This document discusses early pregnancy complications including miscarriage, ectopic pregnancy, and molar pregnancy. It provides details on the different types of miscarriage such as threatened, inevitable, incomplete, complete, and missed miscarriage. Risk factors for miscarriage include advanced maternal age, infections, endocrine disorders, and chromosomal abnormalities. Ectopic pregnancy is defined as implantation outside the uterine cavity, most commonly in the fallopian tubes. Risk factors include previous ectopic pregnancy, history of pelvic inflammatory disease, and uterine abnormalities. Clinical features may include vaginal bleeding, abdominal pain, and hypovolemic shock in severe cases. Diagnosis is made through ultrasound and beta-hCG levels. Treatment involves surgery or medical management

1. Dr. Shazia Iqbal
Assistant Professor (Obstetrics & Gynaecology)
Director of Medical Education Unit
Faculty of Medicine
Associate fellow AMEE (AFAMEE)
Member of Saudi Society for Medical Education (SSME)
Vision College of Medicine, Riyadh

2.  3 main categories of early
pregnancy
complications are:
Miscarriage
Ectopic pregnancy
Molar pregnancy

3. MISCARRIAGE

4. Miscarriage
 Definition : Expulsion of product of conception (POC) before
22nd week of period of gestation (POG), which mean before
period of fetal viability.
 Etiology factors:
• Maternal’s age >35 years old
• Trauma
• Infections (TORCHES, malaria)
• Endocrine disorders (diabetes, hypothyroidism, PCOS)
• Immunological disorders (SLE, antiphospholipid syndrome)
• Abnormalities in uterus (uterine fibroid)
• Psychological disorder (stress)
• Chromosomal abnormalities (Down syndrome)
• Exposure to chemical agents (tobacco, arsenic, pesticides)

5. TYPES OF ABORTION:
Threatened
Miscarriage
Inevitable
Miscarriage
Incomplete
Miscarriage
Complete
Miscarriage
Recurrent
Miscarriage
Missed
Miscarriage

6. THREATENED
MISCARRIAGE
 Definition : Painless vaginal bleeding, that occur at anytime
between implantation and 24 weeks of gestation.
# POC has threatened to abort but has not done so yet.
 Clinical features:
• Bleeding (minimal, painless)
• Associated with dull aching lower abdominal pain
 Examination:
• Size of uterus is correspond to period of amenorrhea (POA)
• Closed cervical os
• U/S : well-formed, rounded gestational sac
with fetus within it

7. CON’T
 Management:
• Bed rest
• Folic acid supplements
• Avoid coitus

8. INEVITABLE
MISCARRIAGE
 Definition : Painful vaginal bleeding from retro-
placental site
: POC is about to be MISCARRIAGE but not yet
It can progress to complete/ incomplete miscarriage depending
on whether or not all
fetal & placental tissues have been expelled from uterus.
 Clinical features:
• Vaginal bleeding (painful)
• Associated with cramping pain at lower abdomen

9. CON’T
 Examination:
• Size of uterus is correspond to/less than
POA
• Dilated cervical OS
 Management
•Hospitalization
•Analgesics for control of pain

10. INCOMPLETE
MISCARRIAGE
 Definition : POC has aborted but not completely
 Clinical features:
• Vaginal bleeding (heavy, passed out POC as fleshy
masses)
• Associated with colicky pain at lower abdomen
• +/- signs of shock

11. COM’T
 Examination:
• Size of uterus is smaller than POA
• Open cervical os
• U/S : reveal retained POC in uterine cavity
 Management:
• Resuscitate if bleeding is severe, do blood
group and cross match
• Give analgesia for pain
• Evacuation retained product of conception

12. COMPLETE
MISCARRIAGE
 Definition : All the POC has completely
aborted.
 Clinical features:
• History of pain and passage of product
• Followed by absent of pain, minimal
bleeding

13. CON’T
 Examination:
• Size of uterus is smaller than POA
• Closed cervical os
• U/S : empty uterine cavity
 Management:
• Do U/S to look for empty of uterine cavity

14. MISSED MISCARRIAGE
 Definition : When the embryo/fetus is already died
: but still remain in the uterine cavity for a period of
time
: without symptoms of miscarriage
 Clinical features:
• Decreased in pregnancy symptoms
• Vaginal bleeding (absent, minimal)

15. CON’T
 Examination:
• Size of uterus is smaller than POA
• Closed cervical os
• U/S : crumpled gestational sac
: revealed fetal pole but no signs of activity
(no heart activity)
 Management:
•Wait for spontaneous expulsion
• ERPOC

16. RECURRENT
MISCARRIAGE
 Definition : 3 or more consecutive spontaneous
miscarriage
 Can be divided into:
1st trimester
miscarriage
(<12 weeks)
2nd trimester
miscarriage
(>12 weeks)
• Uterine abnormality (uterine fibroid)
• Endocrine (DM, thyrotoxicosis,
PCOS)
• Autoimmune (SLE)
• Infection (TORCHES)
• Cervical incompetence (hx of
termination of pregnancy, vigorous
dilatation of cervix, hx of cone biopsy)
• Uterine abnormalities (septate or
subseptate uterus)

17. ECTOPIC PREGNANCY
SUMMARY

18. ECTOPIC PREGNANCY

19. ECTOPIC PREGNANCY
 Definition : Pregnancy outside uterine cavity
 Sites of implantation:
1. In fallopian tube (fimbriae,
ampullary, isthmus,
interstitial)
2. In the ovary
3. In the abdominal cavity
4. In the cervical site

20. RISK FACTORS
 Previous ectopic pregnancy
 History of PID
 Induction of ovulation
 Previous procedure on fallopian tube
 Previous pelvic surgery
 Structural :
 Uterine fibroid
 Abnormal uterine anatomy

21. CLINICAL FEATURES
 Vaginal Bleeding
 Lower abdominal pain, back or pelvic
pain
 Shoulder pain
 Syncopal attacks (hemoperitoneum)
 Symptoms of hypovolemic shock

22. EXAMINATIONS
 Vital signs – hypotension, tachycardia,
fever
 Generally – pale, CRT
 Abdominal palpation : uterus not palpable,
tenderness,
 guarding
 Per speculum & VE – os closed, cervical
excitation,
 adnexa mass, bimanual examination of
uterus.

23. INVESTIGATIONS
 UPT
 Positive
 Beta hCG
 If a patient has a beta subunit of human
chorionic gonadotropin level of 1,500 mIU
per mL or greater, but the transvaginal
ultrasonography does not show an
intrauterine gestational sac, ectopic
pregnancy should be suspected

24. CON’T
 Transvaginal ultrasound
 Empty uterus
 Presence of free fluid especially in
Pouch of Douglas
 Diagnostic laparoscopic

25. MANAGMENT
 Stabilize patient
 Surgical : salpingectomy/salpingotomy
either by laparotomy/laparoscopy
 Medical
 Methotrexate ; i.m/direct into tubal
pregnancy

26. MISCARRIAGE SUMMARY

27. THANK YOU