Early Pregnancy Loss

Basics

Description

  • Spontaneous termination of a <20-wk intrauterine pregnancy
  • Formerly: Spontaneous abortion
  • Synonyms: miscarriage, early pregnancy failure
  • Most common complication of early pregnancy:
    • 9–17% in women aged 20–30
    • 20% at age 35
    • 40% at age 40
    • 80% at age 45
    • ∼80% occur in 1st trimester
  • Vaginal bleeding in the 1st trimester is seen in about 25% of pregnant patients:
    • Early pregnancy loss rate is highest in patients with heavy vaginal bleeding (defined as similar or greater than normal menses), estimated to be 24%
  • Definitions:
    • No intervention indicated:
      • Threatened abortion: Vaginal bleeding, cervical os is closed, viable intrauterine pregnancy confirmed
      • Complete abortion: Vaginal bleeding, cervical os closed, complete passage of products of conception (POC)
    • Intervention indicated:
      • Incomplete abortion: Vaginal bleeding, cervical os is open with partial passage of some POC and some retained POC
      • Inevitable abortion: Vaginal bleeding, cervical os is open; POC have not been expelled
      • Missed abortion: Fetal demise with no uterine activity to expel
      • Septic abortion: Spontaneous abortion complicated by intrauterine infection
      • Recurrent spontaneous abortion: 3 or more consecutive pregnancy losses

Etiology

  • Chromosomal abnormalities of the fetus
  • Uterine abnormalities (eg, leiomyoma, uterine adhesions, congenital anomalies)
  • Risk factors include:
    • Increased age of both mother and father
    • Increased parity
    • Alcohol use
    • Cigarette smoking
    • Cocaine use
    • Conception within 3–6 mo after delivery
    • Assisted reproduction
    • Chronic maternal disease (eg, HTN, DM, thyroid disease)
    • Maternal infections (eg, syphilis, parvovirus B19, Zika virus, CMV, and ascending pelvic infections)
    • Medications:
      • Misoprostol
      • Methotrexate
      • NSAIDs
    • Previous early pregnancy loss
    • Toxins

There's more to see -- the rest of this topic is available only to subscribers.