CLINICAL ENTITIES
The following diagnoses represent findings along a continuum, from the
beginnings of losing the pregnancy to complete expulsion of the products of
conception (POC).
Missed abortion: sonogram finding of a nonviable pregnancy without
vaginal bleeding, uterine cramping, or cervical dilation. Management:
Scheduled suction D&C, conservative management awaiting a spontaneous
completed abortion, or induce contractions with misoprostol (PGE 1).
Threatened abortion: sonogram finding of a viable pregnancy with vaginal
bleeding but no cervical dilation (50% of these pregnancies will continue to
term successfully). Management: Often the cause is implantation bleeding.
Observation. No intervention is generally indicated or effective.
Inevitable abortion: vaginal bleeding and uterine cramping leading to
cervical dilation, but no POC has yet been passed. Management: Emergency
suction D&C if bleeding is heavy to prevent further blood loss and anemia.
Otherwise, conservative management awaiting a spontaneous completed
abortion or induce contractions with misoprostol PGE 1.
Incomplete abortion: vaginal bleeding and uterine cramping leading to
cervical dilation, with some, but not all, POC having been passed.
Management: Emergency suction D&C if bleeding is heavy to prevent
further blood loss and anemia. Otherwise conservative management awaiting
a spontaneous completed abortion or induce contractions with misoprostol
PGE 1.
Completed abortion: vaginal bleeding and uterine cramping have led to all
POC being passed. This is confirmed by a sonogram showing no intrauterine