As long ago as 1895, Hegar meticulously described the clinical diagnosis of early pregnancy. Since it is difficult to date a pregnancy before the 8th week by vaginal examination, the length of an early pregnancy is usually estimated from the last menstrual period (LMP).1,18 Because vaginal bleeding occurs in 25% of normal pregnancies and in the majority of pathological pregnancies, the exact length of a pregnancy complicated by bleeding is often difficult to establish.19 As Goldstein has previously discussed in Chapter 4, before the era of ultrasound, inevitable miscarriage was considered to be present when pain or bleeding threatened the mother's wellbeing. Incomplete miscarriage when part of the products of conception had passed the cervix, and complete miscarriage when the products of conception had been passed, the uterus was contracted toward normal size and the cervix was closed.20 As has been discussed in previous chapters, relying on clinical measures alone does not enable the clinician to differentiate between threatening, incomplete and complete miscarriage, ectopic pregnancy, very early normal pregnancy and chorionic malignancies.19
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