Threatened Miscarriage
Vaginal bleeding
• Cervical os is closed
• Fetus is viable
Gestational sac

Inevitable Miscarriage
• Vaginal bleeding and uterine pain
• Cervical os is open
• Pregnancy cannot be preserved

Incomplete Miscarriage
• Partial expulsion of products of conception
• Cervical os is open
• Retained products present in the uterus

Complete Miscarriage
• All products of conception are expelled
• Cervical os is closed
• Uterus is empty

Missed Miscarriage
• Fetal death with retention of products inside the uterus
• No bleeding or minimal bleeding
• Cervical os is closed

Diagnosis
Ultrasound (TVS)
Gestational sac appears at 5 weeks
• Yolk sac at 5–6 weeks
• Fetal pole + cardiac activity at 6 weeks
• Used to:
• Confirm viability
• Detect retained products
• Differentiate types of miscarriage

β-hCG
Quantitative β-hCG:
• Should double every 48 hours in normal pregnancy
• Used to:
• Detect non-viable pregnancy
• Help in pregnancy of unknown location

Threatened → Reassure
• Incomplete → Stabilize + Evacuate
• Complete → Reassure only
• Missed → Expectant / Medical / Surgical
• Septic → IV antibiotics + Evacuation immediately
• Recurrent → Treat the cause

Hydatidiform mole is an abnormal form of pregnancy caused by a chromosomal abnormality, resulting in abnormal proliferation of trophoblastic tissue with grape-like vesicles instead of a normal fetus.

Complete Mole :46
The ovum is empty (no maternal DNA).
One or two sperm fertilize it → paternal DNA duplicates.
Result: no fetal tissue, only abnormal placenta.

Ultrasound shows the classic:

Snow-storm appearance,
with no visible fetus

• Vaginal bleeding
• Severe vomiting
• Uterus larger than gestational age
• Very high β-hCG
• Signs of hyperthyroidism
• Early preeclampsia (rare)

Partial Mole is an abnormal pregnancy where an abnormal, non-viable fetus is present, along with partially normal placenta and partially molar vesicles.

It occurs when:
• A normal ovum
• Is fertilized by two sperm
→ leading to Triploidy (69 chromosomes

Ultrasound shows:
• A fetus (abnormal and non-viable)
• Mixed placental appearance (normal + cystic areas)

Vaginal bleeding
• Mild–moderate vomiting
• Uterus normal or slightly large
• Moderately high β-hCG

Ectopic pregnancy
implantation of the embryo outside the uterine cavity (most commonly in the fallopian tube). It is not viable (usually) and can be life-threatening

Ampulla 80% (most common)

isthmus
early rupture and acute pain, but bleeding is usually less catastrophic than interstitial.

Interstitial pregnancy late rupture
• It is supplied by both uterine and ovarian arterie
When rupture occurs → massive, sudden hemorrhage → highest mortality.

Abdominal pregnancy is a rare ectopic pregnancy, usually secondary to tubal rupture, and carries a high risk of massive hemorrhage.due to Abnormal placental location

Surgical management is the treatment of choice
• Fetus is removed

• Placenta:
• If attached to vital organs → left in situ to avoid catastrophic hemorrhage
• Methotrexate may be used for placental resorption

Heterotopic pregnancy is the simultaneous presence of an intra-uterine pregnancy and an ectopic pregnancy in the same patient.
Much more common with assisted reproductive techniques (IVF/ART)

Risk Factors of Ectopic Pregnancy
1Structural Risk Factors
2Functional Risk Factors