Early pregnancy loss

See miscarriage

Almost one in three pregnancies is spontaneously lost in the first trimester, affecting 1 million patients in the US annually. 

The most common cause of early pregnancy loss is fetal chromosomal abnormalities.

This accounts  for more than 2/3 of pregnancy losses  is between six and 10 weeks gestation 

Risk factors for early pregnancy loss include advanced maternal age, prior pregnancy loss, teratogenetic exposures, maternal endocrine, or autoimmune conditions, such as diabetes, hypothyroidism, and systemic lupus erythematosus. 

Early pregnancy loss is diagnosed clinically by the presence of symptoms, such as vaginal bleeding or an open cervical os with decreasing beta human hCG values. 

Of patients with early pregnancy loss 25 to 50% pass pregnancy tissue within one week without any external intervention and more than 80% of patients with bleeding will completely expel the pregnancy tissue within two weeks. 

In the absence of infection or bleeding, expectant management is safe. 

Pain management typically includes over-the-counter analgesics, as well as heat or lower back massage. 

Medication management includes misoprostol only and mifepristone-misoprostol regimens. 

Misoprostol can be taken either buccaly or vaginally with rates of complete expulsion 70 to 80%. 

Treatment failure or need for surgical intervention occurs in 24% of patients.

In mifepristone-misoprotol regimens include pre-treatment with Mifepristone 24 hours prior to misoprotol. 

The addition of Mifepristone, greatly improved the efficacy of misoprotol treatments, increasing the rate of complete explosion by nearly 20% and reducing the need for surgery by 60%.

Procedural management include uterine aspiration via dilation and suction curettage: success rate approaches 99%. 

Surgical management facilitates the collection of products of conception for histologic inside a genetic evaluation, if needed.

Complications. Following medical or surgical management of early pregnancy loss includes infection, hemorrhage, retained products, and surgical injury, but they are rare.

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