Early Pregnancy Loss / Spontaneous Abortion - 81
Spontaneous abortion (miscarriage) is a loss of an early pregnancy and is very common. Spontaneous abortion occurs most frequently in the first trimester. A threatened abortion is the more common presentation. When recurrent, spontaneous abortion can be associated with infertility. Spontaneous abortion can result in grief reactions. Thus effective primary care management of this common problem is important.
The cause is usually not determined but may include:
- Genetic factors (e.g., chromosomal abnormalities)
- Reproductive tract abnormalities (e.g., uterine anomalies)
- Prothrombotic factors (e.g., thrombophilia)
- Endocrinologic factors (e.g., polycystic ovary syndrome)
- Immunologic factors (e.g., antiphospholipid syndrome)
Given a patient with a threatened abortion, the candidate will clarify the status of the pregnancy, will identify any complications, and will initiate an appropriate management plan. Particular attention should be paid to supportive counseling of parents, and to appropriate investigation in cases of recurrent abortion.
Given a patient with threatened abortion, the candidate will
- list and interpret critical clinical findings, including
- the results of a thorough obstetrical history;
- the results of a physical examination, with an emphasis on the status of the pregnancy (e.g., speculum examination, evidence of an ectopic pregnancy);
- identification of urgent complications (e.g., assessment of hemodynamic stability);
- list and interpret critical investigations, including
- transvaginal ultrasound;
- laboratory investigations when appropriate (e.g., maternal antibody screen, complete blood count, beta-hCG);
- proper investigation regarding recurrent abortion (e.g., anti-phospholipid antibody screen, karyotype, hystero-salpingogram);
- construct an effective initial management plan, including
- emergent management in case of hemodynamic instability (e.g., ruptured ectopic pregnancy);
- referral for surgical evacuation or medical management (e.g., incomplete or missed abortion), if necessary;
- counseling (e.g., grief, fertility implications, contraception);
- referral for specialized care, if indicated (e.g., serious hemorrhage, recurrent abortion).