Threatened miscarriage: Clinically if women present in the first trimester with vaginal bleeding with or without lower abdominal pain (cervical os is closed) they are labelled as a 'threatened miscarriage'. This very common problem requires an ultrasound scan to establish the viability of the pregnancy.
Complete miscarriage: Clinically the products of conception have totally passed; the cervix is likely to be closed on examination; bleeding and cramping should have diminished. A transvaginal ultrasound scan (TVS) demonstrates a thin endometrial thickness (often defined as <15 mm). These women should be treated as a pregnancy of unknown location (PUL) if they have not had a previous scan to confirm the location. Follow-up serum human chorionic gonadotrophin (hCG) levels should be performed to confirm the outcome of pregnancy failure.
Incomplete miscarriage: Clinically partial passage of the products of conception, bleeding and cramping is variable; characterized by an open cervical os on physical examination. Products of conception may be seen in the cervical os or vagina. TVS demonstrates heterogeneous material within the endometrial cavity. In most cases the condition does not require dilatation and curettage (D&C) and if managed expectantly will have 90% successful resolution.
Early embryonic demise (previously termed an anembryonic pregnancy or blighted ovum): If the uterus contains an empty gestational sac of >20 mm on TVS, this almost certainly represents early embryonic demise, however an interval scan in 7 days or for the findings to be checked by a second operator is recommended if there is any doubt.
Early fetal demise (previously termed missed miscarriage): This is a failed pregnancy of up to 12 weeks; definitively non-viable but not yet passed. If the CRL is at least 6 mm and there is no fetal cardiac activity or if the crown-rump length is >6 mm with no change at the time of a repeat scan 7 days later, this is classified as early fetal demise. This is sometimes treated expectantly, medically or electively removed by D&C. (This often depends on gestational age, the size of pregnancy as well as the availability of resources and the woman's preference.)
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