Obstetrics & Gynecology
Miscarriage (Spontaneous Abortion)
유산
Spontaneous loss of pregnancy before 20 weeks; mostly chromosomal abnormalities
- How common
- 10–20% of recognized pregnancies
- Typical age
- 12% at age 20 → 50% at age 40
What is it?
Mostly fetal chromosomal abnormalities → arrested development → chorionic separation → bleeding and uterine contraction → expulsion.
Commonly affected: Uterus, placenta, fetus
How it develops
- Chromosomal abnormality>50% are trisomy/monosomy/triploidy
- Arrested developmentEmbryonic/fetal demise
- Chorionic separationDetaches from endometrium with hemorrhage
- Uterine contraction & expulsionCervix dilates and products of conception expelled
Symptoms
- Vaginal bleedingSpotting to heavy with clots
- Cramping painMenstrual-like
- Tissue passagePassage of products of conception
- Loss of pregnancy symptomsSudden loss of nausea/breast tenderness
How it is examined
- Speculum examCervical dilation, bleeding amount, products
- Transvaginal USCardiac activity, sac size, retained products
- Serial β-hCGConfirm declining trend
Imaging
X-ray not helpful.
- Not applicable
TVUS: no cardiac activity with CRL ≥7 mm or empty sac ≥25 mm confirms loss.
- Absent cardiac activity
- Empty gestational sac
- Retained POC
Non-surgical care
- Expectant managementWait 1–2 weeks for natural passage if stable
- Medical: misoprostol800 mcg vaginal; reassess at 48 h
- Mifepristone + misoprostolCombination improves efficacy
- Anti-D immunoglobulinFor Rh-negative mothers
- Emotional supportGrief counseling and emotional support
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Heavy bleeding, septic abortion, patient preference
Procedures that may be discussed
- Manual vacuum aspiration (MVA)
- Dilation and curettage (D&C)
- Antibiotics for septic abortion
Outlook
Most have normal subsequent pregnancies; recurrent loss (≥3) warrants workup.