Threatened Miscarriage

Women who present in the first trimester with vaginal bleeding with or without lower abdominal pain are given the label of a threatened miscarriage. This is a common first trimester problem occurring in up to one-third of pregnancies.19 This condition requires an ultrasound scan to establish the viability of the pregnancy. If the uterus contains an embryopositive cardiac activity, then the woman can be reassured that she has a viable intrauterine pregnancy. If the crown-rump length (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 was formally classified as a missed miscarriage or more recently as 'early fetal demise'.20 Care must be taken when making this diagnosis, as approximately one-third of embryos with a CRL of less than 5 mm have no demonstrable cardiac activity; under such circumstances a repeat scan should be performed in 7 days.21 If the uterus contains an empty gestational sac of >20 mm on TVS, this was previously described as an anembryonic pregnancy or blighted ovum. More recent nomenclature has termed this as 'early embryonic demise'. An interval scan in 7 days is recommended if there is any doubt. 20

Subchorionic haematomas are common and seen in up to 18% of women with a threatened miscarriage.21 They are insignificant sonographic findings and there is no association between the rate of premature delivery and haematoma size.22 The confirmation of fetal cardiac activity in a threatened miscarriage confers an excellent prognosis.23 The management of miscarriage is covered in depth in Chapters 5 and 6.

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