Management of First Trimester Pregnancy Failure

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Management of First Trimester Pregnancy Failure

• Linda Prine MD
• Vanita Kumar MD
• AFP- New York City Chapter

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Definitions

• Spontaneous Ab- loss of pregnancy without outside
  intervention before 20 weeks
• Incomplete Ab- some, but not all POCs (products
  of conception) have been passed.
• Missed Ab- either a fetal demise occult embryo
  with no uterine activity to expel POCs.
• Anembryonic Gestation- empty sac

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General Facts

• About 20 pregnant women have some bleeding
  before 20 weeks
• Half of these will end in spontaneous abortion
• One meta-analysis found that chromosomal
  abnormalities occurs 49 of spontaneous abortions
  (Goddijn et al Best Pract Res Clin Ob-Gyn, 2000)
• Risk Factors
• Alcohol, tobacco, heavy caffeine use, cocaine
• Maternal infection (BV, HSV etc), uterine
  abnormalities, toxins,

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Management

• Surgical- traditional
• D C
• Suction- EVA or MVA
• Medical- Misoprostol
• Expectant Management

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Case 1

• Maria is 24 y/o who is 6wks pregnant by LMP who
  comes into your office complaining of heavy
  bleeding and cramping for 2 days.
• She is comfortable but concerned.
• Vitals signs are stable
• Urine BHCG- positive

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Case 2

• Sonia 38 y/o w/ a planned pregnancy.
• By LMP she is 6 wks
• She goes for a 1st tri sono.
• The radiologist calls you empty gestational sac,
  irregular in appearance, too small for a 6 week
  pregnancy.
• She has had no bleeding or cramping.

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Case 3

• Ayesha comes into your office bleeding. She
  reluctantly admits she used misoprostol on her
  own, and learned about it from a lay midwife in
  her community.
• On exam, her uterus is 8 weeks in size and her
  vagina is full of clots. The cervix is soft and
  the os is open.
• What are the options for treatment?