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Miscarriage
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Erich T. Wyckoff, Hadeer Usama Ebrahem Metwally
Threatened abortion may best be described as vaginal bleeding in the setting of a closed cervix but the diagnostic criteria for spontaneous abortion have not been met. Inevitable abortion refers to cases in which the patient has vaginal bleeding and cervical dilation, typically accompanied by crampy pelvic pain. In this case, products of conception may be visualized protruding through the internal cervical os. Missed abortion refers to a spontaneous abortion in a patient with or without symptoms and with a closed cervical os, with criteria for spontaneous abortion having been met. Incomplete abortion refers to cases in which vaginal bleeding and/or pain are present, the cervix is dilated, and products of conception are found within the cervical canal or have been reported to have passed, but the uterus is not completely evacuated. Complete abortion refers to cases in which the products of conception are entirely evacuated from the uterus and cervix and the cervix is closed on examination. Vaginal bleeding and pain may be mild or resolved.
Ultrasound in the First Trimester
Published in Asim Kurjak, CRC Handbook of Ultrasound in Obstetrics and Gynecology, 2019
Asim Kurjak, Vincenzo D’Addario
The missed abortion is used to describe the lifeless embryo or fetus retained within the uterus for 4 or more weeks. The diagnosis of missed abortion is determined by the identification of a fetus which does not demonstrate any heart activity or motion and the lack of uterine growth or an actual decrease in uterine size. In addition, the amniotic fluid volume may be diminished. In larger fetus the skull will appear collapsed. If an early concept has been dead for some time, it will be a problem to distinguish the fetus and placenta. In this case, a scan will demonstrate an ill-defined collection of echoes within the uterine cavity. This diagnosis is relatively easy and, therefore, can be established during a single examination and with great certainty.
Obstetric Hemorrhage I: Antepartum Hemorrhage
Published in Lauren A. Plante, Expecting Trouble, 2018
John C. Smulian, Casey Brown, Amanda Flicker
If the cervix is not dilated and an ultrasound shows an intrauterine pregnancy, the diagnosis is based on the potential viability of the pregnancy. A nonviable pregnancy is considered a missed abortion. The features of a nonviable pregnancy are noted in Table 13.7 (7).
Vitamin D insufficiency as a risk factor for reproductive losses in miscarriage
Published in Gynecological Endocrinology, 2021
V. E. Radzinsky, F. U. Ramazanova, M. B. Khamoshina, M. M. Azova, M. R. Orazov, A. A. Orazmuradov
Missed abortion(MA) is a topical problem of modern obstetrics and gynecology. The MA is defined as a pathological symptom complex that includes the non-viability of the embryo, pathological inertia of myometrium, and/or dysfunction in the hemostasis system [1], which, according to ICD-10, is encoded as O02.0 or O02.1. According to various authors, the proportion of miscarriages in the cohort of early pregnancy loss patients ranges from 10 to 88.6% [2,3]. At the same time, about 80% of reproductive losses occur in the 1st trimester [2,4]. Miscarriage in the first trimester is a special problem, as the factors that determine it stop the gestation program at the beginning. These include genetic and chromosomal abnormalities of the embryo, genital anatomy, endometrium pathology, hereditary thrombophilia, antiphospholipid syndrome and others [5]. Most of these factors are difficult to correct, but there are also controllable ones whose negative effects can be completely mitigated before conception. These include nutritional deficits, including vitamin D insufficiency (E 55.9) [6,7].
Practical applications of DNA genotyping in diagnostic pathology
Published in Expert Review of Molecular Diagnostics, 2019
A 28-year-old pregnant female patient presented to her obstetrician with pelvic discomfort, nausea, and vaginal bleeding. Ultrasound examination showed an empty gestational sac, and a presumptive diagnosis of missed abortion was made. The patient underwent endometrial curettage, and histopathologic examination of the tissue revealed chorionic villi with mildly trophoblastic hyperplasia and hydropic changes. No fetal parts were found. Based on these findings, the differential diagnosis included either a partial hydatidiform mole, or a non-molar hydropic abortus, two findings with drastically different clinical implications for implementing the gestational trophoblastic disease surveillance including clinical follow-up with monitoring hCG levels, required interval before attempting a subsequent pregnancy, future molar pregnancy risk, and risk of progression to gestational trophoblastic neoplasia [82–86].
Oral contraceptive pills as an option for non-surgical management of retained products of conception – a preliminary study
Published in Gynecological Endocrinology, 2018
Anat Hershko Klement, Mitri Frederic, Yaakov Bentov, Paul Chang, Dan Nayot, Jigal Haas, Robert F. Casper
Miscarriage is a common event in general gynecological practice and is an age-dependent outcome. It is estimated – that approximately 20% of clinically recognized pregnancies will result in a miscarriage, and the prevalence is much higher if preclinical pregnancies are included as well [1–3]. The emotional reaction to a pregnancy loss is complex and commonly involves feelings of guilt and shame [4], especially in a population of patients who are experiencing difficulties in conceiving [5], or who have gone through a previous pregnancy loss. These patients may opt for expectant management and commonly will prefer a medical management for an early missed abortion rather than a surgical evacuation of uterine content. In the event of failure of expectant or medical management and follow up demonstrating retained products of conception (RPOC), the option of treating the problem with D&C or operative hysteroscopy is concerning to many women because of the potential risk for intrauterine synechia or Asherman’s syndrome that may jeopardize future fertility attempts [6–8].