ABSTRACT
Relatively little was known before the twentieth century about first-trimester miscarriage, probably due to difficulties in diagnosing early pregnancy.
In 1884, Meinl noted selective softening in the lower part of the uterus during vaginal examination in early pregnancy and in 1895 Hegar described signs, symptoms and findings during vaginal examination in early pregnancy in his publication ‘Diagnose der frühesten Schwangerschaftsperiode’.1 Furthermore Aschheim and Zondek, in 1927 and 1928 demonstrated that the urine of pregnant women contained a gonadstimulating substance which, when injected subcutaneously into female mice, induced follicular maturation.2 These authors believed that the anterior pituitary produced this gonadotropic substance, but subsequent work by other investigators demonstrated that the placenta was responsible for the production of the hormone and consequently it was given the name human chorionic gonadotrophin (hCG). Immunological pregnancy testing based on antibodies raised against parts of the hCG molecule became available for broad clinical use during the 1960s.3 Sensitive pregnancy tests made early diagnosis possible and it soon became evident that certain pregnancies were so short-lived that they could only be diagnosed as so-called biochemical pregnan-
cies. This was discussed briefly in the previous chapter.
