Spontaneous Abortion

Colloquially known as a miscarriage, a spontaneous abortion, is the loss of an embryo or fetus prior to 20 weeks of gestation. First trimester abortion is a common emergency center diagnosis for a patient who had complaints of abnormal vaginal bleeding or abdominal/pelvic pain. Most causes are chromosomal abnormalities incompatible with life, though toxic exposures, trauma, structural disease, or maternal systemic disease can be causative. The type of spontaneous abortion is defined by the state of the internal cervical os and whether there is passage of fetal tissue. The presence of fetal tissue and markers of viability by uterine ultrasound can also determine the type of spontaneous abortion. In addition to the ultrasound evaluation, a lower beta human chorionic gonadotropin than expected for their gestational age can suggest a spontaneous abortion. The emergency physician should support the patient’s hemodynamic status and coordinate definitive management with a specialist. Management in the first trimester can be expectant or augmented by pharmaceuticals or surgical intervention.