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In recent years ultrasound diagnosis and improved understanding of problems related to early pregnancy have led to the introduction of medical and expectant management of miscarriage and selected cases of ectopic pregnancy. The commonest early pregnancy complication of spontaneous miscarriage occurs in approximately 15-20% of all pregnancies, as recorded by hospital episode statistics. The embryonic period occupies the first 8 postfertilization weeks, during which organogenesis takes place. Gynecologists and ultrasonographers acknowledge the embryonic period by speaking about fetal heart action and fetal activity before the end of organogenesis. Between 1% and 2% of fertile women will experience recurring miscarriage (RM). Recent papers testify to the high rate of abnormal chromosome type when pregnancy loss has occurred. By actuarial analysis, the success rate for the next pregnancy can be reasonably predicted based on maternal age and number of losses. High-resolution transvaginal ultrasound provides surveillance and reassurance for the majority of women.
Early pregnancy problems form a major part of all gynaecological emergencies. Approximately one in five pregnancies will end in pregnancy loss. The model of care for all early pregnancy events and complications provides the timeline base along which the core standards of care elements, care pathways and clinical protocols can support the care provision for best patient experience. Many agents, including prostaglandins, mifepristone, potassium chloride and dactinomycin, have all been used for the medical management of ectopic pregnancy. It is vital that only appropriately trained and competent staff should perform transabdominal and transvaginal early pregnancy scans. As an essential component of clinical governance, all early pregnancy assessment units and recurrent miscarriage clinics should have regular meetings to review clinical guidelines and protocols. This would provide an ideal opportunity to discuss audits, to generate research ideas and discuss recruitment to national or international multicentre trials.
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