ABSTRACT
Miscarriages Symptoms, Signs and Ultrasonic Findings A miscarriage or spontaneous abortion is defi ned as the loss of a foetus before 24 weeks of gestation. Up to 20% of all pregnancies miscarry with 80% occurring in fi rst trimester. The frequency of miscarriage decreases with increasing gestational age. Symptoms include a history of vaginal bleeding with blood clots and severe suprapubic abdominal pain. The vaginal bleeding may be signifi cant enough to soak tampons, pads, sanitary towels or even clothes. Contractions and abdominal pain may co-exist but tend to resolve in a complete abortion. This is associated with the passage of products of conception and a cessation of vaginal bleeding. An ultrasound scan is the investigation of choice for suspected cases of miscarriages. Ultrasonic features consistent with a non-viable pregnancy include:
An embryo with absent heartbeat when the CRL is >5 mm • Loss of previously observed foetal cardiac activity • Irregular-edged or collapsed gestational sac • Abnormal echogenic material within the uterine cavity • Lack of growth of the sac or foetal pole over a 5-day period •
Foetal heart sounds are good markers for a viable pregnancy with the risk of spontaneous abortion decreasing from 50% to 3%. The earliest time they can be detected is by week 5 of gestation or when the crownrump length is 2 to 4 mm and the gestational sac is 10 mm
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