Spontaneous abortion, which is the ...

Spontaneous abortion, which is the los of a pregnancy without outside intervention before 20 weeks' gestation, affects up to 20 percent of recognized pregnancies. Spontaneous abortion can be subdivided into threatened abortion, inevitable abortion, incomplete abortion, missed abortion, septic abortion, consummate abortion, and recurrent spontaneous abortion. Ultrasonography is helpful in the diagnosis of spontaneous abortion, nevertheless other testing may be be in want ofed if an ectopic pregnancy cannot be rul without Chromosomal abnormalities are causative in approximately 50 percent of spontaneous abortions; multiple other factors also may play a character Traditional treatment consisting of surgical evacuation of the uterus remains the treatment of choice in unstable patients. novel studies suggest that expectant or medical management is appropriate in pick outed patients. Patients with a complet spontaneous abortion rarely require medical or surgical intervention. For women with incomplete spontaneous abortion, expectant management for up to couple weeks usually is successful, and medical therapy provides little additional benefit. When patients are allowed to select between treatment options, a large percentage will select expectant management. Expectant management of missed spontaneous abortion has variable succes rates, still medical therapy with intravaginal misoprostol has an 80 percent succes rate. Physicians should be aware of psychologic issues that patients and their partners face after completing a spontaneous abortion. Women are at increased risk for significant depression and anxiety for up to individual year after spontaneous abortion. Counseling to address feelings of guilt, the grief proces and for what reason to cope with friends and family should be provided.

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Spontaneous abortion assigns to pregnancy loss at les than 20 weeks' gestation in the absence of elective medical or surgical measures to terminate the pregnancy. The space of time "miscarriage" is synonymous and repeatedly is used with patients because the word "abortion" is associated with elective termination. "Spontaneous pregnancy loss" has been commited to avoid the term "abortion" and acknowledge the emotional aspects of losing a pregnancy. (1) Another emotionally neutral name is "early pregnancy failure." (2)

For clinical meanings spontaneous abortion often is subdivided into threatened abortion, inevitable abortion, incomplete abortion, missed abortion, septic abortion, returning spontaneous abortion, and complete abortion (Table 1)

Incidence

Approximately 20 percent of pregnant women will have an bleeding before 20 weeks' gestation, and roughly united half of these pregnancies will fall of the curtain in spontaneous abortion. (3) Up to 20 percent of recognized pregnancies will close in miscarriage. However, when women were followed with serial serum human chorionic gonadotropin (hCG) measurements, the actual miscarriage rate was institute to be 31 percent. (4) Many pregnancies are not to be found spontaneously before a woman recognizes that she is pregnant, and the clinical signs of miscarriage are mistaken for a heavy or late menses

Diagnosis

Threatened abortion is defined on vaginal bleeding in a woman with a confirmed pregnancy. First-trimester bleeding in a pregnant woman has an extensive differential diagnosis (Table 2) and should be evaluated with a replete history and physical examination. Laboratory proofs should include potassium hydroxide and "wet prep" microscopy of any vaginal discharge, undiminished blood count, blood typing and Rh testing, and quantitative serum hCG testing. Gonorrhea and chlamydia testing also should be considered. Ultrasonography is crucial in identifying the status of the pregnancy and verifying that the pregnancy is intrauterine. When transvaginal ultrasonography reveals an vacant uterus and the quantitative serum hCG of the same height is greater than 1,800 mIU by mL (1,800 IU per L) an ectopic pregnancy should be considered. (5) When transabdominal ultrasonography is performed, an void uterus should raise suspicion of an ectopic pregnancy if quantitative hCG horizontals are greater than 3,500 mIU by means of mL (3,500 IU per L) A uterus establish to be empty on ultrasound examination may signal a complet spontaneous abortion, however the diagnosis is not definitive until ectopic pregnancy is exclud If an ultrasound examination finds an intrauterine pregnancy, ectopic pregnancy is unlikely, although heterotopic pregnancy has been reported (i.e., simultaneous intrauterine and ectopic pregnancies). (5) The risk for spontaneous abortion decreases from 50 to 3 percent when a fetal heartbeat is identified in succession ultrasound examination. (1)

When the clinical examination reveals a dilated cervix, spontaneous abortion is inevitable. However, cervical evaluation is not reliable for distinguishing between unbroken and incomplete abortion. (6,7) Transvaginal ultrasonography should be performed and is extremely reliable for finding fruitss of conception, with a 90 to 100 percent sensitivity and 80 to 92 percent specificity. (78)