First trimester abortion: Difference between revisions

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*Estimates are up to 15% of pregnancies end in a 1st trimester abortion usually due to fetal chromosomal abnormalities
*Estimates are up to 15% of pregnancies end in a 1st trimester abortion usually due to fetal chromosomal abnormalities


==Clinical Features==
===Types===
*Visualize any clots or bleeding from external os
====Complete Abortion====
*Assess '''internal os''' as open or closed based on ability to pass finger through os
*Pregnancy ≤ 13 weeks
 
==Differential Diagnosis==
===Complete Abortion===
*<12 weeks + no IUP
*<12 weeks + no IUP
*Distinguish from ectopic based on decreasing hCG, decreased bleeding
*Distinguish from ectopic based on decreasing hCG, decreased bleeding
*Only need to send hCG if unable to examine POC
*Only need to send hCG if unable to examine POC
===Threatened Abortion===
====Threatened Abortion====
*Closed os + IUP + bloody vaginal dischrage or frank bleeding
*Closed os + IUP + bloody vaginal dischrage or frank bleeding
*If <11wk >90% go to term
*If <11wk >90% go to term
*If between 11 and 20wk 50% go to term
*If between 11 and 20wk 50% go to term
===Inevitable Abortion===
====Inevitable Abortion====
*Open os + contractions/cramps
*Open os + contractions/cramps
===Incomplete Abortion===
====Incomplete Abortion====
*>12 wks + passage of only portion of POC
*>12 wks + passage of only portion of POC
===Missed Abortion===
====Missed Abortion====
*Fetal death at <20wk w/o passage of any fetal tissue for 4wk after fetal death
*Fetal death at <20wk w/o passage of any fetal tissue for 4wk after fetal death
===Septic abortion===
====Septic abortion====
*Evidence of infection during any stage of abortion
*Evidence of infection during any stage of abortion
*Most commonly caused by retained products of conception
*Most commonly caused by retained products of conception
==Clinical Features==
*Visualize any clots or bleeding from external os
*Assess '''internal os''' as open or closed based on ability to pass finger through os
*Pregnancy ≤ 13 weeks
==Differential Diagnosis==
{{VB DDX less than 20}}


==Workup==
==Workup==

Revision as of 18:48, 12 September 2014

Background

  • Estimates are up to 15% of pregnancies end in a 1st trimester abortion usually due to fetal chromosomal abnormalities

Types

Complete Abortion

  • <12 weeks + no IUP
  • Distinguish from ectopic based on decreasing hCG, decreased bleeding
  • Only need to send hCG if unable to examine POC

Threatened Abortion

  • Closed os + IUP + bloody vaginal dischrage or frank bleeding
  • If <11wk >90% go to term
  • If between 11 and 20wk 50% go to term

Inevitable Abortion

  • Open os + contractions/cramps

Incomplete Abortion

  • >12 wks + passage of only portion of POC

Missed Abortion

  • Fetal death at <20wk w/o passage of any fetal tissue for 4wk after fetal death

Septic abortion

  • Evidence of infection during any stage of abortion
  • Most commonly caused by retained products of conception

Clinical Features

  • Visualize any clots or bleeding from external os
  • Assess internal os as open or closed based on ability to pass finger through os
  • Pregnancy ≤ 13 weeks

Differential Diagnosis

Vaginal Bleeding in Pregnancy (<20wks)

Workup

Management

Disposition

  • Discharge with close OB followup for repeat ultrasound
  • Urgent OBGYN consult if active hemorrhage and need for Dilation and Curretage

See Also

Sources

  • Hasan R, Baird DD, Herring AH, Olshan AF, Jonsson Funk ML, Hartmann KE. Association between first-trimester vaginal bleeding and miscarriage. Obstet Gynecol. Oct 2009;114(4):860-7
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