Abstract

PIP: The incidence, clinical presentation, diagnosis, and treatment of 2 problems of early pregnancy--spontaneous abortion and ectopic pregnancy--are reviewed. The incidence of spontaneous abortion is reported to be 10-20% of all pregnancies and may be decreasing. Abnormal development of the pregnancy, unsuccessful implantation, maternal disease, noxious agents, previous surgery, abnormalities of the genital tract, and psychological stress have all been implicated in the etiology of spontaneous abortion. The clinical presentations include threatened, inevitable, incomplete, complete, missed, septic, and habitual abortion. The management of threatened abortion has changed from strict limitations of activity and the use of progestational agents to more liberal recommendations regarding activity and the avoidance of progestins. Combined use of radioimmunoassay for the beta subunit of human chorionic gonadotropin and ultrasound examination of the pelvis can lead to accurate prediction of the pregnancy outcome in patients with 1st trimester bleeding. Evacuation of the uterus is the treatment of choice in inevitable or incomplete abortion. Clinicians should be aware of the guilt feelings, grief reactions, and fears about future pregnancies that often follow spontaneous abortion. Reports of the incidence of ectopic pregnancy have ranged from 1 in 250 to 1 in 70 pregnancies, and the rate has been increasing. The significant morbidity and mortality associated with this condition make early diagnosis essential. The 3 most common symtoms are abdominal pain, amenorrhea, and abnormal vaginal bleeding. Ultrasonography and new methods of measuring human chorionic gonadotropin facilitate early diagnosis. Culdocentesis remains the definitive method of diagnosis. Earlier diagnosis has led some physicians to advocate salpingostomy via laparoscopy rather than salpingectomy for treatment in selected cases.