Management of First Trimester Pregnancy Failure

1. Management of First Trimester Pregnancy Failure Linda Prine MD Vanita Kumar MD AFP- New York City Chapter

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

3. 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,

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

5. 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

6. 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.

7. 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?