Skip to main content Accessibility help
×
Hostname: page-component-6d856f89d9-jhxnr Total loading time: 0 Render date: 2024-07-16T09:03:53.106Z Has data issue: false hasContentIssue false

Chapter 24 - Early Pregnancy

Published online by Cambridge University Press:  03 June 2019

Jane A. Stewart
Affiliation:
Newcastle Hospitals NHS Foundation Trust
Get access

Summary

Early pregnancy problems are common and cause significant physical and psychological morbidity and mortality. Miscarriage is thought to affect one in five pregnancies and ectopic pregnancy to occur in 1 in 100 gestations though these rates are higher in pregnancies resulting from assisted reproductive techniques (ART) than in spontaneous pregnancies. According to the third annual report of the Confidential Enquiry into Maternal Deaths by MBRRACE-UK, in 2009–2014, 12 women died from early pregnancy-associated causes [1]. Nine of these women died as a direct result of an ectopic pregnancy and three women died following termination or attempted termination of pregnancy. In the triennium 2012–2014, the maternal mortality rate due to early pregnancy problems was 0.29 per 100,000 maternities.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Knight, M, Nair, M, Tuffnell, D, Kenyon, S, Shakespeare, J, Brocklehurst, P, Kurinczuk, JJ (Eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care – Surveillance of maternal deaths in the UK 2012–14 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–14. Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2016 [www.npeu.ox.ac.uk/mbrrace-uk].Google Scholar
Kolte, AM, Bernardi, LA, Christiansen, OB, Quenby, S, Farquharson, RG, Goddijn, M, Stephenson, MD; ESHRE Special Interest Group. Early Pregnancy Terminology for pregnancy loss prior to viability: a consensus statement from the ESHRE early pregnancy special interest group. Hum Reprod. 2015 Mar; 30(3): 495–8. doi: 10.1093/humrep/deu299. Epub 2014 Nov 5.CrossRefGoogle ScholarPubMed
RCOG. Ultrasound from conception to 10+0 weeks of gestation. Scientific Impact Paper No. 49. March 2015.Google Scholar
NICE. Ectopic pregnancy and miscarriage: diagnosis and initial management. Clinical Guideline 154. December 2012.Google Scholar
Luise, C, Jermy, K, Collons, WP, Bourne, TH. Expectant management of incomplete, spontaneous first-trimester miscarriage: outcome according to initial ultrasound criteria and value of follow-up visits. Ultrasound Obstet Gynecol 2002; 19: 580–2.Google Scholar
Elson, J, Salim, R, Tailor, A, BAnerjee, S, Zosmer, N, Jurkovic, D. Prediction of early pregnancy viability in the absence of an ultrasonically detectable embryo. Ultrasound Obstet Gynecol 2003; 21: 5761.Google Scholar
Sawyer, E, Ofusasia, E, Ofili-Yebovi, D, Helmy, S, Gonzalez, J, Jurkovic, D. The value of measuring endometrial thickness and volume on transvaginal ultrasound scan for the diagnosis of incomplete miscarriage. Ultrasound Obstet Gynecol 2007; 23: 205–9.Google Scholar
Kohls, G1, Ruiz, F, Martínez, M, Hauzman, E, de la Fuente, G, Pellicer, A, Garcia-Velasco, JA. Early progesterone cessation after in vitro fertilization/intracytoplasmic sperm injection: a randomized, controlled trial. Fertil Steril 2012; 98(4):858–62. doi: 10.1016/j.fertnstert.2012.05.046. Epub 2012 Jun 29.CrossRefGoogle ScholarPubMed
Graziosi, GC, Mol, BW, Ankum, WM, Bruinse, HW. Management of early pregnancy loss. Int J Gynecol Obstet 2004; 86: 337–46.Google Scholar
Trinder, J, Brocklehurst, P, Porter, R, Read, M, Vyas, S, Smith, L. Management of miscarriage: expectant, medical, or surgical? Results of randomized controlled trial (miscarriage treatment (MIST) trial). BMJ 2006; 332: 1235–40.Google Scholar
Gronlund, A, Gronlund, L, Clevin, L, Andersen, B, Palmgren, N, Lidegaard, O. Management of missed abortion: comparison of medical treatment with either mifepristone + misoprostol or misoprostol alone with surgical evacuation. A multi-center trial in Copenhagen County, Denmark. Acta Obstet Gynecol Scand 2002; 81: 1060–5.Google Scholar
Sotiriadis, A, Makrydimas, G, Papatheodorou, S, Ionnidis, JP. Expectant, medical, or surgical management of first-trimester miscarriage: a meta-analysis. Obstet Gynecol 2005; 105: 1104–13.CrossRefGoogle ScholarPubMed
RCOG. Diagnosis and management of ectopic pregnancy. Green-top guideline no. 21. November 2016.Google Scholar
Brown, DL, Doubilet, PM. Transvaginal sonography for diagnosing ectopic pregnancy: positivity criteria and performance characteristics. J Ultrasound Med 1994; 13: 259–66.Google Scholar
Nyberg, DA, Hughes, MP, Mack, LA, Wang, KY. Extrauterine findings of ectopic pregnancy of transvaginal US: importance of echogenic free fluid. Radiology 1991; 178: 823–6.CrossRefGoogle Scholar
Craig, LB, Khan, S. Expectant management of ectopic pregnancy. Clin Obstet Gynecol 2012; 55: 461–70.CrossRefGoogle ScholarPubMed
Jurkovic, D, Hacket, E, Campbell, S. Diagnosis and treatment of early cervical pregnancy: a review and a report of two cases treated conservatively. Ultrasound Obstet Gynecol 1996: 8: 373–80.CrossRefGoogle Scholar
Kung, FT, Chang, SY. Efficacy of methotrexate treatment in viable and nonviable cervical pregnancies. Am J Obstet Gynecol 1999; 181: 1438–44.Google Scholar
Joseph, RJ, Irvine, LM. Ovarian ectopic pregnancy: aetiology, diagnosis and challenges in surgical management. J Obstet Gynecol 2012; 32: 472–4.Google Scholar
Mavrelos, D, Sawyer, E, Helmy, S, Holland, TK, Ben-Nagi, J, Jurkovic, D. Ultrasound diagnosis of ectopic pregnancy in the non-communicating horn of a unicornuate uterus (cornual pregnancy). Ultrasound Obstet Gynecol 2007; 30: 765–70.Google Scholar
Shaw, SW, Hsu, JJ, Chueh, HY, Han, CM, Chen, FC, Chang, YL et al. Management of primary abdominal pregnancy: twelve years of experience in a medical centre. Acta Obstet Gynecol Scan 2007; 86(9): 1058–62.Google Scholar
Moayeri, SE, Behr, B, Lathi, RB, Westphal, LM, Milki, AA. Risk of monozygotic twinning with blastocyst transfer decreases over time: an 8-year experience. Fertil Steril 2007; 87: 1028–32.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×