Early Pregnancy Complications

Miscarriage
Definition and Terminology
 Spontaneous miscarriage
o Spontaneous loss of a pregnancy prior to viability
 Biochemical Pregnancies – 50% of the early pregnancies will fail within the first 4 weeks from
LMP
 Viability threshold – beyond which gestation a foetus is capable of surviving in an
extrauterine environment with support.
o UK – 23+6
o Sri Lanka
 Miscarriage < 22+0
 Perinatal death > 22+0
 Still birth > 28+0

Classification

Epidemiology
 Pregnancy failure rate
o Within first 4 weeks – 50% (biochemical pregnancies)
o By 6 weeks’ gestation – 1 in 5 pregnancies
o By second trimester – 1 in 40 pregnancies

Pathology

Clinical Workup
Diagnosis and laboratory evaluation
 If a foetal cardiac pulsation is detected at 6 week, the chance of the pregnancy to continue
beyond the first trimester is 90%


Management
Follow Up