Spontaneous Abortion (Miscarriage) - Diagnosis

Diagnosis of spontaneous miscarriages is usually straightforward. It is based on the patient's complaints, general and gynecological examination data, and the results of colposcopy, hormonal, and ultrasound tests.

The patient's general condition may be determined by both the pregnancy itself and the degree of blood loss associated with the type of spontaneous miscarriage. In threatened and incipient miscarriages, women's condition is usually satisfactory unless there is precipitating early toxicosis of pregnancy and the miscarriage is precipitated by severe somatic pathology. In cases of ongoing, incomplete, or complete abortion, the patient's condition depends on the duration, intensity, and extent of blood loss. Prolonged, light bleeding leads to anemia, the severity of which depends on the woman's condition. Acute blood loss can cause shock.

Gynecological examination findings in cases of threatened miscarriage indicate that the uterine size corresponds to the length of the missed period. The uterus responds to palpation with contraction. There are no structural changes in the cervix. When miscarriage has begun, the cervix may be slightly shortened with a slightly open external os. A contracted uterine body corresponding to the gestational age and the lower pole of the fertilized egg easily accessible through the cervical canal indicate an ongoing abortion. In an incomplete abortion, the uterine size is smaller than the gestational age, and the cervical canal or external os is slightly open.

Additional diagnostic methods for spontaneous miscarriages are not necessary in all cases. Abortion is common, and incomplete abortions generally do not require additional diagnostic methods. Only in isolated cases is ultrasound used to help differentiate incomplete abortions from those already in progress.

Laboratory and instrumental methods are used for early diagnosis and dynamic monitoring of the initial stages of termination of pregnancy.

Colpocytological studies help identify the risk of miscarriage long before clinical symptoms appear. It is known that the karyopyknotic index (KPI) should not exceed 10% in the first 12 weeks of pregnancy, 3-9% in weeks 13-16, and generally stays below 5 % later. An elevated KPI indicates a risk of miscarriage and requires hormonal intervention.

However, it should be remembered that in the case of pregnancy against the background of androgenism, a decrease in the CPI is an unfavorable sign, dictating the need to use estrogen drugs.

Determination of plasma chorionic gonadotropin (HCG), estradiol, and progesterone levels has prognostic value. Termination of pregnancy in the first trimester becomes a real possibility if HCG levels are below 10,000 mIU/ml, progesterone levels are below 10 ng/ml, and estradiol levels are below 300 pg/ml.

In women with androgenism, determining the 17-KS level in daily urine is of great diagnostic and prognostic value. If the 17-KS level exceeds 42 μmol/L, or 12 mg/day, the risk of spontaneous abortion becomes real.

The value of laboratory diagnostic methods for threatened miscarriage increases when combined with an ultrasound examination. Ultrasound signs of threatened miscarriage in early pregnancy include the location of the fertilized egg in the lower uterus, the appearance of unclear contours, deformations, and constrictions of the fertilized egg. From the end of the first trimester, if miscarriage is threatened, areas of placental abruption can be identified and the diameter of the isthmus can be measured.