Spontenous abortion

(early pregnancy loss, miscarriage): loss of pregnancy before 20 weeks' gestation

two or more pregnancy losses occurring before 20 weeks' gestation

• Abnormalities of the reproductive organs

  • Septate uterus

  • Uterine leiomyomas

  • Uterine adhesions

  • Cervical incompetence

• Systemic diseases

  • Including diabetes mellitus, hyperthyroidism, hypothyroidism, genetic disorders, infections, hypercoagulability (e.g., antiphospholipid syndrome, which is associated with recurrent miscarriages)

• Chromosomal abnormalities account for up to half of all spontaneous abortions

• Congenital anomalies

• Anembryonic pregnancy

• Trauma

• Iatrogenic (e.g., amniocentesis or chorionic villus sampling)

• Environmental (exposure to toxins such as drugs or maternal smoking during pregnancy)

• Unknown

1. Doppler ultrasound -> absence fetal cardiac activity?

2. Pelvic examination —> in all cases of vaginal bleeding

3. Transvaginal ultrasound —> best imaging test once abscence fetal cardiac activity/ confirmed uterine bleeding

• Doppler ultrasound is always used to detect fetal heartbeats during prenatal visits. Absence of fetal cardiac activity should raise suspicion of spontaneous abortion.

• Pelvic examination should be performed in all cases of vaginal bleeding. In cases of suspected spontaneous abortion, visualization of the cervix is necessary to confirm that the source of bleeding is uterine.

• Transvaginal ultrasound is the best imaging test once there is absence of fetal cardiac activity or confirmed uterine bleeding. Findings consistent with a spontaneous abortion include:

  • Absence of fetal cardiac motion

  • Abnormalities of the yolk sac or gestational sac

• A downtrending β -hCG is consistent with a failed pregnancy.

• Minimize risk with treatment of maternal disease and adequate prenatal care.