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For further information, see CMDT Part 19-08: Spontaneous Abortion
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Essentials of Diagnosis
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Intrauterine pregnancy < 20 weeks
Low or falling levels of human chorionic gonadotropin (hCG)
Bleeding or midline cramping pain, or both
Open cervical os
Complete or partial expulsion of products of conception
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General Considerations
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Defined as termination of gestation prior to the 20th week of pregnancy
75% of cases occur before the 16th week, with 75% of these before the 8th week
Almost 20% of clinically recognized pregnancies terminate in spontaneous abortion
More than 60% of cases result from chromosomal defects
About 15% of cases are associated with
Maternal trauma
Infection
Dietary deficiency
Diabetes mellitus
Hypothyroidism
The lupus anticoagulant-anticardiolipin-antiphospholipid antibody syndrome
Anatomic malformations
There is no evidence that psychic stimuli such as severe fright, grief, anger, or anxiety can induce termination
There is no evidence that electromagnetic fields are associated with an increased risk of termination
It is important to distinguish women with incompetent cervix from more typical early abortion, premature labor, or rupture of the membranes
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Predisposing factors
History of incompetent cervix
Cervical conization or surgery
Cervical injury
Diethylstilbestrol exposure
Anatomic abnormalities of the cervix
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Incompetent cervix
Threatened abortion
Inevitable abortion
Complete abortion
Incomplete abortion
Missed abortion
The pregnancy has ceased to develop, but the conception has not been expelled
There may be brownish vaginal discharge but no active bleeding
Symptoms of pregnancy disappear
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Differential Diagnosis
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Falling levels of hCG
Complete blood count should be obtained if bleeding is heavy
Rh type should be determined and Rho(D) Ig given if the type is Rh negative
All recovered tissue should be preserved and assessed by a pathologist
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Transvaginal ultrasound can identify the gestational sac 5–6 weeks from the last menstrual period, a fetal pole at 6 weeks, and fetal cardiac activity at 6–7 weeks
Diagnostic criteria of early pregnancy loss