Abstract
This chapter includes definitions and diagnosis of early pregnancy complications (including spontaneous abortion, early pregnancy failure, threatened or incomplete abortion, septic abortion, and molar pregnancy). Management of these conditions is discussed, with particular emphasis on septic abortion—a potentially life-threatening condition that requires expedient surgical management.
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References
Everett C. Incidence and outcome of bleeding before the 20th week of pregnancy: prospective study from general practice. BMJ. 1997;315:32–4.
Eiben B, Bartels I, Bähr-Porsch S, Borgmann S, Gatz G, Gellert G, et al. Cytogenetic analysis of 750 spontaneous abortions with the direct-preparation method of chorionic villi and its implications for studying genetic causes of pregnancy wastage. Am J Hum Genet. 1990;47:656–63.
Feodor Nilsson S, Andersen P, Strandberg-Larsen K, Nybo Andersen AM. Risk factors for miscarriage from a prevention perspective: a nationwide follow-up study. BJOG. 2014;121:1375–85.
Maconochie N, Doyle P, Prior S, Simmons R. Risk factors for first trimester miscarriage–results from a UK-population-based case–control study. BJOG. 2007;114:170–86.
Cramer DW, Wise LA. The epidemiology of recurrent pregnancy loss. Semin Reprod Med. 2000;18:331–9.
Practice Committee of the American Society for Reproductive Medicine. Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertil Steril. 2012;98:1103–11.
Regan L, Braude PR, Trembath PL. Influence of past reproductive performance on risk of spontaneous abortion. BMJ. 1989;299:541–5.
Hoffman BL, Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunningham F, et al. Chapter 6. First-trimester abortion. In: Hoffman BL, Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunningham F, Calver LE, editors. Williams gynecology. 2nd ed. New York: McGraw-Hill; 2012. http://accessmedicine.mhmedical.com.ezp-prod1.hul.harvard.edu/content.aspx?bookid=399&Sectionid=41722294. Accessed 1 Sep 2015.
Lapinsky SE. Obstetric infections. Crit Care Clin. 2013;29:509–20.
Stubblefield PG, Grimes DA. Septic abortion. N Engl J Med. 1994;331:310–4.
Semer DA, Macfee MS. Gestational trophoblastic disease: epidemiology. Semin Oncol. 1995;22:109–12.
Shanbhogue AK, Lalwani N, Menias CO. Gestational trophoblastic disease. Radiol Clin North Am. 2013;51:1023–34.
Berkowitz RS, Goldstein DP. Chorionic tumors. N Engl J Med. 1996;335:1740–8.
Berkowitz RS, Goldstein DP. Clinical practice. Molar pregnancy. N Engl J Med. 2009;360:1639–45.
Soper JT, Mutch DG, Schink JC, American College of Obstetricians and Gynecologists. Diagnosis and treatment of gestational trophoblastic disease: ACOG Practice Bulletin No. 53. Gynecol Oncol. 2004;93:575–85.
Morrow CP. Postmolar trophoblastic disease: diagnosis, management, and prognosis. Clin Obstet Gynecol. 1984;27:211–20.
Niemann I, Petersen LK, Hansen ES, Sunde L. Predictors of low risk of persistent trophoblastic disease in molar pregnancies. Obstet Gynecol. 2006;107:1006–11.
Barnhart KT. Clinical practice. Ectopic pregnancy. N Engl J Med. 2009;361:379–87.
von Hertzen H, Piaggio G, Wojdyla D, Nguyen TM, Marions L, Okoev G, et al. Comparison of vaginal and sublingual misoprostol for second trimester abortion: randomized controlled equivalence trial. Hum Reprod. 2009;24:106–12.
Fischerova D. Urgent care in gynaecology: resuscitation and management of sepsis and acute blood loss. Best Pract Res Clin Obstet Gynaecol. 2009;23:679–90.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580–637.
Committee on Trauma. Advanced trauma life support 1 student manual. 8th ed. Chicago: American College of Surgeons; 2008.
Doubilet PM, Benson CB, Bourne T, Blaivas M; Society of Radiologists in Ultrasound Multispecialty Panel on Early First Trimester Diagnosis of Miscarriage and Exclusion of a Viable Intrauterine Pregnancy et al. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med. 2013;369:1443–51.
Doubilet PM, Benson CB. Embryonic heart rate in the early first trimester: what rate is normal? J Ultrasound Med. 1995;14:431–4.
Tuuli MG, Norman SM, Odibo AO, Macones GA, Cahill AG. Perinatal outcomes in women with subchorionic hematoma: a systematic review and meta-analysis. Obstet Gynecol. 2011;117:1205–12.
Sadan O, Golan A, Girtler O, Lurie S, Debby A, Sagiv R, et al. Role of sonography in the diagnosis of retained products of conception. J Ultrasound Med. 2004;23:371–4.
Achiron R, Goldenberg M, Lipitz S, Mashiach S. Transvaginal duplex Doppler ultrasonography in bleeding patients suspected of having residual trophoblastic tissue. Obstet Gynecol. 1993;81:507–11.
Abbasi S, Jamal A, Eslamian L, Marsousi V. Role of clinical and ultrasound findings in the diagnosis of retained products of conception. Ultrasound Obstet Gynecol. 2008;32:704–7.
American College of Obstetricians and Gynecologists. ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol. 2009;113:1180–9.
Fowler DJ, Lindsay I, Seckl MJ, Sebire NJ. Routine pre-evacuation ultrasound diagnosis of hydatidiform mole: experience of more than 1000 cases from a regional referral center. Ultrasound Obstet Gynecol. 2006;27:56–60.
Achilles SL, Reeves MF, Society of Family Planning. Prevention of infection after induced abortion. Contraception. 2011;83:295–309.
Royal College of Obstetricians and Gynaecologists. The care of women requesting induced abortion: summary. Evidence-based clinical guideline number 7. London: RCOG Press; 2011. https://www.rcog.org.uk/globalassets/documents/guidelines/abortion_guideline_summary.pdf. Accessed 22 Sept 2015.
O'Connell K, Jones H, Simon M, Saporta V, Paul M, Lichtenberg E. First-trimester surgical abortion practices: a survey of National Abortion Federation members. Contraception. 2009;79:385–92.
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin: postpartum hemorrhage. Obstet Gynecol. 2006;108:1039–47.
Nygaard IH, Valbø A, Heide HC, Kresovic M. Is oxytocin given during surgical termination of first trimester pregnancy useful? A randomized controlled trial. Acta Obstet Gynecol Scand. 2011;90:174–8.
Meckstroth K, Whitaker A, Bertisch S, Goldberg A, Darney P. Misoprostol administered by epithelial routes: drug absorption and uterine response. Obstet Gynecol. 2006;108:582–90.
Cunningham F, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Obstetrical hemorrhage. In: Cunningham F, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS, editors. Williams obstetrics. 24th ed. New York: McGraw-Hill; 2013. http://accessmedicine.mhmedical.com.ezp-prod1.hul.harvard.edu/content.aspx?bookid=1057&Sectionid=59789185. Accessed 10 June 2015.
Kauff ND, Chelmow D, Kawada CY. Intractable bleeding managed with Foley catheter tamponade after dilation and evacuation. Am J Obstet Gynecol. 1995;173:957–8.
Olamijulo J, Doufekas K. Intrauterine balloon tamponade for uncontrollable bleeding during first trimester surgical termination of pregnancy. J Obstet Gynaecol. 2007;27:440–1.
Kerns J, Steinauer J. Management of postabortion hemorrhage: release date November 2012 SFP Guideline #20131. Contraception. 2013;87:331–42.
Katz MD, Sugay SB, Walker DK, Palmer SL, Marx MV. Beyond hemostasis: spectrum of gynecologic and obstetric indications for transcatheter embolization. Radiographics. 2012;32:1713–31.
Steinauer JE, Diedrich JT, Wilson MW, Darney PD, Vargas JE, Drey EA. Uterine artery embolization in postabortion hemorrhage. Obstet Gynecol. 2008;111:881–9.
Grimes DA, Flock ML, Schulz KF, Cates Jr W. Hysterectomy as treatment for complications of legal abortion. Obstet Gynecol. 1984;63:457–62.
Boynukalin FK, Boyar H, Gormus H, Aral AI, Boyar N. Bilateral hypogastric artery ligation in emergency setting for intractable postpartum hemorrhage: a secondary care center experience. Clin Exp Obstet Gynecol. 2013;40:85–8.
Wolman I, Gordon D, Yaron Y, Kupferminc M, Lessing JB, Jaffa AJ. Transvaginal sonohysterography for the evaluation and treatment of retained products of conception. Gynecol Obstet Invest. 2000;50:73–6.
Stiglich N, Alston M, Vanswam S. Optimizing treatment of intra-amniotic infection and early-onset postpartum endometritis: advantages of single-agent therapy. Perm J. 2011;15:26–30.
Meaney-Delman D, Bartlett LA, Gravett MG, Jamieson DJ. Oral and intramuscular treatment options for early postpartum endometritis in low-resource settings: a systematic review. Obstet Gynecol. 2015;125:789–800.
2015 STD Treatment Guidelines. Centers for Disease Control and Prevention website. http://www.cdc.gov/std/tg2015/2015-poster-press.pdf. Updated 4 June 2015. Accessed 10 June 2015.
Kohorn EI. The new FIGO 2000 staging and risk factor scoring system for gestational trophoblastic disease: description and critical assessment. Int J Gynecol Cancer. 2001;11:73–7.
Luise C, Jermy K, May C, Costello G, Collins WP, Bourne TH. Outcome of expectant management of spontaneous first trimester miscarriage: observational study. BMJ. 2002;324:873–5.
Zhang J, Gilles JM, Barnhart K, Creinin MD, Westhoff C, Frederick MM, National Institute of Child Health Human Development (NICHD) Management of Early Pregnancy Failure Trial. A comparison of medical management with misoprostol and surgical management for early pregnancy failure. N Engl J Med. 2005;353:761–9.
Nanda K, Lopez LM, Grimes DA, Peloggia A, Nanda G. Expectant care versus surgical treatment for miscarriage. Cochrane Database Syst Rev. 2012;3:CD003518.
Wieringa-de Waard M, Vos J, Bonsel G, Bindels P, Ankum W. Management of miscarriage: a randomized controlled trial of expectant management versus surgical evacuation. Hum Reprod. 2002;17:2445–50.
Winikoff B, Dzuba IG, Chong E, Goldberg AB, Lichtenberg ES, Ball C, et al. Extending outpatient medical abortion services through 70 days of gestational age. Obstet Gynecol. 2012;120:1070–6.
American College of Obstetricians and Gynecologists. Practice bulletin no. 143: medical management of first-trimester abortion. Obstet Gynecol. 2014;123:676–92.
American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 427: Misoprostol for postabortion care. Obstet Gynecol. 2009;113:465–8.
Blum J, Winikoff B, Gemzell-Danielsson K, Ho PC, Schiavon R, Weeks A. Treatment of incomplete abortion and miscarriage with misoprostol. Int J Gynaecol Obstet. 2007;99:S186–9.
Gemzell-Danielsson K, Ho PC, Gómez Ponce de León R, Weeks A, Winikoff B. Misoprostol to treat missed abortion in the first trimester. Int J Gynaecol Obstet. 2007;99:S182–5.
Neilson JP, Gyte GM, Hickey M, Vazquez JC, Dou L. Medical treatments for incomplete miscarriage. Cochrane Database Syst Rev. 2013;3:CD007223.
Stockheim D, Machtinger R, Wiser A, Dulitzky M, Soriano D, Goldenberg M, et al. A randomized prospective study of misoprostol or mifepristone followed by misoprostol when needed for the treatment of women with early pregnancy failure. Fertil Steril. 2006;86:956–60.
Verkuyl DA, Crowther CA. Suction v. conventional curettage in incomplete abortion. A randomised controlled trial. S Afr Med J. 1993;83:13–5.
Wong LF, Schliep KC, Silver RM, Mumford SL, Perkins NJ, YE A, et al. The effect of a very short interpregnancy interval and pregnancy outcomes following a previous pregnancy loss. Am J Obstet Gynecol. 2015;212:e1–11.
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Brady, P.C., Pocius, K.D. (2016). Spontaneous Abortions. In: Handbook of Consult and Inpatient Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-27724-0_8
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DOI: https://doi.org/10.1007/978-3-319-27724-0_8
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