Diagnosis

First-trimester miscarriage can be further defined according to stage of pregnancy loss and associated symptoms.

Threatened abortion is diagnosed when the pregnant woman presents with vaginal bleeding, lower back discomfort, or midline pelvic cramping. On examination, the cervical os is closed, and the pregnancy is viable (by Doppler ultrasound). About 25% of women will have some degree of bleeding in the first trimester, about half of whom will miscarry. The remaining women may have a slightly higher risk of perinatal complications, such as preterm labor and IUGR. The risk of congenital malformations is not increased.

Inevitable abortion occurs when there is profuse bleeding requiring surgical intervention or overt rupture of membranes. Although the cervical os may be initially closed and tissue has not passed, the miscarriage is inevitable.

Incomplete abortion is diagnosed when products of conception have passed the level of the cervical os. There is often heavy vaginal bleeding, midline cramping, and an open cervical os.

Complete abortion occurs when all the gestational products have passed. This is ascertained by examination of the passed products of conception, pelvic ultrasonography to ascertain emptiness of the uterus, and at times retrospectively with falling quantitative hCG levels.

"Missed abortion" is a poor term still in use to describe retention of a nonviable pregnancy for longer than 4 weeks. Ultrasound scans of these women provide a more specific and usually earlier diagnosis, such as empty sac or an embryonic gestation, or fetal demise.

Septic abortion is diagnosed when there is infection of the uterus and products of conception. This occurs most often with incomplete abortions. Fever, uterine tenderness, foul discharge, and leukocytosis should aid the practitioner in making this diagnosis.

Recurrent spontaneous abortion is reserved for those women who have had three or more first-trimester losses. This diagnosis should prompt further evaluation for etiology.

Pregnancy Guide

Pregnancy Guide

A Beginner's Guide to Healthy Pregnancy. If you suspect, or know, that you are pregnant, we ho pe you have already visited your doctor. Presuming that you have confirmed your suspicions and that this is your first child, or that you wish to take better care of yourself d uring pregnancy than you did during your other pregnancies; you have come to the right place.

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