Review Question - QID 105227

At less than 20 weeks gestation, minimal vaginal bleeding and a closed cervix in the setting of a normal fetal ultrasound is consistent with a threatened abortion.

Vaginal bleeding in the first 20 weeks is assumed to be a threatened abortion unless another diagnosis is apparent, such as ectopic pregnancy, cervicitis, cervical polyp, molar pregnancy, or other form of spontaneous abortion. Evaluation of vaginal bleeding prior to 20 weeks gestation should include pelvic exam, fetal ultrasound, serum progesterone level, and b-HCG level. Observation alone is indicated in management of threatened abortion. Threatened abortion is associated with increased risk of subsequent abortion of the pregnancy; however, specific rates of subsequent pregnancy failure are variable among studies.

Griebel et al. discuss the management of spontaneous abortion. 50% of spontaneous abortions are estimated to be caused by chromosomal abnormalities. When a patient is unstable, surgical evacuation of the uterus is recommended. Expectant management is usually appropriate for incomplete spontaneous abortion. Medical or surgical intervention is rarely needed in completed spontaneous abortion.

Sotiriadis et al. review comparisons of expectant versus medical versus surgical management of first trimester spontaneous abortion. Surgical intervention was shown to be superior to medical intervention, with 1 additional success per 3 women treated surgically. Expectant management strategies showed variable results depending on the specific type of spontaneous abortion.

Figure A depicts a normal ultrasound of a fetus at 16 weeks gestation.
Illustration A depicts a graphical representation of the differences between threatened, inevitable, and incomplete abortions.

Incorrect Answers:
Answer 2: A missed abortion consists of an abnormal ultrasound suggesting fetal demise in the absence of vaginal bleeding or cervical dilation.
Answer 3: An inevitable abortion presents with vaginal bleeding and cervical dilation, but no loss of products of conception. An abnormal ultrasound is also seen.
Answer 4: An incomplete abortion presents with vaginal bleeding, cervical dilation, and loss of some but not all products of conception. An abnormal ultrasound is also expected.
Answer 5: A completed abortion presents with vaginal bleeding, cervical dilation, and total loss of products of conception. An abnormal ultrasound is also seen.