Miscarriage, Inevitable

Too early

Step 1: View clinicals

A 32 year old pregnant lady presents with vaginal bleeding for 1 day, which was associated with intermittent lower abdominal pain. Her period of amenorrhea is 9 weeks. This is her first pregnancy and her medical history is unremarkable.


Step 2: Order all relevant investigations

Pelvic Ultrasound

An intra-uterine gestational sac with a yolk sac and fetal pole is noted. The crown rump length is compatible with the age of gestation. Fetal cardiac activity is absent. No adnexal masses or free pelvic fluid is seen.

Serum beta-hCG

The beta-hCG level is 51,000 mIU/ml.

Blood Group

B -ve (negative)

MRI Abdomen

The MRI of the abdomen shows an intrauterine gestational sac compatible with the period of gestation. The uterus, fallopian tubes and ovaries appear normal. No adnexal masses or free pelvic or peritoneal fluid is seen.


Step 3: Select appropriate management

Expectant management
Antibiotics
Anti-D immune globulin
Methotrexate


Score: ★★☆