Which clinical history findings are characteristic of early pregnancy loss?

Updated: Nov 05, 2018
  • Author: Slava V Gaufberg, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Answer

Patients with spontaneous miscarriage usually present to the ED with vaginal bleeding, abdominal pain, or both. Note the following:

  • Vaginal bleeding may vary from slight spotting to a severe life-threatening hemorrhage. The patient's history should include the number of pads or tampons used. Hasan et al found that heavy bleeding in the first trimester, particularly when associated with abdominal pain, is associated with higher risk of miscarriage. [12]

  • Presence of blood clots or tissue may be an important sign indicating progression of spontaneous miscarriage.

  • Abdominal pain is usually located in the suprapubic area or in one or both lower quadrants.

  • Pain may radiate to the lower back, buttocks, genitalia, and perineum.

The patient's history should also include the following:

  • Date of last menstrual period (LMP)

  • Estimated length of gestation

  • Sonogram results, if previously performed

  • Bleeding disorders

  • Previous miscarriage or elective abortions

Other symptoms, such as fever or chills, are more characteristic of a septic miscarriage or abortion.

Consider any woman of childbearing age with vaginal bleeding pregnant until proven otherwise.


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