvaginal ultrasound for an intrauterine sac, fetal heart activity and any subchorionic collection.
3. **Estimate prognosis:** a live fetus with a heartbeat and a closed os favours continuation, while an empty sac or absent cardiac activity signals miscarriage.
4. **Advise and reassure:** explain the prognosis, advise moderation of activity and give clear warning signs for heavy bleeding or pain.
5. **Check Rh status:** Rh-negative women are given anti-D immunoglobulin according to the local protocol.
6. **Review:** repeat the scan after one to two weeks if bleeding persists, and refer promptly for heavy bleeding.

The ultrasound findings and the os status carry more prognostic weight than the amount of bleeding.

## Where the exam tries to catch you

Threatened abortion questions test whether the candidate reads the scan and the os rather than reacting to the bleeding alone.

- **Trap:** Assuming all bleeding in early pregnancy predicts miscarriage. **Correct:** Many women with a closed os and fetal heart activity continue the pregnancy.
- **Trap:** Treating bed rest as a proven intervention. **Correct:** Rest is advisory, and evidence that it prevents miscarriage is weak.
- **Trap:** Missing anti-D in Rh-negative bleeding. **Correct:** Blood group and Rh status must be checked, and anti-D given according to protocol.

## Frequently asked questions

### What is the prognosis of threatened abortion with a closed os?

Threatened abortion with a closed cervical os and fetal cardiac activity on ultrasound has a good chance of continuing. Bleeding alone does not predict miscarriage. Threatened abortion prognosis depends most on the scan findings and the os.

### Does progesterone prevent miscarriage in threatened abortion?

Progestogen use in threatened abortion has inconsistent trial evidence and varies by protocol. Some centres use dydrogesterone or vaginal progesterone. Threatened abortion management should not rely on progesterone as proven therapy.

### Should Rh-negative women with threatened abortion receive anti-D?

Indian practice commonly gives anti-D immunoglobulin to Rh-negative women with bleeding in pregnancy, usually as a 300 microgram intramuscular dose. Protocols differ on the gestational threshold and timing. Local guidelines should be checked when deciding.

### Is bed rest required in threatened abortion?

Bed rest is commonly advised, but there is no good evidence that it prevents miscarriage. Women are usually advised to limit heavy activity and seek review for heavy bleeding. Rest is a comfort measure, not a proven treatment for threatened abortion.