Miscarriage - Classification

Classification

The clinical presentation of a threatened abortion describes any bleeding seen during pregnancy prior to viability, that has yet to be assessed further. At investigation it may be found that the fetus remains viable and the pregnancy continues without further problems.

Alternatively the following terms are used to describe pregnancies that do not continue:

• An empty sac is a condition where the gestational sac develops normally, while the embryonic part of the pregnancy is either absent or stops growing very early. Other terms for this condition are blighted ovum and anembryonic pregnancy.
• An inevitable abortion describes a condition in which the cervix has already dilated open, but the fetus has yet to be expelled. This usually will progress to a complete abortion. The fetal heart beat may have been shown to have stopped, but this is not part of the criteria.
• A complete abortion is when all products of conception have been expelled. Products of conception may include the trophoblast, chorionic villi, gestational sac, yolk sac, and fetal pole (embryo); or later in pregnancy the fetus, umbilical cord, placenta, amniotic fluid, and amniotic membrane.
• An incomplete abortion occurs when tissue has been passed, but some remains in utero.
• A missed abortion is when the embryo or fetus has died, but a miscarriage has not yet occurred. It is also referred to as delayed or missed miscarriage.

The following two terms consider wider complications or implications of a miscarriage:

• A septic abortion occurs when the tissue from a missed or incomplete abortion becomes infected. The infection of the uterus carries risk of spreading infection (septicaemia) and is a grave risk to the life of the woman.
• Recurrent pregnancy loss (RPL) or recurrent miscarriage (medically termed habitual abortion) is the occurrence of three consecutive miscarriages. If the proportion of pregnancies ending in miscarriage is 15% and assuming that miscarriages are independent events, then the probability of two consecutive miscarriages is 2.25% and the probability of three consecutive miscarriages is 0.34%. The occurrence of recurrent pregnancy loss is 1%. A large majority (85%) of women who have had two miscarriages will conceive and carry normally afterward.

The physical symptoms of a spontaneous abortion vary according to the length of pregnancy:

• At up to six weeks only small blood clots may be present, possibly accompanied by mild cramping or period pain.
• At 6 to 13 weeks a clot will form around the embryo or fetus, and the placenta, with many clots up to 5 cm in size being expelled prior to completion of the process. The process may take a few hours or be on and off for a few days. Symptoms vary widely and may include vomiting and loose bowels, possibly due to physical discomfort.
• At more than 13 weeks the fetus may be passed easily from the uterus, however the placenta is more likely to be fully or partially retained in the uterus, resulting in an incomplete abortion. The physical signs of bleeding, cramping, and pain may be similar to an early stage abortion, but sometimes more severe and labour-like.