Spontaneous Abortion

Spontaneous abortion occurs in as many as 40 percent of gestational events and approximately 15 percent of clinically apparent pregnancies. Most pregnancy losses occur early in the first trimester and few are lost after fetal cardiac activity is noted sonographically. 6 A completed abortion occurs when all of the products of conception have left the uterus. After a completed abortion, the cervical os may be opened or closed. If the os is closed and products of conception are not clearly identified, one should be skeptical about the diagnosis. An incomplete abortion occurs when some of the products of conception have been expelled and some still remain within the uterus. After a completed abortion, an empty uterus should be visualized sonographically; thus a postpartum endometrial stripe greater than 10 mm in a symptomatic patient suggests the presence of retained products of conception (Fig 109-12). An inevitable abortion occurs when the cervical os is open but the products of conception have not yet been expelled.1 A missed abortion occurs when the fetus is dead and is retained for greater than 4 to 8 weeks.

FIG. 109-12. Retained products of conception. There is a very thick (hyperechoic) endometrial echo measuring approximately 3 cm within the uterus on this transabdominal midline longitudinal view. This represents retained products of conception in a patient who had aborted a 10-week IUP. (Courtesy of J. Mateer, M.B. Phelan, and the Department of Emergency Medicine, Medical College of Wisconsin.)

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